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Is race a poor prognostic factor in breast cancer?

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第1期189卷 41-45页

作者： El-Tamer, MB Homel, P Wait, RB SUNY Brooklyn Hlth Sci Ctr Brooklyn NY USA

Background: African American breast cancer patients have a higher mortality rate than their Caucasian counterparts. The purpose of this study was to evaluate whether race is a poor prognostic factor in breast cancer survival after multiple other prognostic factors are taken into account. Study Design: The tumor registry data from two institutions between the years 1982 and 1995 were combined for the analysis. A total of 1,745 patients, including 1,297 African American and 448 Caucasian women, were available for analysis. Race, age, income, stage, histologic findings, type of operation, and treating institution were evaluated as possible key prognostic variables. Results: In a univariate Cox proportional hazards regression analysis, African American patients with breast cancer were 1.27 times more likely to die than Caucasians when death from disease was measured (p = 0.01, 35% confidence interval 1.03 to 1.47). When all factors were included in a Cox regression analysis, only the stage of disease at diagnosis, age, and whether the patient had a therapeutic surgical treatment were statistically significant. Race, income, hospital, and histologic findings were not significant, although they were significant when used in a univariate analysis. Conclusions: poor survival of African American breast cancer patients seems to be related to their advanced stage at presentation and young age. To improve survival in these women, efforts should be concentrated on aggressive screening at a young age to detect the disease at an earlier stage. (J Am Cell Surg 1999;189:41-45. (C) 1999 by the American College of Surgeons).

关键词：非洲裔美国人/统计学和数值数据年龄分布乳腺肿瘤/人种学乳腺肿瘤/死亡率乳腺肿瘤/病理学欧洲大陆世系人群/统计学和数值数据收入/统计学和数值数据肿瘤分期纽约/流行病学预后登记/统计学和数值数据危险成年人老年人老年人 80以上女(雌)性人类中年人

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A comparison of complementary therapy use between breast cancer patients and patients with other primary tumor sites

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AMERICAN JOURNAL OF SURGERY 2000年第5期179卷 407-411页

作者： Morris, KT Johnson, N Homer, L Walts, D Oregon Hlth Sci Univ Dept Surg Portland OR 97201 USA Legacy Hlth Syst Portland OR USA

BACKGROUND: interest in complementary therapies in the United States is rising. We sought to characterize the use of complementary therapies among our cancer patients in our community and analyze differences in use between patients with breast versus those with other primary tumor sites. METHODS: A survey of 1,935 randomly selected patients from the tumor registry was performed. A questionnaire was mailed to 935 breast cancer patients and 1,000 patients with other primary site diagnoses. RESULTS: There were 617 responses (288 breast, 329 other). Seventy-five patients (75%) reported use of a complementary modality. Top therapies used were nutrition (63%), massage (53%), and healing herbs (44%). The most common reason for use, immune modulation (73%), was similar in both groups. Therapy was used consistently by 84% of breast patients versus 66% of others (P = 0.003). CONCLUSION: A significant number of cancer patients are using complementary therapies. Breast cancer patients are far more likely to be consistent users compared with other tumor sites. (C) 2000 by Excerpta Medica, Inc.

关键词：乳腺肿瘤/心理学乳腺肿瘤/治疗补充疗法/经济学补充疗法/统计学和数值数据补充疗法/利用药物信息机构药物相互作用筹资个人/统计学和数值数据目的卫生保健调查健康知识态度实践收入/统计学和数值数据肿瘤/心理学肿瘤/治疗病人接受卫生保健的程度/心理学病人接受卫生保健的程度/统计学和数值数据问卷调查美国青少年成年人老年人女(雌)性人类男(雄)性中年人

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Dental care utilization: How saturated is the patient market? (vol 130, pg 573, 1999)

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第10期130卷 1430-1430页

作者： Brown, LJ Lazar, VL American Dental Association Health Policy Resources Center

Background. Dental care utilization is the percentage of the population who access dental services over a specified period. In this article, the authors report on the results of several dental care utilization studies. Methods. To date, dental utilization data have been gathered by large national studies via telephone interviews, face-to-face interviews or written surveys. In this article, the authors report on and compare dental care utilization rates provided by the Centers for Disease Control and Prevention, the National Center for Health Statistics, the Agency for Health Care Policy and Research and the American Dental Association. Results. As captured by the various studies, the percentage of people who indicated they visited a dentist within the past year increased gradually between 1983 and 1997. The authors found that dental care utilization rates are higher among women than they are among men, and they de- crease with age and increase with income and educational level. Conclusions. Although the available data vary, they suggest that more Americans are visiting a dentist. The demand for dental care is increasing overall, as well as across educational, racial and economic lines. Practice Implications. If, as re- cent studies suggest, approximately 75 percent of the population visits a dentist annually, there is only modest room for further expansion of dental care utilization. However, if dental care utilization rates are substantially lower, as reported in older studies, then there is a greater potential for in- creased dental care utilization.

关键词：年龄因素美国牙科协会美国疾病控治中心数据收集牙科医疗/统计学和数值数据牙科保健服务/统计学和数值数据教育程度人种群/统计学和数值数据收入/统计学和数值数据国家卫生统计中心(美国) 性别因素美国美国卫生保健研究和质量评估署成年人老年人女(雌)性人类男(雄)性中年人

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Effect of socioeconomic status on out-of-hospital transport delays of patients with chest pain

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 481-490页

作者： Govindarajan, A Schull, M Sunnybrook & Womens Coll Hlth Sci Ctr Clin Epidemiol Unit Toronto ON M4N 3M5 Canada Univ Toronto Fac Med Toronto ON Canada

Study objective: The effect of socioeconomic status on out-of-hospital care has not been widely examined. We determine whether socioeconomic status was associated with out-of-hospital transport delays for patients with chest pain. Methods: A retrospective study of patients with chest pain transported by means of ambulance in Toronto, Ontario, Canada, in 1999 was conducted. The primary outcome measure was the 90th percentile system response interval, with secondary outcomes being the 90th percentile on-scene interval, transport interval, and total out-of-hospital interval. Socioeconomic status was the primary independent variable. Covariates were age, sex, case severity, dispatch and return priority, time and day of transport, paramedic training, and percentage of high-rise apartments in the region. Results: Four thousand three hundred fifty-six patients met the inclusion criteria. The 90th percentile system response interval and total out-of-hospital interval were 11 minutes and 49 minutes, respectively. In multivariate analyses, the highest socioeconomic status neighborhoods were significantly associated with decreased system response interval (34.0 seconds;95% confidence interval [Cl] 6.2 to 70.9 seconds) and transport interval (132.3 seconds;95% Cl 24.1 to 229.6 seconds). In addition, age (+45.3 seconds per 10 years;95% Cl 13.3 to 75.1 seconds), female sex (+205.0 seconds;95% C1 78.1 to 287.7 seconds), and advanced care paramedic crews (+371.6 seconds;95% Cl 263.3 to 490.1 seconds) were associated with delays in total out-of-hospital interval. Lastly, calls originating from the highest socioeconomic status neighborhoods were dispatched the highest proportion of advanced care paramedic crews, despite similar dispatch priorities and case severities. Conclusion: High socioeconomic status neighborhoods were associated with shorter out-of-hospital transport intervals for patients with chest pain. In addition, out-of-hospital delays were associated with age, sex, and a

关键词：急救医疗服务/经济学急救医疗服务/统计学和数值数据卫生服务研究收入/统计学和数值数据安大略贫困区试验预期值回归分析居住特征/统计学和数值数据回顾性研究疾病严重程度指数性别因素社会阶级时间因素病人转送/经济学病人转送/统计学和数值数据女(雌)性人类男(雄)性中年人

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How and why public sector doctors engage in private practice in Portuguese-speaking African countries

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HEALTH POLICY AND PLANNING 1998年第3期13卷 332-338页

作者： Ferrinho, P Van Lerberghe, W Julien, MR Fresta, E Gomes, A Dias, F Gonçalves, A Bäckström, B Univ Nova Lisboa Dept Saude Publ Inst Higiene & Med Trop Unidade Sistemas Saude P-1300 Lisbon Portugal Univ Nova Lisboa Inst Higiene & Med Trop Ctr Malaria & Outras Doencas Tropicais P-1300 Lisbon Portugal Inst Trop Med Prince Leopold Dept Publ Hlth B-2000 Antwerp Belgium Univ Eduardo Mondlane Fac Med Maputo Mozambique Minist de Saude Luanda Angola Minist da Saude Ctr Reg Desenvolvimento Sanitario Maputo Mozambique Minist Saude Lab Saude Publ Bissau Guinea Bissau

Objective: To explore the type of private practice supplementary income-generating activities of public sector doctors in the Portuguese-speaking African countries, and also to discover the motivations and the reasons why doctors have not made a complete move out of public service. Design: cross-sectional qualitative survey. Subjects: In 1996, 28 Angolan doctors, 26 from Guinea-Bissau, 11 from Mozambique and three from S Tome and Principe answered a self-administered questionnaire. Results: All doctors, except one unemployed, were government employees. Forty-three of the 68 doctors that answered the questionnaire reported an income-generating activity other than the one reported as principal. Of all the activities mentioned, the ones of major economic importance were: public sector medical care, private medical care, commercial activities, agricultural activities and university teaching. The two outstanding reasons why they engage in their various side-activities are 'to meet the cost of living' and 'to support the extended family'. Public sector salaries are supplemented by private practice. Interviewees estimated the time a family could survive on their public sector salary at seven days (median value). The public sector salary still provides most of the interviewees income (median 55%) for the rural doctors, but has become marginal for those in the urban areas (median 10%). For the latter, private practice has become of paramount importance (median 65%). For 26 respondents, the median equivalent of one month's public sector salary could be generated by seven hours of private practice. Nevertheless, being a civil servant was important in terms of job security, and credibility as a doctor. The social contacts and public service gave access to power centres and resources, through which other coping strategies could be developed. The expectations regarding the professional future and regarding the health systems future were related mostly to health personnel issues.

关键词：非洲非洲西部安哥拉几内亚比绍卫生保健调查卫生服务研究收入/统计学和数值数据莫桑比克私人开业/经济学私人开业/统计学和数值数据公共卫生管理/人力公共卫生管理/统计学和数值数据问卷调查薪金和附加福利/统计学和数值数据

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Private health care provision in developing countries: a preliminary analysis of levels and composition

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HEALTH POLICY AND PLANNING 1998年第3期13卷 195-211页

作者： Hanson, K Berman, P Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England Harvard Univ Sch Publ Hlth Dept Populat & Int Hlth Boston MA 02115 USA

While the importance of the private sector in providing health services in developing countries is now widely acknowledged, the paucity of data on numbers and types of providers has prevented systematic cross-country comparisons. Using available published and unpublished sources, we have assembled data on the number of public and private health care providers for approximately 40 countries. This paper presents some results of the analysis of this database, looking particularly at the determinants of the size and structure of the private health sector. We consider two different types of dependent variable: the absolute number of private providers (measured here as physicians and hospital beds), and the public-private composition of provision. We examine the relationship between these variables and income and other socioeconomic characteristics, at the national level. We find that while income level is related to the absolute size of the private sector, the public-private mix does not seem to be related to income. After controlling for income, certain socioeconomic characteristics, such as education, population density, and health status are associated with the size of the private sector, though no causal relationship is posited. Further analysis will require more complete data about the size of the private sector, including the extent of dual practice by government-employed physicians. A richer story of the determinants of private sector growth would incorporate more information about the institutional structure of health systems, including provider payment mechanisms, the level and quality of public services, the regulatory structure, and labour and capital market characteristics. Finally, a normative analysis of the size and growth of the private sector will require a better understanding of its impact on key social welfare outcomes.

关键词：发展中国家卫生保健调查卫生经费支出/统计学和数值数据卫生资源卫生服务研究收入/统计学和数值数据私人开业/统计学和数值数据私营部门/经济学私营部门/统计学和数值数据社会经济因素

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Dental services: Use, expenditures and sources of payment, 1987

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第4期130卷 500-508页

作者： Manski, RJ Moeller, JF Maas, WR Univ Maryland Sch Dent Dept Oral Hlth Care Delivery Baltimore MD 21201 USA

Background This article pro rides per capita estimates of dental care utilization, expenditures mix of services and sources of payment for each of several socioeconomic and demographic categories. Methods. The focus of the analyses presented here is on dental cafe utilization by the U.S, population during 1987. Specifically, national estimates are provided for dental visits, expenditures, sources of payment and procedure type for each of several socioeconomic and demographic categories using household data from the 1987 National Medical Expenditure Survey, or NMES. Results. During 1987, less that 50 percent of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. Conclusions. These analyses establish the magnitude of the dental care market and the amounts paid by individual patients, private insurance companies and Medicaid. They also reveal that the type of care received varies among people in distinct socioeconomic and demographic groups. Practice Implications. Although the dental care market is substantial, many Americans do not visit a dentist. By understanding these analyses. practitioners will be better positioned to meet the dental needs of all Americans.

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Researching the public/private mix in health care in a Thai urban area: methodological approaches

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HEALTH POLICY AND PLANNING 1998年第3期13卷 234-248页

作者： Pannarunothai, S Mills, A Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England Buddhachinaraj Hosp Phitsanulok Thailand

The private health sector has been growing rapidly in many low and middle income countries, yet not enough is known about its sources of finance or characteristics of its users. Moreover, health care reform measures are leading to alterations in the mix of public and private finance and provision, increasing further the need for information. This paper presents and evaluates some research methods which can be used to collect information relevant to considering policies on the public/private mix. They comprise a household survey, a health diary and interview survey, a bed census, and a health resource survey. Each method is described as it was used in a study in a large urban setting in Thailand, and strengths and weaknesses of the methods are identified. The use of data to estimate the shares of public and private finance and provision, and particularly private sources of finance of public hospitals and public sources of finance for private hospitals, is demonstrated. Policy issues highlighted by the data are identified.

关键词：卫生保健改革卫生保健调查/方法卫生经费支出/统计学和数值数据医院私立/经济学医院私立/统计学和数值数据医院私立/利用医院公立/经济学医院公立/统计学和数值数据医院公立/利用收入/统计学和数值数据模型经济计量学私营部门/经济学私营部门/统计学和数值数据公共卫生管理/经济学公共卫生管理/统计学和数值数据社会经济因素泰国

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Access to Health Care: Urban‐Rural Comparisons from a Midwestern Agricultural State

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The Journal of Rural Health 1995年第2期11卷 128-136页

作者： Comer, John Mueller, Keith Nebraska Center for Rural Health Research University of Nebraska Medical Center Omaha Nebraska 68198‐4350 600 S. 42nd St United States

Abstract: Lack of access to quality health care for a large number of Americans, particularly those living in rural areas, is a major health care problem. Differences in access between rural and urban areas are caused by obstacles to providing adequate care, such as hospital closures and physician shortages, and low income and/or employment that does not provide health insurance as an employee benefit. This study, based on a random sample of 6,000 households in Nebraska, finds that access to health care is better for residents of rural than urban areas. The relationship holds with controls for health status and health insurance. The pattern in Nebraska reflects an absence of differences in income, health insurance, and health status that produce differences in access between rural and urban areas nationwide. The findings suggest that any serious proposal to reform health care delivery should involve the states and use established patterns of seeking care among state residents. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：数据收集卫生服务易得程度/统计学和数值数据健康状况医院/利用收入/统计学和数值数据保险健康/统计学和数值数据内布拉斯加诊室就医/利用农村卫生/统计学和数值数据城市卫生/统计学和数值数据

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Structure and adequacy of human service facilities: Challenges for nonprofit managers

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Nonprofit Management and Leadership 1994年第2期5卷 117-140页

作者： Grønbjerg, Kirsten A. Nagle, Ami E. LoyolaUniversity Chicago.

Findings from a statewide survey of nonprofit human service organizations in Illinois show great diversity in access to and use of facilities. Large proportions have facility‐related problems that will require substantial investments beyond the financial capacity of the organizations themselves. The findings also point to major shortcomings in attention to or knowledge about facility‐related problems among managers of these organizations. The findings have important policy implications for nonprofit managers, as well as for public and private funders and policy makers. Copyright © 1994 Wiley Periodicals, Inc., A Wiley Company

关键词：资本筹集/方法资本筹集/统计学和数值数据数据收集设施的设计和建造/经济学设施的设计和建造/统计学和数值数据伊利诺伊收入/统计学和数值数据维修/经济学维修/统计学和数值数据组织非盈利/经济学组织非盈利/统计学和数值数据政策制订

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