Gerald Caplan (1917–2008).

Presents an obituary for Gerald Caplan who was a world leader in the areas of preventive psychiatry; adult, child, and family psychiatry; and community mental health. His contributions to prevention, crisis intervention, mental health consultation, and social support are monumental and unprecedented. Briefly described is Caplan's life history, educational background, and scholarly accomplishments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New measures for reporting the magnitude of small-area variation in rates

Measuring the variation in health outcomes, for example, mortality, morbidity, hospitalization, across small areas is an accepted way of screening large amounts of routinely-collected data. Although simple measures of variation, for example, the extremal quotient, are intuitively appealing, they have poor statistical properties. More sophisticated measures, based on hierarchical models, have better statistical properties, but are in a form that is foreign to most public health officials. The analyses in this paper converted the small-area variance obtained from a hierarchical model into three new measures: the ratio of high versus low rates across small areas, and the percentage and number of adverse events, such as deaths, that might be avoidable if the causes of the variation between areas could be removed. The approach was applied to mortality data from New South Wales, Australia. The three new measures can help public health officials make judgements about whether to proceed with more detailed (and expensive) studies without having to rely on the statistical significance of an obscure index.     

Public health crises of cities in developing countries

During the decade and a half after Alma Ata hundreds of projects were started in developing countries to implement the principles of PHC and start community based health care programs in the rural areas of developing countries. Until the past five years urban health was not seen as a special health problem. Population pressure in the rural areas has created shortages of land, food and employment opportunities. These forces have generated major population movements to the urban centres. The population movements have encouraged unprecedented expansion of urban centres. This sudden concentration of large populations in small geographical areas has resulted in the urban health crises of the developing world. The poor who live in the slum areas have no access to adequate health services, they experience frequent epidemics of communicable diseases like cholera, they live within a heavily polluted environment, and their children have very poor health because they are not immunized and are malnourished. The paper agrees with approaches which have been championed by development agencies to address the urban health crises. These approaches propose the reorientation of urban health systems to include adoption of PHC for urban health programs, intersectoral collaboration and extra budgetary support. The paper argues for further strengthening of the reorientation approach by adjusting the development planning model. It is proposed that the urban plan be integrated into the national development plan so that emerging urban health crises can receive special attention in resource allocation.     

Urban small area variation in adolescents' health behaviour

Our previous study indicated that region plays a relatively small role in adolescents' health behaviour. Here, the regional patterning of health behaviour is studied further by shifting the focus to small areas. First, we test whether small area socioeconomic, demographic and housing characteristics correlate with health behaviour. The analysis then turns to the relationship between these characteristics and their individual level correlates. We wish to ascertain if behaviour is related to small area characteristics similarly for both genders and for adolescents' socioeconomic characteristics. The Adolescent Health and Lifestyle Survey data from 1989-1995 (16- and 18-year-olds, n = 1048, response rate 71%) were linked with data describing 33 subareas of Helsinki, the capital of Finland. Smoking, alcohol use, abstention from dietary fat and physical activity were used as lifestyle indicators. Gender apparently influences the extent to which the area plays a role. Logistic regression demonstrated that prolonged unemployment predicted low prevalence of abstention from dietary fat (traditional dietary patterns) among girls and heavy drinking among boys. High total rate of unemployment predicted lower physical activity among girls. Also owner-occupied housing correlated positively with girls' physical activity. Although the individual level socioeconomic characteristics were not as strongly related to health behaviour as the small area factors, a low level of education predicted smoking and alcohol use and, among girls, decreased physical activity. We conclude that small area characteristics, especially the level of unemployment of the area, may be even more strongly related to health behaviour than individual socioeconomic characteristics.     

Social reforms and the future of school practice: Implications for American psychology.

Social reforms in American education are setting the stage for a paradigm shift in our nation's schools. The convergence of education and health care reform and the movement in the human services arena toward service integration models provide an unprecedented opportunity to redefine psychological services related to schools for the next century. Whereas school psychological services historically have been linked to changes in special education legislation, social reforms in education and health care that emphasize educational achievement and whole-child development offer promise for expanding and enhancing the roles of psychologists whose practices relate to schools and children. This article explores the foundations for change and highlights critical areas in which psychological practice in the schools may develop in the 1990s and beyond. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Islet amyloid polypeptide in patients with pancreatic cancer and diabetes

Population-based psychiatric admission rates vary across geographic areas, but reasons for this variation are unknown. Insofar as Community Mental Health Centers (CMHCs) provide outpatient services that may deter the need for hospitalization, the presence and structural characteristics of CMHCs may have an impact on a population's psychiatric admission rates. This study uses small area analysis to examine how general hospital psychiatric admission rates are associated with CMHC characteristics. Based on a survey of all CMHCs in Iowa and corresponding small area variation data, it was found that population admission rates were higher in areas closer to the CMHC and lower in outlying catchment areas, adjusting for age, sex, and urban/rural differences in populations. There was little evidence that differences in staffing and service variables influenced admission rates, although greater CMHC staff coverage by social workers and psychiatric residents was associated with lower admission rates. The results suggest that CMHCs do not lower an area's hospitalization rate, and in fact, the presence of CMHCs may promote a "supplier-induced demand" phenomenon of higher admissions.     

Interpreting the new illness question in the UK census for health research on small areas

STUDY OBJECTIVE: The study aimed to identify the various factors that seem to influence the average response to the new census question on limiting, long standing illness at the small area level, to assess the extent to which the new questions adds to information already available in the census and elsewhere, and to discuss how useful the data are likely to be for those planning health and social services. DESIGN: This was a cross sectional analysis of the relationship between rates of limiting, long standing illness (standardised for age and sex) and a large number of indicators of health and socioeconomic status at the small area level. SETTING: The study used data relating to 4985 small areas covering the whole of England. The average population was about 10 000. PARTICIPANTS: The 1991 census of population was addressed to the entire population of England. MAIN RESULTS: There are wide variations in the levels of self reported long standing illness between small areas, 70% of which are explained by demographic factors. Variation in age/sex standardised responses to the new census question at the small area level can largely be explained by census data on self reported disability among those of working age, standardised mortality ratio, and by indicators of socioeconomic circumstances relating to social class, ethnicity, and the elderly living alone. These does not seem to be a significant reporting bias due to underemployment. CONCLUSION: Unlike the disability question in the census, the standardised, self reported long standing limiting illness ratio covers the entire population and it is not skewed towards men. Although the variable is a synthesis of the health and social determinants of perceived morbidity, it does not provide much information that was not already available. In addition, it is available every 10 years only and thus may be rather inaccurate as an indicator of relative need towards the end of the decade. Moreover, in future censuses, individuals' answers might be influenced by the knowledge that their responses will affect the volume of resources allocated to the area in which they live.     

Assessment of vocal function using simultaneous aerodynamic and calibrated videostroboscopic measures

Despite many attempts to model how vocal fold movements relate to the aerodynamic forces acting on them during phonation, there have been few simultaneous measurements of glottal area and transglottal air pressures and flows. A novel system is described that combines endoscopic measurement of glottal area with aerodynamic flow and pressure measures made during phonation. Results from bench top model tests and from one human subject are presented. For both tests, an aerodynamic model of airflow through a constriction was used to predict the area of the constriction (glottis), and these predictions were compared with endoscopic measurements. The results showed good correlation between predicted and observed areas; however, for small constrictions (<0.025 cm2), whether artificial or glottal, the errors in estimating areas with either optical or aerodynamic methods increase significantly. These results suggest that this measurement system has the potential to enhance the assessment of vocal function.     

Methods of cost-effectiveness analysis: areas of consensus and debate

Methods of evaluating socioeconomic relationships have evolved over many years, and a number of specific approaches have been developed. Among the techniques available, cost-effectiveness analysis (CEA) has emerged as the most widely used and accepted method. Yet, despite considerable effort by the analytical community to refine this technique into one more useful for making health policy decisions, much debate and confusion still persist among analysts, readers, and policy-makers concerning methods standards and the overall usefulness of CEA in resource allocation decision making. Thus the purpose of this paper is to summarize, critically examine, and comment on existing recommended methods for socioeconomic evaluation of health care interventions. In particular, we examine an exhaustive set of component methods within the general area of cost-effectiveness and comment on areas of apparent consensus and debate. Our review reveals many areas of agreement and many yet to be resolved. Analysts generally agree on the components of the overall framework for an analysis; basic methodologic principles; the general treatment of costs; the principle of marginal analysis; the need for and general approach to discounting; the use of sensitivity analysis; the extent to which ethical issues can be incorporated; and the importance of choosing appropriate alternatives for comparison. The principal areas in which disagreement still persists are choice of study design, measurement and valuation of health outcomes including conversion of health outcomes to economic values, transformation of efficacy results into effectiveness outcomes, and the empirical measurement of costs.     

Cancer burden in the aged: an epidemiologic and demographic overview

Sixty percent of all cancer occurs in persons aged > or =65 years. This article provides an overview of aspects of the burden of cancer in the elderly, highlighting certain demographic and epidemiologic data. It served as a frame of reference for participants in the Oncology Geriatric Education Retreat, San Juan, Puerto Rico, February 21-26, 1997. Information comes from several major sources: U. S. Bureau of the Census; National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program; National Center for Health Statistics; National Institute on Aging (NIA)/NCI SEER Study on Comorbidity and Cancer in the Elderly; and NCI cancer prevalence estimates. Data on the aging population demonstrate an unprecedented expansion of the segment of the population aged > or =65 years. By 2030, 1 in 5 Americans will be aged > or =65 years. Because cancer incidence and mortality rates are highest in persons aged > or =65 years, expansion of this age group takes on great importance for medical professionals who provide treatment to older aged cancer patients. In addition, older aged cancer patients are likely to have preexisting conditions at diagnosis, creating a special clinical challenge. There is an urgent need to better understand the influence of aging on the early detection, diagnosis, and treatment of cancer. Clinicians who treat older persons (geriatricians, oncologists, and other health professionals) can benefit from the integration of the knowledge and approaches of each others' fields. The foundation for this multidisciplinary effort is linked with the education and training of future clinicians.     

Thy-1 is a component common to multiple populations of synaptic vesicles

To understand the influence of the ascending path linking area 17 to area 18 of visual cortices, experiments were carried out in which a small neuronal population of area 17 was inactivated with GABA, while unitary responses were recorded in area 18. In the latter, cells are identified as belonging to the simple or complex family according to their firing pattern evoked in response to sine-wave gratings scrolling through the receptive fields. Anesthetized cats were prepared for single-cell recordings. In area 17, a GABA-containing pipette was placed in superficial layers in order to inactivate reversibly a small neuronal population. Prior to blockade, the orientation tuning curves were obtained in both areas and the difference in optimal orientation between areas 17 and 18 was recorded. In area 18, cells were classified as simple or complex. The strategy was to study the reaction of neurons in area 18 prior to, during and after area 17 depression. In most simple cells, whenever the difference in orientation was in the iso-range, that is when the difference in optimal orientations of the injected site (in area 17) and of the neuron in area 18 was less than 30 degrees, the GABA application produced a decline of the evoked discharges, whereas GABA injection augmented the evoked firing rate when the difference was in the cross-range (>60 degrees). In contrast to simple cells, GABA depression enhanced the responses in the majority of complex cells with like orientations in both areas. When the difference between recording sites was in the cross-range, then area 17 depression produced weaker evoked firing. A tangential penetration of the injecting pipette, allowing injection of different orientation sites while testing the same unit in area 18, revealed that the latter could react with an enhancement or a decline of the responses as the injecting pipette shifted from iso (or cross) to cross (or iso) disparity in optimal orientations between areas 17 and 18. These results suggest that the path connecting area 17 to area 18 may be functionally discriminated on the basis of the orientation domain and cell types. In addition, our data suggest that the ascending visual streams are required to generate orientation specificity in area 18.     

Community health reporting exemplified by the city of Nürnberg

Taking the example of Nuremberg, a city of half a million inhabitants, the article illustrates how, despite very restricted resources, the local public health department was able to establish a series of health reports dealing with different topics. Treatment of a number of topics was only possible through cooperation with the local university. Initially two health reports were produced on a regional basis for the purpose of supporting health promotion in particular areas of the city. Whereas the first report attempts to give a comprehensive picture of health relevant living conditions in a certain area, the second report concentrates on an analysis of the situation of children and young people in a different part of the city. Another area of concern deals with the gathering of specific health related data. The data from a pediatric health sentinel in Nuremberg were combined with data on climate and air pollution in the years 1995 and 1996. Various dissertation topics were useful in the analysis of everyday public health data. Most of these results have been published in a separate reader. They include an analysis of the reports regarding pregnancy counciling, standardised reports of the HIV antibody tests as well as an analysis of the causes of infant mortality based on death certificates. Finally, a comparative study of basic health data from various cities is in progress. It is hoped that this will offer a basis for an evaluation of the health situation in Nuremberg.     

Health maintenance organization penetration and the practice location choices of new physicians: a study of large metropolitan areas in the United States

OBJECTIVES: The rapid growth of health maintenance organizations is reshaping the practice opportunities available to physicians. The practice location decisions of new physicians provide a sensitive bellwether of these changes. This study assessed the effect of health maintenance organization penetration on practice location for physicians completing graduate medical education (GME). METHODS: Conditional logit regression analysis was used to determine the effect of health maintenance organization penetration on practice location, controlling for other market characteristics. Subjects were physicians who finished GME between 1989 and 1994 and who located in one of the 98 US metropolitan areas with more than 500,000 population. The outcome measure was the particular metropolitan area chosen by each new physician. RESULTS: Early in the study period, new generalists were significantly more likely to locate in metropolitan areas with high health maintenance organization penetration than in low penetration areas, whereas new specialists' practice location choices were not associated with health maintenance organization penetration. The likelihood of choosing a high penetration relative to a low penetration area declined with time, however, for both generalists and specialists. Consequently, by the end of the study period, health maintenance organization penetration had a weak but significant negative effect on practice location for generalists and a strong negative influence on practice location for specialists. CONCLUSIONS: New generalists who completed graduate medical education between 1989 and 1994 were more likely than new specialists to locate in market areas with high health maintenance organization penetration; however, the proportions of both generalists and specialists who chose high penetration areas decreased during the study period. This finding may reflect reduced practice opportunities in high penetration areas relative to low penetration areas as health maintenance organizations' systems for controlling utilization began to yield results. Alternatively, new physicians may have become more hesitant to accept available positions in high penetration areas.     

Prevalence of diagnosing extrinsic allergic alveolitis in Poland in the years 1990-1994

Poland is the country, where almost 40% of population inhabit rural areas. So EAA may be an important health problem. The aim of the study was to assess incidence of EAA in different districts in Poland. We asked hospitals to send us lists of patients with diagnosis of EAA established in the period of 1990-1994. In some hospitals we collected information by ourselves. This way, we have got data concerning patients with EAA. The highest prevalence of EAA 1.5-7.0/100,000 population was observed in eastern and south-western regions of Poland. Eastern Poland is rural area with small not specialised farms and possible high exposure to EAA antigens. In south-western Poland (Silesia) keeping pigeons is a very popular hobby, which may explain high incidence of EAA.     

Predicting Performance of Design-Build and Design-Bid-Build Projects

Design-build (DB) and design-bid-build (DBB) are two principal project delivery systems used in many countries. This paper reports on models constructed to predict performance of DB and DBB projects on 11 areas, using project-specific data collected from 87 building projects. The study included collecting, checking, and validating industry data, and the statistical development of multivariate linear regression models for predicting project performance. Robust models are developed to predict construction and delivery speeds of DB and DBB projects. Gross floor area of the project is the most significant factor affecting speed. Besides this, for DBB projects, contractors’ design ability, and adequacy of plant and equipment would ensure speedy completion of the projects. For DB projects, if the contract period is allowed to vary during tender evaluation, this would slow down the project. Robust models to predict turnover and system quality of DB projects are also constructed. A DB contractor’s track record is an important variable. They must have completed past projects to acceptable quality and have ability in financial, health and safety management.     

Technological and Medical Advances: Implications for Health Psychology.

Behavioral telehealth, health informatics, organ and tissue transplantation, and genetics are among the areas that have been affected by advances in technology and medicine. These areas illustrate the opportunities and the challenges that new developments can pose to health psychologists. Each area is discussed with respect to implications for practice, research, public policy, and education and training: recommendations are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A taxonomy of health status instruments

Clinicians and policymakers are recognizing the importance of measuring health related quality of life (HRQL) to inform patient management and policy decisions. Self or interviewer administered questionnaires can be used to measure cross sectional differences in quality of life between patients at a point in time (discriminative instruments) or longitudinal changes in HRQL within patients over time (evaluative instruments). Both discriminative and evaluative instruments must be valid (really measuring what they are supposed to measure) and have a high ratio of signal to noise (reliability and responsiveness, respectively). Reliable discriminative instruments are able to reproducibly differentiate between persons. Responsive evaluative measures are able to detect important changes in HRQL over time, even if those changes are small. HRQL should be interpretable--that is, clinicians and policymakers must be able to identify differences in scores that correspond to trivial, small, moderate, and large differences. Two basic approaches to quality of life measurement are available: generic instruments that attempt to provide a summary of health related quality of life; and specific instruments that focus on problems associated with individual disease states, patient groups, or areas of function. Generic instruments include health profiles and instruments that generate health utilities. The approaches are not mutually exclusive. Each approach has its strengths and weaknesses and may be suitable under different circumstances. Investigations in HRQL have led to instruments suitable for detecting minimally important effects in clinical trials, measuring the health of populations, and for providing information for policy decisions.     

Women's occupational health: a critical review and discussion of current issues

Action to improve women's occupational health has been slowed by a notion that women's jobs are safe and that any health problems identified among women workers can be attributed to unfitness for the job or unnecessary complaining. With increasing numbers of women in the labor force, the effects of work on women's health have recently started to interest health care providers, health and safety representatives and researchers. We begin our summary of their discoveries with a discussion of women's place in the workplace and its implications for occupational health, followed by a brief review of some gender-insensitive data-gathering techniques. We have then chosen to concentrate on the following four areas: methods and data collection; directing attention to women's occupational health problems; musculoskeletal disease; mental and emotional stress. We conclude by pointing out some neglected occupational groups and health issues.     

Foreword to the special issue on long-term care.

This special issue on long-term care, guest edited by Carl and Susan Eisdorfer, addresses an issue that is rapidly becoming the most important health policy issue of the 1980s. The dilemma that we face as citizens and as rehabilitation professionals alike centers on our rapidly growing population of elderly citizens. While we have made unprecedented medical advances that have allowed for greater longevity, our health and social policies have not kept pace with these advances. We are therefore ill-equipped to deal with the myriad of economic, social, and health issues that confront our nation's elderly citizens. This issue of Rehabilitation Psychology is an attempt to address these questions by individuals who are leaders in the field of aging and long-term care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)