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PubMed1982

[Health statistics and health index in developing countries].

Having briefly criticized those health indexes which are currently used, the author suggests that the LDC'S should exploit the information contained in routine statistical reports of health services activities: utilization rate (number of patients divided by population served) and intensity of service rate (number of visits per patient). She shows that these rate depend not only on morbidity, but also on the characteristics of the supply of health services (distance . . .) and on the characteristics of the demand for those services (behavioral attitudes of the patients . . .). The author uses multiple regression techniques to isolate the influence of these factors on utilization rate and on service's intensity. She concludes that the residual may be considered as a health status indicator. The application of this method to data for the forty administrative areas of Cameroon (1970 and 1975), shows that the resulting health index is correlated with infant mortality rates and with sanitary conditions.

Cameroon↗
PubMed1981

[Late Becker's nevus. One hundred cases (author's transl)].

The authors make a survey of a series of a hundred Becker's nevi diagnosed in a recruiting center of the French National Service. It is a statistic study bearing on the male population, aged 17 to 26, in a French region which is supposed to be representative of the French male population of the same age. First of all the authors focus on the various clinical descriptions since this nevus was first described by Becker in 1949, then discuss the problems raised by pathogenic interpretation and the results of microscopic studies. About this lesion, usually said to be pigmentary and hairy, and generally appearing before 20 years of age, is still very little known. Then after a short explanation of their method of study the authors give original results. A hundred Becker's nevi were diagnosed among 19,302 young men, that is to say in a proportion of 0.52 p. 100. A study of the racial, genetic and pigmentary background doesn't enable to retain general causes but rather leads to think of local causes. Half of these Becker's nevi appeared before ten years of age, the other half appearing between 10 and 20. In only one quarter of the cases can the role of the sun be pointed out. The location of the nevi is variable; they are mainly situated on the trunk and only 32 p. 100 of them are located above nipples, which was believed to be the usual place of the lesion. Pigmentation in three quarter of the cases is light brown. The average surface is 125 cm2. Hairs can be seen in only a little more than half of the cases of no lesion associated to the nevus could be found. The study points out that Becker's nevi seem to be more various in their clinical expression and more pigment than could be thought through more classical description.

Adolescent↗
PubMedDate not supplied

[A surveillance method for products used by drug addicts examined in emergency units].

Products used in a toxicomaniac way are in rapid change, and different from different area. Users too have to be better known. Authors present a simple survey method of these products, based on sample use. First results seem to be correct. These method may be used, associated with others, in a network as those existent for many years in the United States.

Adult↗
PubMed1994

Health maintenance organizations, independent practice associations, and cesarean section rates.

OBJECTIVE: This study tests two hypotheses: that a given delivery is less likely to be by cesarean section (c-section) in an HMO (closed-panel health maintenance organization) or IPA (independent practice association), than in other settings; and that where HMO and IPA penetration is high, the probability of a c-section will be reduced for all deliveries, whether in prepaid groups or not. DATA SOURCES AND STUDY SETTING: A data set consisting of 104,595 obstetric deliveries in New York state in 1986 is analyzed. STUDY DESIGN: A series of probit regressions is estimated, in which the dependent variable is either the probability that a given delivery is by c-section, or that a given delivery will result in a c-section for dystocia or fetal distress. DATA COLLECTION/EXTRACTION METHODS: The Live Birth File is linked with SPARCS hospital discharge data and other variables. PRINCIPAL FINDINGS: HMO setting reduces the probability of a cesarean section by 2.5 to 3.0 percentage points. However, this result is likely to be partly an artifact of offsetting diagnostic labeling and of choice of method of delivery, given diagnosis; a better estimate of the effect of HMO setting is -1.3 percentage points. IPA setting appears to affect the probability of a cesarean section even less, perhaps not at all. And HMO and IPA penetration in a region, as measured by HMO and IPA deliveries, respectively, as a percent of all deliveries, has relatively large depressing effects on the probability of a cesarean section. CONCLUSIONS: Ceteris paribus, the probability of a c-section is lower for an HMO delivery than for a fee-for-service delivery; however, HMO effects are smaller than previously reported in the literature for other types of inpatient care. For IPA deliveries, the effects are still smaller, perhaps nil. However, HMO and IPA penetration, possibly measuring the degree of competition in obstetrics markets, have important effects on c-section rates, not only in HMO/IPA settings, but throughout an area. These results appear to have important implications for public policy.

Cesarean Section↗
PubMed1996

Assessment tools: small area analysis.

Small area analysis, the examination of geographic variation in the medical care utilization of populations, provides a method for analyzing medical care resource use and can lead to improved medical care. Variations in rates of hospital admissions for most common causes of hospitalization are related to differences in the supply of medical care resources, such as hospital beds, and uncertainty in the outcomes of different diagnostic and therapeutic procedures. Introducing clinicians to practice variation can lead to process improvements. The article describes small area analysis and the limitations of this methodology.

Data Collection↗
PubMed1996

Determinants of ambulatory mental health services use for school-age children and adolescents.

OBJECTIVE: To analyze a comprehensive multivariate model of the use of mental health-related ambulatory care services by children ages 6-17. STUDY SETTING: The 1987 National Medical Expenditure Survey, a national probability sample of the U.S. civilian noninstitutionalized population. STUDY DESIGN: A cross-sectional survey of a national probability sample of the U.S. population. Key independent variables include person-level mental health status, health care coverage, family income, and use of mental health services by other family members. DATA COLLECTION: Four in-person interviews were conducted during 1987 using structured questionnaires. A designated family respondent was used to answer questions for other family members, including children. PRINCIPAL FINDINGS: Children with poor mental health in high-income families were more than three times as likely to have a mental health-related visit than children with poor mental health in low-income families. The number of mental health-related visits and the likelihood of seeing a mental health specialist also increased along with family income. Mental health use by other family members was strongly associated with use. CONCLUSIONS: The results from this study provide strong evidence that the socioeconomic status of children is an important factor in explaining unmet need for mental health services.

Adolescent↗
PubMed1997

[ Qualitative methods in empirical health research. II. Validity requirements].

From the epistemological question of what we can know about the world, the authors discuss the validity criteria occurring in the literature of qualitative research, as well as constructivist and post-modernist criteria. Finally, various techniques for enhancing validity in qualitative research are outlined in detail.

Data Interpretation, Statistical↗