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Proxy Measure (proxy + measure)
Selected AbstractsShould uptake of state benefits be used as indicators of need and disadvantage?HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2006Michael Rosato BSc MSc Abstract Government requires indicators of disadvantage to guide programmes and allocate resources to those areas which are most in need. Proxy measures of relative disadvantage are often utilised for this task in the absence of ideal indicators of need. The recent availability of government administrative datasets, such as social security benefit uptake levels, are increasingly being used throughout the UK and have been hailed as a significant advance on previous measures of need. However, their suitability presupposes that the association between those in need of benefit and those actually in receipt of benefit is not confounded by non-needs-related factors. In the present study, the authors examine area-level factors associated with uptake of one health-related benefit and show that, while closely correlated with health status, it is also associated with factors which might be related to the propensity and ability to make a successful claim, as well as local adjudication practices. They conclude that, while the use of these government datasets has increased our ability to target resources, researchers and policy makers should be aware of these additional influences. [source] Mental health and well-being within rural communities: The Australian Rural Mental Health StudyAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 1 2010Brian J. Kelly Abstract Objective:,This paper outlines the methods and baseline data from a multisite cohort study of the determinants and outcomes of mental health and well-being within rural and remote communities. Methods:,A stratified random sample of adults was drawn in non-metropolitan New South Wales using the Australian Electoral Roll, with the aim of recruiting all adult members of each household. Surveys assessed psychological symptoms, physical health and mental disorders, along with individual-, family/household- and community-level characteristics. A stratified subsample completed a telephone-administered World Mental Health-Composite International Diagnostic Interview (World Mental Health-3.0). Proxy measures of child health and well-being were obtained. Follow up of this sample will be undertaken at one, three and five years. Results:,A total of 2639 individuals were recruited (1879 households), with 28% from remote/very remote regions. A significant relationship was found between recent distress (Kessler-10 scores), age and remoteness, with a linear reduction of Kessler-10 scores with age and the lowest mean scores in remote regions. Conclusions:,Existing rurality categories cannot address the diverse socio-cultural, economic and environmental characteristics of non-metropolitan regions. While it has limitations, the dataset will enable a fine-grained examination of geographic, household and community factors and provide a unique longitudinal dataset over a five-year period. [source] The legacy of a community mobilisation project to reduce alcohol related harmDRUG AND ALCOHOL REVIEW, Issue 1 2005RICHARD MIDFORD Associate Professor Abstract The Community Mobilisation for the Prevention of Alcohol Related Injury (COMPARI) project was established to investigate how alcohol related harm could be reduced within the Geraldton community through community action. Twenty-two major component activities were carried out over three years. On completion of the demonstration phase the project was taken over by the community and evolved into the region's main alcohol and drug service provider. This research seeks to identify the legacy of COMPARI from interviews with 23 key informants and from serial measures of alcohol consumption and harm. Key informants indicated that the original community prevention focus of the project has been diluted and there is more emphasis on individual prevention through education and training. A culture of intersectoral collaboration on alcohol issues has endured and this contributes to better use of resources and higher levels of treatment referral. There was also strong acknowledgement that the local committee was crucial in sustaining the project. Since the inception of COMPARI, local alcohol consumption has decreased and a proxy measure of alcohol harm, weekend, night, hospital accident and emergency occasions of service, also indicates better outcomes in Geraldton. The original project initiated cultural and structural change in the way alcohol problems are dealt with in Geraldton and this has produced on-going benefit for the community. [source] Nutrient constraints to tropical agroecosystem productivity in long-term degrading soilsGLOBAL CHANGE BIOLOGY, Issue 12 2008SOLOMON NGOZE Abstract Soil degradation is one of the most serious threats to sustainable crop production in many tropical agroecosystems where extensification rather than intensification of agriculture has occurred. In the highlands of western Kenya, we investigated soil nitrogen (N) and phosphorus (P) constraints to maize productivity across a cultivation chronosequence in which land-use history ranged from recent conversion from primary forest to 100 years in continuous cropping. Nutrient treatments included a range of N and P fertilizer rates applied separately and in combination. Maize productivity without fertilizer was used as a proxy measure for indigenous soil fertility (ISF). Soil pools of mineral nitrogen, strongly bound P and plant-available P decreased by 82%, 31% and 36%, and P adsorption capacity increased by 51% after 100 years of continuous cultivation. For the long rainy season (LR), grain yield without fertilizer declined rapidly as cultivation age increased from 0 to 25 years and then gradually declined to a yield of 1.6 Mg ha,1, which was maintained as time under cultivation increased from 60 to 100 years. LR grain yield in the old conversions was only 24% of the average young conversion grain yield (6.4 Mg ha,1). Application of either N or P alone significantly increased grain yield in both the LR and short rainy (SR) seasons, but only application of 120 kg N ha,1 on the old conversion increased yield by >1 Mg ha,1. In both SR and LR, there was a greater average yield increment response to N and P when applied together (ranging from 1 to 3.8 Mg ha,1 for the LR), with the greatest responses on the old conversions. The benefit,cost ratio (BCR) for applying 120 kg N ha,1 alone was <1 except on the old conversions, while BCRs were>1 for applying 25 kg P ha,1 alone at all levels of conversion for both seasons. Application of both N (120 kg N ha,1) and P (25 kg P ha,1) on the old conversions resulted in the greatest BCRs. This study clearly indicates that maize productivity responses to N and P fertilizer are significantly affected by the age of cultivation and its influence on ISF, but that loss of productivity can be restored rapidly when these limiting nutrients are applied. Management strategies should consider ISF and economic factors to determine optimal N and P input requirements for achieving and sustaining profitable crop production on degraded soils. [source] Information needs to support environmental impact assessment of the effects of European marine offshore wind farms on birdsIBIS, Issue 2006A.D. FOX European legislation requires Strategic Environmental Assessments (SEAs) of national offshore wind farm (OWF) programmes and Environmental Impact Assessments (EIAs) for individual projects likely to affect birds. SEAs require extensive mapping of waterbird densities to define breeding and feeding areas of importance and sensitivity. Use of extensive large scale weather, military, and air traffic control surveillance radar is recommended, to define areas, routes and behaviour of migrating birds, and to determine avian migration corridors in three dimensions. EIAs for individual OWFs should define the key avian species present; as well as assess the hazards presented to birds in terms of avoidance behaviour, habitat change and collision risk. Such measures, however, are less helpful in assessing cumulative impacts. Using aerial survey, physical habitat loss, modification, or gain and effective habitat loss through avoidance behaviour can be measured using bird densities as a proxy measure of habitat availability. The energetic consequences of avoidance responses and habitat change should be modelled to estimate fitness costs and predict impacts at the population level. Our present ability to model collision risk remains poor due to lack of data on species-specific avoidance responses. There is therefore an urgent need to gather data on avoidance responses; energetic consequences of habitat modification and avoidance flights and demographic sensitivity of key species, most affected by OWFs. This analysis stresses the importance of common data collection protocols, sharing of information and experience, and accessibility of results at the international level to better improve our predictive abilities. [source] A Privileged Status for Male Infant-Directed Speech in Infants of Depressed Mothers?INFANCY, Issue 2 2010Role of Father Involvement Prior research showed that 5- to 13-month-old infants of chronically depressed mothers did not learn to associate a segment of infant-directed speech produced by their own mothers or an unfamiliar nondepressed mother with a smiling female face, but showed better-than-normal learning when a segment of infant-directed speech produced by an unfamiliar nondepressed father signaled the face. Here, learning in response to an unfamiliar nondepressed father's infant-directed speech was studied as a function both of the mother's depression and marital status, a proxy measure of father involvement. Infants of unmarried mothers on average did not show significant learning in response to the unfamiliar nondepressed father's infant-directed speech. Infants of married mothers showed significant learning in response to male infant-directed speech, and infants of depressed, married mothers showed significantly stronger learning in response to that stimulus than did infants of nondepressed, married mothers. Several ways in which father involvement may positively or negatively affect infant responsiveness to male infant-directed speech are discussed. [source] Validation of Length of Hospital Stay as a Surrogate Measure for Injury Severity and Resource Use Among Injury SurvivorsACADEMIC EMERGENCY MEDICINE, Issue 2 2010Craig D. Newgard MD Abstract Objectives:, While hospital length of stay (LOS) has been used as a surrogate injury outcome when more detailed outcomes are unavailable, it has not been validated. This project sought to validate LOS as a proxy measure of injury severity and resource use in heterogeneous injury populations. Methods:, This observational study used four retrospective cohorts: patients presenting to 339 California emergency departments (EDs) with a primary International Classification of Diseases, Ninth Revision (ICD-9), injury diagnosis (years 2005,2006); California hospital injury admissions (a subset of the ED population); trauma patients presenting to 48 Oregon EDs (years 1998,2003); and injured Medicare patients admitted to 171 Oregon and Washington hospitals (years 2001,2002). In-hospital deaths were excluded, as they represent adverse outcomes regardless of LOS. Duration of hospital stay was defined as the number of days from ED admission to hospital discharge. The primary composite outcome (dichotomous) was serious injury (Injury Severity Score [ISS] , 16 or ICD-9 ISS , 0.90) or resource use (major surgery, blood transfusion, or prolonged ventilation). The discriminatory accuracy of LOS for identifying the composite outcome was evaluated using receiver operating characteristic (ROC) analysis. Analyses were also stratified by age (0,14, 15,64, and ,65 years), hospital type, and hospital annual admission volume. Results:, The four cohorts included 3,989,409 California ED injury visits (including admissions), 236,639 California injury admissions, 23,817 Oregon trauma patients, and 30,804 Medicare injury admissions. Composite outcome rates for the four cohorts were 2.1%, 29%, 27%, and 22%, respectively. Areas under the ROC curves for overall LOS were 0.88 (California ED), 0.74 (California admissions), 0.82 (Oregon trauma patients), and 0.68 (Medicare patients). In general, the discriminatory value of LOS was highest among children, tertiary trauma centers, and higher volume hospitals, although this finding differed by the injury population and outcome assessed. Conclusions:, Hospital LOS may be a reasonable proxy for serious injury and resource use among injury survivors when more detailed outcomes are unavailable, although the discriminatory value differs by age and the injury population being studied. ACADEMIC EMERGENCY MEDICINE 2010; 17:142,150 © 2010 by the Society for Academic Emergency Medicine [source] Perception of body image as indicator of weight status in the European UnionJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 2 2001A. Sánchez-Villegas Objective To identify the factors associated with an adequate perception of body image in relation to body weight. Material and methods An observational, cross-sectional study was conducted in a representative sample of the European Union (7155 men and 8077 women). Body Mass Index (BMI) was grouped into four categories, perceived body image was assessed using the nine silhouettes drawing scheme. A multivariable logistic regression model for each sex was used to adjust for potentially confounding variables. Results Underweight men and women classified themselves better than other groups (92.9% of correct answers among men and 79.3% among women). Overall, women classified themselves better than men (57.6% vs. 32.7%). Discussion Perceived body image as a method of assessment for body weight has different validity depending on sociodemographic or attitudinal categories. Perceived body image as an estimate of the nutritional status has a limited individualized application. Thus, perhaps it could be applied as a proxy measure of adiposity among slim males and among slim and overweight females, but not among the other groups. [source] The geography of tyranny and despair: development indicators and the hypothesis of genetic inevitability of national inequalityTHE GEOGRAPHICAL JOURNAL, Issue 3 2008STEPHEN MORSE Development geography has long sought to understand why inequalities exist and the best ways to address them. Dependency theory sets out an historical rationale for under development based on colonialism and a legacy of developed core and under-developed periphery. Race is relevant in this theory only insofar that Europeans are white and the places they colonised were occupied by people with darker skin colour. There are no innate biological reasons why it happened in that order. However, a new theory for national inequalities proposed by Lynn and Vanhanen in a series of publications makes the case that poorer countries have that status because of a poorer genetic stock rather than an accident of history. They argue that IQ has a genetic basis and IQ is linked to ability. Thus races with a poorer IQ have less ability, and thus national IQ can be positively correlated with performance as measured by an indicator like GDP/capita. Their thesis is one of despair, as little can be done to improve genetic stock significantly other than a programme of eugenics. This paper summarises and critiques the Lynn and Vanhanen hypothesis and the assumptions upon which it is based, and uses this analysis to show how a human desire to simplify in order to manage can be dangerous in development geography. While the attention may naturally be focused on the ,national IQ' variables as a proxy measure of ,innate ability', the assumption of GDP per capita as an indicator of ,success' and ,achievement' is far more readily accepted without criticism. The paper makes the case that the current vogue for indicators, indices and cause,effect can be tyrannical. [source] The Relationship Between the Emergent Primary Percutaneous Coronary Intervention Quality Measure and Inpatient Myocardial Infarction MortalityACADEMIC EMERGENCY MEDICINE, Issue 8 2010Rahul K. Khare MD ACADEMIC EMERGENCY MEDICINE 2010; 17:793,800 © 2010 by the Society for Academic Emergency Medicine Abstract Background:, In the setting of acute ST-segment elevation myocardial infarction (STEMI), reperfusion therapy with emergent primary percutaneous coronary intervention (PCI) significantly reduces mortality. It is unknown whether a hospital's performance on the Centers for Medicare & Medicaid Services (CMS) quality metric for time from patient arrival to angioplasty is associated with its overall hospital acute myocardial infarction (AMI) mortality rate. Objectives:, The objective of this study was to evaluate if hospitals with higher performance on the time-to-PCI quality measure are more likely to achieve lower mortality for patients admitted for any type of AMI. Methods:, Using merged 2006 data from the Nationwide Inpatient Sample (NIS), the American Hospital Association (AHA) annual survey, and CMS Hospital Compare quality indicator data, we examined 69,101 admissions with an International Classification of Diseases, Ninth Revision (ICD-9)-coded principal diagnosis of AMI in the 116 hospitals that reported more than 24 emergent primary PCI admissions in that year. Hospitals were categorized into quartiles according to percentage of admissions in 2006 that achieved the primary PCI timeliness threshold (time-to-PCI quality measure). Using a random effects logistic regression model of inpatient mortality, we examined the significance of the hospital time-to-PCI quality measure after adjustment for other hospital and individual patient sociodemographic and clinical characteristics. Results:, The unadjusted inpatient AMI mortality rate at the 27 top quartile hospitals was 4.3%, compared to 5.1% at the 32 bottom quartile (worst performing) hospitals. The risk-adjusted odds ratio (OR) of inpatient death was 0.83 (95% confidence interval [CI] = 0.72 to 0.95), or 17% lower odds of inpatient death, among patients admitted to hospitals in the top quartile for the time-to-PCI quality measure compared to the case if the hospitals were in the bottom 25th percentile. Conclusions:, Hospitals with the highest and second highest quartiles of time-to-PCI quality measure had a significantly lower overall AMI mortality rate than the lowest quartile hospitals. Despite the fact that a minority of all patients with AMI get an emergent primary PCI, hospitals that perform this more efficiently also had a significantly lower mortality rate for all their patients admitted with AMI. The time-to-PCI quality measure in 2006 was a potentially important proxy measure for overall AMI quality of care. [source] Fast times and easy questions: the effects of age, experience and question complexity on web survey response timesAPPLIED COGNITIVE PSYCHOLOGY, Issue 1 2008Ting Yan This paper examines response times (RT) to survey questions. Cognitive psychologists have long relied on response times to study cognitive processes but response time data have only recently received attention from survey researchers. To date, most of the studies on response times in surveys have treated response times either as a predictor or as a proxy measure for some other variable (e.g. attitude accessibility) of greater interest. As a result, response times have not been the main focus of the research. Focusing on the nature and determinants of response times, this paper examines variables that affect how long it takes respondents to answer questions in web surveys. Using the survey response model proposed by Tourangeau, Rips, and Rasinski (2000), we include both item-level characteristics and respondent-level characteristics thought to affect response times in a two-level cross-classified model. Much of the time spent on processing the questions involves reading and interpreting them. The results from the cross-classified models indicate that response times are affected by question characteristics such as the total number of clauses and the number of words per clause that probably reflect reading times. In addition, response times are also affected by the number and type of answer categories, and the location of the question within the questionnaire, as well as respondent characteristics such as age, education and experience with the Internet and with completing web surveys. Aside from their fixed effects on response times, respondent-level characteristics (such as age) are shown to vary randomly over questions and effects of question-level characteristics (such as types of questions and response scales) vary randomly over respondents. Copyright © 2007 John Wiley & Sons, Ltd. [source] Reversing spontaneous succession to protect high-value vegetation: Assessment of two Scottish mires using rapid survey techniquesAPPLIED VEGETATION SCIENCE, Issue 1 2001Andrew R.G. Large Abstract. Despite existing management agreements, significant change has occurred on Carnwath Moss and Coladoir Bog, two mire complexes in central and western Scotland. Spontaneous succession has accelerated, resulting in extensive degradation of the mire vegetation on both sites and, in particular, widespread expansion of Calluna vulgaris - and Molinia caerulea -dominated vegetation types. Vegetation surveys across strong gradients of change were conducted with the aim of quantifying the extent of early (desirable) and late (undesirable) successional vegetation on both sites. For each site multivariate analyses of the vegetation data were carried out using TWINSPAN, which clearly differentiated higher quality and degraded surfaces. In management terms percentage Sphagnum cover can act as a useful proxy measure of water level and shrub layer height can also serve as a useful indicator of the degree of degradation. A broad-based, five class condition continuum was developed for the Carnwath Moss site. While such an assessment scheme is a somewhat arbitrary means of allocating mesotope areas to specific condition classes, it is rapid to apply and simple enough to be applied by a range of users. A drawback is that the methodology is data-light in temporal terms and is not a long-term substitute for properly-funded monitoring programmes for important sites. For both mires, recommendations are made for management with the main emphasis being on maintaining water tables at appropriate levels to maximise the floristic diversity of active mires. [source] Accuracy of Ottawa Ankle Rules to Exclude Fractures of the Ankle and Midfoot in Children: A Meta-analysisACADEMIC EMERGENCY MEDICINE, Issue 4 2009Shawn Dowling MD Abstract Objectives:, The objectives were to conduct a systematic review to determine the diagnostic accuracy of the Ottawa Ankle Rules (OAR) to exclude ankle and midfoot fractures in children and the extent to which x-ray use could be reduced without missing significant fractures. Methods:, The authors conducted comprehensive searches of electronic databases and gray literature sources. Independent reviewers applied standard inclusion and exclusion criteria. The criterion standard diagnostic test was an ankle and/or foot x-ray or proxy measure to ensure no missed fractures. Standard 2 × 2 tables were constructed. Sensitivities and specificities were pooled using an approximation of the inverse variance; 95% confidence intervals (95% CIs) were calculated using the exact method. Likelihood ratios (LR ±) and diagnostic odds ratios were combined under DerSimonian and Laird random effects model. Results:, A pooled analysis of 12 studies (N = 3,130) identified 671 fractures (prevalence = 21.4%). Ten studies reported Salter-Harris Type I (SH-I) fractures. The pooled sensitivity was 98.5% (95% CI = 97.3 to 99.2), suggesting that the OAR can be used to rule out a fracture. Four of 10 missed fractures were characterized: 1 SH-I, 1 SH-IV, and 2 "insignificant fractures" (either SH-I or avulsion fractures <3 mm). The pooled estimate for rate of x-ray reduction was 24.8% (95% CI = 23.3% to 26.3%; range = 5% to 44%). Conclusions:, The OAR appear to be a reliable tool to exclude fractures in children greater than 5 years of age presenting with ankle and midfoot injuries. Employing the OAR would significantly decrease x-ray use with a low likelihood of missing a fracture. [source] Cultural Variability in the Manifestation of Expressed EmotionFAMILY PROCESS, Issue 2 2009STEVEN R. LÓPEZ PH.D. We examined the distribution of expressed emotion (EE) and its indices in a sample of 224 family caregivers of individuals with schizophrenia pooled from 5 studies, 3 reflecting a contemporary sample of Mexican Americans (MA 2000, N=126), 1 of an earlier study of Mexican Americans (MA 1980, N=44), and the other of an earlier study of Anglo Americans (AA, N=54). Chi-square and path analyses revealed no significant differences between the 2 MA samples in rates of high EE, critical comments, hostility, and emotional over-involvement (EOI). Only caregiver warmth differed for the 2 MA samples; MA 1980 had higher warmth than MA 2000. Significant differences were consistently found between the combined MA samples and the AA sample; AAs had higher rates of high EE, more critical comments, less warmth, less EOI, and a high EE profile comprised more of criticism/hostility. We also examined the relationship of proxy measures of acculturation among the MA 2000 sample. The findings support and extend Jenkins' earlier observations regarding the cultural variability of EE for Mexican Americans. Implications are discussed regarding the cross-cultural measurement of EE and the focus of family interventions. RESUMEN Examinamos la distribución de emoción expresada y sus índices en una muestra de 224 cuidadores parientes de personas con esquizofrenia tomadas de 5 estudios, tres que reflejaban una muestra contemporánea de personas méxico-estadounidenses (ME 2000, N=126), una de un estudio anterior de méxico-estadounidenses (ME 1980, N=44, Karno et al., 1987) y la otra de un estudio anterior de angloamericanos (AA, N=54, Vaughn et al., 1984). La distribución ji-cuadrado y los análisis de pautas no revelaron diferencias significativas entre las dos muestras de méxico-estadounidenses en cuanto a los índices de alta emoción expresada, comentarios críticos, hostilidad y sobreimplicación emocional. Solo la calidez de los cuidadores fue distinta en las dos muestras de méxico-estadounidenses; el grupo ME 1980 demostró mayor calidez que el grupo ME 2000. Se encontraron sistemáticamente diferencias considerables entre las dos muestras de méxico-estadounidenses y la muestra de angloamericanos; los angloamericanos demostraron índices más altos de alta emoción expresada, más comentarios críticos, menos calidez, menos sobreimplicación emocional y un perfil de alta emoción expresada compuesto mayormente por crítica y hostilidad. También examinamos la relación de los cálculos aproximados de aculturación entre la muestra ME 2000. Los resultados respaldan y amplían las observaciones anteriores de Jenkins (1991) con respecto a la variabilidad cultural de emoción expresada en los méxico-estadounidenses. Se comentan las implicaciones con respecto a la evaluación intercultural de emoción expresada y al enfoque de las intervenciones familiares. Palabras clave: Emoción expresada, cultura, méxico-estadounidenses, sobreimplicación emocional, esquizofrenia, cuidadores parientes [source] Plant species traits and capacity for resource reduction predict yield and abundance under competition in nitrogen-limited grasslandFUNCTIONAL ECOLOGY, Issue 3 2006J. FARGIONE Summary 1The objective of this study is to test whether plant traits that are predicted by resource-competition theory to lead to competitive dominance are correlated with competitive response and abundance in a nitrogen-limited grassland. We collected species trait and soil nutrient data on non-leguminous perennial prairie plant species in replicated monoculture plots established for this purpose. 2The soil nitrate concentration of 13 species grown in long-term (5-year) monocultures (a measure of R*) was correlated with their relative yield (a measure of competitive response) and with their abundance in competition. The trait best correlated with a species' relative yield was root length density (RLD), and the trait best correlated with abundance in competition was biomass : N ratio. 3The traits that best predicted nitrate R* were the biomass : N ratio and allocation to fine roots, where species with higher biomass : N and allocation to fine roots had lower R*. Easily measured species traits may therefore be useful proxy measures for R*. 4The dominance of species with lower nitrate R* levels and higher RLD and biomass : N in monoculture is qualitatively consistent with the prediction of resource-competition theory that the species most efficient at acquiring, retaining and using the major limiting resource will be the best competitors. Additional mechanisms are needed to explain how these species coexist. [source] A unified approach to regression analysis under double-sampling designsJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES B (STATISTICAL METHODOLOGY), Issue 3 2000Yi-Hau Chen We propose a unified approach to the estimation of regression parameters under double-sampling designs, in which a primary sample consisting of data on the rough or proxy measures for the response and/or explanatory variables as well as a validation subsample consisting of data on the exact measurements are available. We assume that the validation sample is a simple random subsample from the primary sample. Our proposal utilizes a specific parametric model to extract the partial information contained in the primary sample. The resulting estimator is consistent even if such a model is misspecified, and it achieves higher asymptotic efficiency than the estimator based only on the validation data. Specific cases are discussed to illustrate the application of the estimator proposed. [source] Resources at Marriage and Intrahousehold Allocation: Evidence from Bangladesh, Ethiopia, Indonesia, and South Africa*OXFORD BULLETIN OF ECONOMICS & STATISTICS, Issue 3 2003Agnes R. Quisumbing We test the unitary versus collective model of the household using specially designed data from Bangladesh, Ethiopia, Indonesia, and South Africa. Human capital and individual assets at the time of marriage are used as proxy measures for bargaining power. In all four countries, we reject the unitary model as a description of household behaviour, but fail to reject the hypothesis that households are Pareto-efficient. In Bangladesh and South Africa, women's assets increase expenditure shares on education, while in Ethiopia it is men's assets that have this effect. These increases have different implications for boys and girls across countries, however. [source] Estimation of the day-specific probabilities of conception: current state of the knowledge and the relevance for epidemiological researchPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2006Courtney D. Lynch Summary Conception, as defined by the fertilisation of an ovum by a sperm, marks the beginning of human development. Currently, a biomarker of conception is not available; as conception occurs shortly after ovulation, the latter can be used as a proxy for the time of conception. In the absence of serial ultrasound examinations, ovulation cannot be readily visualised leaving researchers to rely on proxy measures of ovulation that are subject to error. The most commonly used proxy measures include: charting basal body temperature, monitoring cervical mucus, and measuring urinary metabolites of oestradiol and luteinising hormone. Establishing the timing of the ovulation and the fertile window has practical utility in that it will assist couples in appropriately timing intercourse to achieve or avoid pregnancy. Identifying the likely day of conception is clinically relevant because it has the potential to facilitate more accurate pregnancy dating, thereby reducing the iatrogenic risks associated with uncertain gestation. Using data from prospective studies of couples attempting to conceive, several researchers have developed models for estimating the day-specific probabilities of conception. Elucidating these will allow researchers to more accurately estimate the day of conception, thus spawning research initiatives that will expand our current limited knowledge about the effect of exposures at critical periconceptional windows. While basal body temperature charting and cervical mucus monitoring have been used with success in field-based studies for many years, recent advances in science and technology have made it possible for women to get instant feedback regarding their daily fertility status by monitoring urinary metabolites of reproductive hormones in the privacy of their own homes. Not only are innovations such as luteinising hormone test kits and digital fertility monitors likely to increase study compliance and participation rates, they provide valuable prospective data that can be used in epidemiological research. Although we have made great strides in estimating the timing and length of the fertile window, more work is needed to elucidate the day-specific probabilities of conception using proxy measures of ovulation that are inherently subject to error. Modelling approaches that incorporate the use of multiple markers of ovulation offer great promise to fill these important data gaps. [source] A new index of access to primary care services in rural areasAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2009Matthew R. McGrail Abstract Objective: To outline a new index of access to primary care services in rural areas that has been specifically designed to overcome weaknesses of using existing geographical classifications. Methods: Access was measured by four key dimensions of availability, proximity, health needs and mobility. Population data were obtained through the national census and primary care service data were obtained through the Medical Directory of Australia. All data were calculated at the smallest feasible geographical unit (collection districts). The index of access was measured using a modified two-step floating catchment area (2SFCA) method, which incorporates two necessary additional spatial functions (distance-decay and capping) and two additional non-spatial dimensions (health needs and mobility). Results: An improved index of access, specifically designed to better capture access to primary care in rural areas, is achieved. These improvements come from: 1) incorporation of actual health service data in the index; 2) methodological improvements to existing access measures, which enable both proximity to be differentiated within catchments and the use of varying catchment sizes; and 3) improved sensitivity to small-area variations. Conclusion: Despite their recognised weaknesses, the Australian government uses broad geographical classifications as proxy measures of access to underpin significant rural health funding programs. This new index of access could provide a more equitable means for resource allocation. Implications: Significant government funding, aimed at improving health service access inequities in rural areas, could be better targeted by underpinning programs with our improved access measure. [source] Outcomes for children's health and well-beingCHILDREN & SOCIETY, Issue 3 2003Zarrina Kurtz Health outcomes are implicit in the government's major policies on reducing poverty, unemployment and social exclusion, and in environmental regeneration, as well as in explicitly targeted policies for modernising the National Health Service. The impact of policies in childhood are regarded as a key feature in determining socioeconomic outcomes in many domains, among which mental health plays a particularly important part. But although early intervention is recognised as crucial in the achievement of socioeconomic and health policy aims, outcomes in children and for children have only recently received full recognition. This article outlines the impact that government policies may have on health outcomes for children. However, the assessment of changes in health status is difficult and mostly relies on proxy measures. The evidence that any changes can be related to policy is extremely limited and mostly based on small-scale and locally specific projects. What can be learnt from these and from collective analysis of linked projects, such as those funded through the CAMHS Innovation Grant, is discussed. Because of the attention paid by the government to evidence-based policy, outcomes in all domains will become known before long for major national children's policy initiatives such as the Sure Start programme, highlighting the crucial and continuing need for evaluation of the ways in which policies are implemented. Copyright © 2003 John Wiley & Sons, Ltd. [source] |