The Economic Impact of Health Policy Interventions

The rapid aging of the U.S. population, increases in the absolute prevalence of chronic diseases, and the associated rise in the proportion of the GNP expended on medical care all indicate the need for methods to accurately forecast future health care expenditures for specific chronic diseases. Additionally, if these methods are biomedically realistic, they can be used to evaluate the economic implications of specific prevention strategies designed to reduce chronic disease incidence, prevalence, and mortality. Projection strategies that are not biomedically realistic, such as models that assume that risks for demographic subgroups do not change over time (e.g., "static component" models), though possibly accurate over the short run, are not suitable for assessing the long term effects of specific proposed health policy interventions which are designed to alter risks.
In this paper we present a strategy for forecasting health care costs which is based on a model that represents the natural history of a chronic disease in terms of a preclinical state, a clinical state, case fatality rates, cures, and the implications of exogenous medical factors. Using this model we project that the treatment costs associated with respiratory cancer in the white male population of the U.S. may undergo a two-thirds increase in real dollars over the period 1977 to 2000. About one-half of this increase is due to a demographic shift to an older population structure, with the remainder due to higher respiratory cancer incidence rates in younger cohorts. Alteration of certain parameters of the model to simulate various interventions suggests that about three-quarters of the cost of this disease could be eliminated, though realization of any significant part of this savings would require a lengthy phase-in period.     

The occupational stress indicator locus of control scale: Should this be regarded as a state rather than trait measure?

Robertson et al (1990) concluded that the Occupational Stress Indicator's (OSI) locus of control scale did not have an acceptable level of validity. The present study compared two groups of health service employees, categorized on the basis of their obtained OSI locus of control scale scores as having 'high' versus 'low' control, on a number of other OSI scales. Subjects who regard themselves as having 'high' control reported significantly less work pressure, employed certain coping strategies more frequently, reported lower ill health scores and were more job satisfied. The findings are theoretically consistent with the argument that the OSI locus of control scale is a subjective measure of an individual's appraisal of their control at work (i.e. a state measure) rather than a trait construct as measured by Rotter's scale (as used in the OSI validity study by Robertson et al).     

After-effects of working at visual display units

Two experiments were carried out to examine the acute and chronic after-effects of working with VDUs on subsequent subjective mood and performance efficiency. Both showed that working at a VDU has a negative after-effect on the user's subjective well-being but only if that person has a high level of cognitive failure. There was no evidence of any such effect on measures of performance efficiency.     

A study of coping behaviours and teacher burnout

This study investigated whether or not factors of teacher burnout were associated with adaptive and maladaptive coping behaviour. It was found, in a sample of 365 US (north Texas) school teachers, that many physical and psychological problems (e.g., stomach aches and depression) were related to teacher burnout factors. Furthermore, the data showed that certain maladaptive coping mechanisms (e.g., excessive alcohol consumption) were associated with higher teacher burnout, while adaptive coping strategies (e.g., hobbies) were related to lower burnout levels among school teachers. An association was also revealed between certain demographic factors (e.g., gender) and coping behaviour.     

Relationships of work stress measures for employees with the same job

Most research on job stress is based on the assumption that correlations between perceived work environment and affective measures reflect a relationship between the objective work environment and affective measures. Correlations found among perceived stress measures were similar in magnitude to those found in other work stress studies that had greater variation in the subject sample and jobs. Also, no relationship was found between objective and perceived danger. Alternative explanations for perceived job stress relationships are discussed.     

Work performance and health of junior hospital doctors a review of the literature

Concern has been expressed for a number of years about the long working hours and consequent sleep loss often experienced by junior hospital doctors. In recent months there has been renewed pressure for the demanding work schedules, common in many hospitals, to be changed. Concern centres on two related areas, namely the potential effects on the doctors work performance and the effects on their health. This paper reviews the literature relating to both areas and assesses how far the expressed need for change is supported by existing evidence. In addition attention is drawn to aspects of sleep loss and work performance requiring further investigation.     

Community dissatisfaction and depressed mood in Suburbia

Because of contradicting theoretical statements and empirical data, there is a need to specify the exact part that neighborhood and individual characteristics represent in determining mental health related behavior and the livabiiity of residential neighborhoods. This article adds to the understanding of the general problem by exploring the contributions that economic and social status of neighborhoods and individuals make towards depressed mood and community dissatisfaction. The study was limited to men residing in “classic suburbia” in the early 1960s. Seven hypotheses were proposed — the expectancy congruence, the additive, the big reward, and big failure, the atypical person, the reward visibility, and the economic status maintenance hypotheses. Support for the big reward and pan of the additive hypothesis was observed. The relationships presented in the paper clearly demonstrate that to gain an understanding of community dissatisfaction and depressed mood we must examine an individual's social and economic status and that of his neighborhood.     

福建省建瓯市生殖健康/计划生育项目情景分析调查(上)

本文采用情景分析定性研究方法, 对联合国人口基金援华项目点福建省建瓯市的生殖健康／ 计划生育基础情况进行了全面的考察和深入的讨论, 并为进一步开展项目活动提出了相应的建议本文采用情景分析定性研究方法, 对联合国人口基金援华项目点福建省建瓯市的生殖健康／ 计划生育基础情况进行了全面的考察和深入的讨论, 并为进一步开展项目活动提出了相应的建议     

Accessibility of health and human services for the HIV-infected

Most research on services for the HIV/AIDS population has focused on primary medical care or on service brokering by advocacy groups. Little research data exist on the extent to which services of programs that do not specialize in HIV/AIDS clients are available to these individuals who often have multiple and multi-dimensional problems. The reported research examines selected data from a sample of 236 medical, behavioral health and social service programs in Miami-Dade County, Florida. A constructed measure of involvement in services for HIV/AIDS clients, pertinent provider program and client characteristics are examined in the context of geo-distributed data on reported AIDS cases and census data. In logistic regression analyses, two aspects of race/– the population in the zip code area served by the program, and the clients or patients seen in the program – were significant in predicting program under-response, defined as level of response relative to cumulative reported AIDS cases from the program's zip code area. The analysis is briefly discussed regarding its relevance and methodological generalizability for HIV/AIDS and related public health policy and applied purposes.     

A multi-dimensional client satisfaction instrument

Development of a client satisfaction measure through successive factor analyses is described. Five factors, each defined by five items and accounting for at least 11% of the total variance, were identified and replicated. A single second order factor also emerged in both studies. Reliability of the second order factor, and of three of the first order factors is sufficient for most purposes. The second order factor, which is a linear combination of the first order factors, was not significantly correlated with sex, age, race, or number of attempts made before receiving a client response. The distribution of scores was highly skewed, with most respondents scoring near the upper (satisfied) end.