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Biomedical subjects

Stephen J Kunitz

Publications and source records attributed to Stephen J Kunitz.

13 recordsLinked to original sources
PubMed2007

Differential impacts of health care in Australia: trend analysis of socioeconomic inequalities in avoidable mortality.

BACKGROUND: Recent avoidable mortality trends in Australia suggest that health care has made a substantial contribution to reducing mortality. This study investigates if the benefits of health care have been distributed equally by comparing declines in avoidable with non-avoidable mortality over time by socioeconomic status (SES). METHODS: We calculated avoidable and non-avoidable mortality rates in Australia by small areas for 1986, 1991, 1997 and 2002. We performed pooled cross-sectional trend analysis of indirectly standardized mortality rates by SES and year, modelling using Poisson regression with over-dispersion. Socioeconomic inequalities were quantified using the relative (RII) and slope (SII) index of inequality. RESULTS: The annual percentage decline in avoidable mortality at the higher end of the socioeconomic continuum (5.0%; 95% CI: 4.7-5.4%) was larger than at the lower end (3.5%; 3.2-3.8%), with increasing relative inequality between 1986 (RII = 1.54; 1.46-1.63) and 2002 (RII = 2.00; 1.95-2.06), greater than that in non-avoidable mortality (P = 0.036). In absolute terms, avoidable deaths fell annually by 7.4 (6.9-7.8) and 8.4 (7.9-8.9) deaths per 100 000 at the higher and lower end of the spectrum, respectively, with absolute inequality decreasing between 1986 (SII = 97.8; 87.6-107.9) and 2002 (SII = 81.5; 74.6-88.5). CONCLUSIONS: Health care has contributed to decreasing the absolute SES mortality gap. However, advantaged people have obtained a disproportionate benefit of health care, contributing to widening relative health inequalities. A universal heath care system does not guarantee equality in health-care-related outcomes.

Australia↗
PubMed2006

Small-area variations in conviction rates for DWI: the significance of contextual variables in a Southwestern state.

Average annual conviction rates (1990-2000) of people arrested for driving under the influence of alcohol in each of New Mexico's 33 counties are described. Conviction rates vary from 58 to 95%. Rates are correlated with political conservatism, being higher where a higher proportion of voters voted for the republican presidential candidates, and with measures of crowding in the courts. Conviction rates are higher in rural than urban areas and are correlated with a low prevalence of alcohol-related problems in the population. The variance in conviction rates is higher in rural than urban areas, and higher where measures of court crowding are low. The results suggest that political culture and the efficiency of court functioning are each independently associated with conviction rates for DWI and may also be associated in a reciprocal fashion with both low DWI arrest rates and alcohol-involved crash rates.

Accidents, Traffic↗
PubMed2006

Predictors of conviction and sentencing of DWI offenders in a New Mexico County.

OBJECTIVE: To analyze predictors of conviction and dismissal of individuals charged with DWI, and predictors of the sentences of those who are convicted. METHODS: Data come from the Citation Tracking System of the State of New Mexico's Motor Vehicle Division and includes information on all individuals who were arrested for DWI in San Juan County between August 1994 and December 2000. Independent variables were: age, gender, race/ethnicity, waiver of right to an attorney, court of arraignment, year of arrest, BAC, and number of prior DWI arrests. Dependent variables were: (1) conviction or dismissal, (2) jail or no jail, (3) incarceration/treatment or not, (4) fine or no fine, (5) length of jail sentence, (6) waived right of attorney, and (7) magnitude of fine. Multiple linear and logistic regression was used in the analyses. RESULTS: Use of an attorney is associated with reduced likelihood of conviction and, if convicted, in reduced likelihood of jail sentence and reduced jail time, but greater likelihood and magnitude of a fine. Native Americans were more likely than Hispanics and non-Hispanic whites to waive their right to an attorney. Native Americans were most likely to be sentenced to the detention/treatment program. BAC and number of prior arrests were each positively associated with increased likelihood of conviction and more severe sentences. There is also substantial variability in severity of sentencing among courts. CONCLUSION: Likelihood of conviction and severity of sentences are both determined by extra-legal factors, resulting in inconsistent application of the law. This may in turn contribute to a lack of compliance with laws related to DWI.

Adolescent↗
PubMed2006

Life-course observations of alcohol use among Navajo Indians: natural history or careers?

In this article, I describe changes in patterns of alcohol use and abuse among Navajo Indians from the mid-1960s to the late 1990s. The prevalence of alcohol dependence continues to be higher than in the general U.S. population, but remission is also common, as it was in the 1960s and previously. Men have substantially higher rates of alcohol dependence than women. The former engage in heavy drinking largely in response to the heavy drinking of those around them. The latter drink excessively largely as a response to psychiatric disorders, depression, and abuse by a partner or husband. As increasing numbers of people have moved to reservation and border towns, a youth culture has developed in which alcohol use is initiated by teenagers with their peers rather than, as in the past, with older kinsmen. Alcohol use has thus been freed from the constraints imposed by both isolation and family obligations.

Alcohol Drinking↗
PubMed2005

Variations in jail sentences and the probability of re-arrest for driving while intoxicated.

OBJECTIVE: The probability of re-arrest for driving while intoxicated (DWI) is compared for four different groups of individuals classified by whether the individual was convicted and, if so, the type of sentence received. METHOD: Subsequent re-arrests for DWI were examined for all individuals whose index arrest for DWI had occurred between 1994 and 2001 in a county in New Mexico. The groups included (1) those convicted as a result of the index arrest and sentenced to a 28-day jail/treatment program (N (#)=(#) 2,703); (2) all those not convicted as a result of the index arrest (N = 709); (3) those who were convicted but not sentenced to jail (N = 1,047); and (4) those convicted and sentenced to jail (N = 1,290). RESULTS: Adjusting for covariates of BAC, number of prior arrests, ethnicity, age, and sex, the probability of not being re-arrested was greatest among those sentenced to the jail/treatment program (Group 1), next highest in the two groups convicted but not sentenced to jail/treatment (Groups 3 and 4), and lowest in the group that was not convicted (Group 2). Length of jail sentence among people convicted but not sentenced to the jail/treatment program was unrelated to the probability of re-arrest. CONCLUSION: Conviction for DWI, regardless of the sentence, appears to reduce the probability of re-arrest, and being sentenced to a multi-modal treatment/incarceration program further reduces the probability of re-arrest. However, the other types of sentences do not appear to differ in their impact on probability of re-arrest.

Adult↗
PubMed2005

Mortality of white Americans, African Americans, and Canadians: the causes and consequences for health of welfare state institutions and policies.

The life expectancy of African Americans has been substantially lower than that of white Americans for as long as records are available. The life expectancy of all Americans has been lower than that of all Canadians since the beginning of the 20th century. Until the 1970s this disparity was the result of the low life expectancy of African Americans. Since then, the life expectancy of white Americans has not improved as much as that of all Canadians. This article discusses two issues: racial disparities in the United States, and the difference in life expectancy between all Canadians and white Americans. Each country's political culture and institutions have shaped these differences, especially national health insurance in Canada and its absence in the United States. The American welfare state has contributed to and explains these differences.

Black or African American↗
PubMed2004

The prevention paradox, traffic safety, and driving-while-intoxicated treatment.

BACKGROUND: In San Juan County, New Mexico, a 28-day jail/treatment program for first-time driving-while-intoxicated (DWI) offenders was established in 1994 to reduce both DWI recidivism and alcohol-related crashes. This paper assesses the impact of the program on both outcomes. METHODS: The data are composed of driving records of all people arrested for DWI in San Juan County from August 1994 through December 2001. Subsequent re-arrests and crashes were analyzed to compare people who had been sentenced to the jail/treatment program and those who had not. Kaplan-Meier survival curves and Cox proportional hazards regression analyses were used. Covariates included age, gender, blood alcohol content (BAC), number of prior arrests, and ethnicity (Native American, non-Hispanic white, and Hispanic). RESULTS: Re-arrest rates were significantly lower for the treatment than the nontreatment group. Each of the three major ethnic groups showed similar effects. This was not observed for subsequent alcohol-related crashes, possibly as a result of insufficient numbers. BAC and number of previous arrests were, however, significant risk factors for subsequent crashes. Finally, although BAC and previous arrests were important risk factors for subsequent crashes, the vast majority of subsequent alcohol-related crashes occurred among people in the intermediate risk ranges. CONCLUSIONS: The jail/treatment program is effective in reducing the probability of DWI re-arrests. The evidence with respect to crashes is equivocal. That most crashes occur to people in the intermediate risk range exemplifies the prevention paradox, and means that the courts, which deal most severely with high-risk individuals, cannot be expected to have a major impact on alcohol-related crashes.

Accidents, Traffic↗
PubMed2004

Social capital and health.

Social capital refers to bonds between individuals, both in intimate relationships (primary groups) and in voluntary associations (secondary groups) that make it possible for individuals and groups to achieve a variety of goals. Such bonds have also been claimed to have health promoting effects. In this chapter, I review a variety of empirical studies at both levels of analysis and suggest that the results are mixed, much depending upon the context in which such relationships occur.

Caregivers↗
PubMed2004

Measuring interdisciplinary team performance in a long-term care setting.

OBJECTIVES: The objectives of this study were to test the reliability and the validity of a survey instrument for assessing interdisciplinary team performance in long-term care settings and to measure team performance in the Program of All-Inclusive Care for the Elderly (PACE). RESEARCH DESIGN AND METHODS: The analysis is based on 1220 surveys completed by team members of 26 PACE programs. Cronbach's alphas, analysis of variance, and regression models were used to assess the reliability and the validity of the instrument. Multivariate regression analysis was used to examine factors associated with team performance in PACE. RESULTS: Cronbach's alphas ranging from 0.76 to 0.89 demonstrate good-to-high reliability for all domains of the team process and performance (effectiveness). Construct validity is demonstrated through the results of the regression analysis showing that leadership, communication, coordination, and conflict management are positive and significant (P <0.001) predictors of team cohesion and team effectiveness. The data also support the appropriateness of aggregating individual-level responses to the unit level. Perceived team effectiveness significantly (P <0.05) increases with: age of the respondents; longer length of the team's professional work experience; shorter duration of the team's PACE experience; more ethnically diverse composition of the team; greater ethnic concordance between team members and the participants; and greater perceived resource availability. CONCLUSIONS: Several of the factors influencing team effectiveness in PACE are potentially modifiable and, therefore, could offer insights for improving team practice.

Aged↗
PubMed2004

Social support and risk-adjusted mortality in a frail older population.

OBJECTIVE: The objective of this study was to test the hypothesis that social support is an important predictor of mortality in a frail older population receiving formal long-term care services. RESEARCH DESIGN AND METHODS: The analysis is based on 3138 individuals enrolled in 28 Programs of All-Inclusive Care for the Elderly (PACE). Information about the enrollees is obtained from dataPACE. Semiparametric Cox proportional hazards models are estimated to assess the importance of individual risk factors, program effect, and social support. RESULTS: The introduction of the social support variables into the mortality model containing the sociodemographic, health needs, and the PACE-site indicator variables results in a significant improvement of the overall model fit. Several social support variables are statistically significant predictors of mortality. Controlling for all participant and caregiver characteristics, participants whose caregiver is a spouse have a significantly lower risk of mortality (hazard ratio = 0.63) compared with those whose caregiver is not a spouse. Furthermore, caregivers' assistance with meals confers a significantly lower risk of morality (hazard ratio = 0.66) compared with no assistance with meals. CONCLUSIONS: This study shows that certain aspects of informal caregiving are important factors enhancing survival in a population of frail, nursing home-certifiable individuals enrolled in a health program that already provides extensive services, including personal care, chores, and meals. Further research to better differentiate between the affective versus the instrumental dimensions of social support is needed to guide programs on how to balance the use of resources to provide both the necessary formal services and the support for the informal caregivers.

Activities of Daily Living↗
PubMed2004

The making and breaking of Yugoslavia and its impact on health.

The creation of nation-states in Europe has generally been assumed to be intrinsic to modernization and to be irreversible. The disintegration of Czechoslovakia, the Soviet Union, and Yugoslavia demonstrates that the process is not irreversible. I argue that in the case of Yugoslavia, (1) disintegration was caused by the interaction between domestic policies with regard to nationalities and integration into the global economy and (2) the impact of the disintegration of the federation on health care and public health systems has been profound. Improving and converging measures of mortality before the collapse gave way to increasing disparities afterward. The lesson is that processes of individual and social modernization do not result in improvements in health and well-being that are necessarily irreversible or shared equally.

History, 19th Century↗
PubMed2002

Rearrest rates after incarceration for DWI: a comparative study in a southwestern US county.

OBJECTIVES: This study was undertaken to assess a 28-day detention and treatment program's effect, in a multiethnic county with high rates of alcohol-related arrests and crashes, on first-time offenders sentenced for driving while impaired (DWI). METHODS: We used comparison of baseline characteristics, survival curves of subsequent arrest, and Cox proportional hazards regression to examine probability of rearrest of those sentenced and those not sentenced to the program. RESULTS: Probability of not being rearrested was significantly higher for the treatment group after adjustment for covariates. At 5 years, probability of not being rearrested for the treatment vs the nontreatment group was 76.6% vs 59.9%. CONCLUSIONS: Results suggest that this county's program has significantly affected rearrest rates for Native Americans, Hispanics, and non-Hispanic Whites.

Accidents, Traffic↗