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The Increasing Risk of Mortality in Breast Cancer: A Socioeconomic Analysis Between Countries 乳腺癌死亡风险的增加:国家间的社会经济分析
Pub Date : 2019-01-16 DOI: 10.1453/JSAS.V6I4.1972
M. Coccia
Abstract. The risk of mortality in breast cancer among women is a critical health issue worldwide. Scholars argue that breast cancer mortality rates have decreased in many advanced countries overall. However, about 50% of world population in 2017 was in poor and developing countries (more than 3,652 million with 50.24% female) and breast cancer mortality rates differ among nations also because of socioeconomic factors. This study investigates, at global level, breast cancer mortality in association with breast cancer incidence and some factors of socioeconomic ecosystem between poor and rich countries, to explain trends that can be used to gain insights into country-level “best practices” for health improvement. Global data regarding breast cancer incidence and mortality as the age standardized rate per 100,000 population in 78low-to-middle income countries (LMICs), 50 upper-to-middle-income countries (UMICs) and 63 high income countries (HCIs) were obtained from IARC/WHO for 2012 and 2018. Data regarding GDP per capita, population and mammography (MMG) were obtained from World Bank, United Nations and WHO. Data, transformed in log scale to have normal distribution, were analyzed with descriptive statistics, partial correlation, regression analyses and paired-Samples T Test procedure to assess the statistical significance of increase or decrease of mortality and incidence in breast cancer from 2012 to 2018.Results reveal that a 1% higher level of breast cancer incidence, increases the expected mortality by 0.79% ( p-value < .001) in LMICs, by 0.50% ( p-value <.001) in UMICs and by 0.31% ( p-value < .008) in HICs. These results, confirmed by other analyses here, seem to suggest that breast cancer mortality is increasing over time worldwide in rich and in particular developing countries. The global analysis here reveals that though an improvement of wealth and wellbeing worldwide, the risk of incidence and mortality in breast cancer is increasing. This result suggests that situational factors in the ecosystem of countries support the growing increase and mortality of breast cancer that improvement in healthcare and medicine of the last 40 years are not been sufficient to slowdown. These conclusions need for much more detailed research to investigate into the interaction between factors of socioeconomic systems, health improvement, and breast cancer causes. Keywords. Breast cancer, Wealth of nations, Epidemiology. JEL. I14, I15, I18, I39, O10, O3, O55, Q50.
摘要妇女因乳腺癌死亡的风险是全世界的一个重大健康问题。学者们认为,在许多发达国家,乳腺癌死亡率总体上有所下降。然而,2017年约有50%的世界人口在贫穷和发展中国家(超过36.52亿,其中50.24%是女性),各国之间的乳腺癌死亡率也因社会经济因素而有所不同。本研究在全球范围内调查了乳腺癌死亡率与乳腺癌发病率之间的关系以及穷国和富国之间社会经济生态系统的一些因素,以解释可用于深入了解国家一级改善健康的“最佳做法”的趋势。从国际癌症研究机构/世卫组织获得了2012年和2018年全球78个中低收入国家(LMICs)、50个中高收入国家(UMICs)和63个高收入国家(hci)的乳腺癌发病率和死亡率(每10万人的年龄标准化率)数据。关于人均国内生产总值、人口和乳房x光检查(MMG)的数据来自世界银行、联合国和世卫组织。数据经对数尺度变换为正态分布后,采用描述性统计、偏相关分析、回归分析和配对样本T检验等方法分析2012 - 2018年乳腺癌死亡率和发病率上升或下降的统计学意义。结果显示,乳腺癌发病率每增加1%,低收入国家的预期死亡率增加0.79% (p值< 0.001),低收入国家增加0.50% (p值< 0.001),高收入国家增加0.31% (p值< 0.001)。这些结果得到了其他分析的证实,似乎表明,随着时间的推移,乳腺癌死亡率在全球范围内呈上升趋势,在富裕国家,尤其是在发展中国家。该报告的全球分析显示,尽管世界各地的财富和福祉都有所改善,但乳腺癌发病率和死亡率的风险正在增加。这一结果表明,各国生态系统中的环境因素支持了乳腺癌的不断增长和死亡率,而过去40年医疗保健和医学的改善不足以减缓这一趋势。这些结论需要更详细的研究,以调查社会经济系统、健康改善和乳腺癌病因因素之间的相互作用。关键词。乳腺癌,国富论,流行病学。冻胶。I14, i15, i18, i39, o10, o3, o55, q50。
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引用次数: 3
Palliative Care in Solomon Islands 所罗门群岛的姑息治疗
Pub Date : 2018-12-12 DOI: 10.2139/ssrn.3299814
J. Spratt, G. Spencer
This Discussion Paper presents the findings of initial research into palliative care in Solomon Islands. This research sought to explore the current palliative care policy and service landscape in Solomon Islands, existing strengths to expand upon, and opportunities for future action and research. The result here is the first published exploration of palliative care in Solomon Islands. Following a literature review, data collection involved documentary analysis and interviews with policy-makers, health professionals and other community stakeholders. All interviewees agreed that there is a need to pay more attention to palliative care in Solomon Islands. Key areas for future action include: supporting health professionals to have difficult conversations with people about their prognosis and what to expect during the dying process; training for health professionals in pain assessment and management; improving systems and guidelines, particularly referral systems and access to morphine; and expanding support for families caring for loved ones dying at home. Future research opportunities exist in understanding: families’ and patients’ needs; cultural approaches to care-giving, pain and death; the role of traditional healers; how to increase health literacy; the costs and savings associated with palliative care provision; and the knowledge, attitudes and behaviours of health professionals. An examination of the opiate analgesic system is a pressing research priority. We conclude with recommendations for donors regarding how they could support future action and research.
本讨论文件提出了初步研究的结果,在所罗门群岛姑息治疗。本研究旨在探索所罗门群岛目前的姑息治疗政策和服务格局,现有的优势和未来行动和研究的机会。这里的结果是所罗门群岛首次发表的姑息治疗探索。在文献综述之后,数据收集包括文献分析和对决策者、卫生专业人员和其他社区利益攸关方的访谈。所有受访者都同意,所罗门群岛有必要更加重视姑息治疗。未来行动的关键领域包括:支持卫生专业人员与患者进行艰难的对话,讨论他们的预后以及在死亡过程中会发生什么;对保健专业人员进行疼痛评估和管理方面的培训;改进系统和指南,特别是转诊系统和吗啡的获取;扩大对照顾在家中死去的亲人的家庭的支持。未来的研究机会存在于理解:家庭和患者的需求;对待照料、痛苦和死亡的文化方法;传统治疗师的作用;如何提高卫生知识普及程度;与提供姑息治疗有关的费用和节省;以及卫生专业人员的知识、态度和行为。对阿片类镇痛系统的检查是一个紧迫的研究重点。最后,我们就捐助者如何支持未来的行动和研究提出建议。
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引用次数: 0
When Less Is More: Can Reduced Health Monitoring Improve Patient Behavior? 少即是多:减少健康监测能改善患者行为吗?
Pub Date : 2018-11-30 DOI: 10.2139/ssrn.3354745
Fernanda Marquez-Padilla
Mexico's largest healthcare provider recently began issuing automatic-re ll prescriptions to stable hypertensive patients, thus reducing the frequency of health monitoring from 30- to 90-day intervals. Exploiting this change, I find that lower monitoring implies no drawbacks in health outcomes and actually improves an important health behavior: medication adherence. The number of days when patients are out of medication between fillings falls by 2.6 days -- an improvement in adherence of 7.5%. Furthermore, patients appear to value being on a low-frequency regime as they improve adherence to remain on it, suggesting that lower monitoring could be used as a "reward" to promote healthy behaviors.
墨西哥最大的医疗保健提供者最近开始向稳定的高血压患者发放自动处方,从而将健康监测的频率从30天减少到90天。利用这一变化,我发现较低的监控意味着健康结果没有缺点,实际上改善了一个重要的健康行为:药物依从性。患者在两次补牙之间停药的天数减少了2.6天,依从性提高了7.5%。此外,患者似乎重视低频率治疗,因为他们提高了坚持治疗的能力,这表明低监测可以作为促进健康行为的“奖励”。
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引用次数: 0
Implications of Outbound Medical Tourism on Public Health Care Development in Nigeria 出境医疗旅游对尼日利亚公共卫生保健发展的影响
Pub Date : 2018-10-31 DOI: 10.19044/ESJ.2018.V14N30P353
Ibrahim Orekoya, O. Oduyoye
Medical tourism is the practice of patients travelling out of their country of origin or residence for the purpose of getting access to medical care services abroad. Outbound medical tourism is a phenomenon in Nigeria thereby contributing to the growth of the health care industry in destination countries. The paper examines the implications of outbound medical tourism on public health care development in Nigeria and reinforces the need for the Federal Government of Nigeria to restructure and reposition the health sector in the country towards effective and efficient health service delivery. The study employs secondary source of data. Public administrators and health care practitioners concerned about transforming Nigeria into a centre of medical tourist attraction may find it suitable to start by examining the issues raised in this study to initiate a good policy framework for the health sector. The study concludes that huge investment in the health sector can drastically reduce outbound medical tourism, make health care services affordable to all Nigerians and utilising foreign exchange to develop other relevant sectors of the Nigerian economy.
医疗旅游是指病人离开原籍国或居住国前往国外接受医疗服务的做法。出境医疗旅游是尼日利亚的一种现象,从而促进了目的地国家医疗保健行业的增长。本文考察了出境游对尼日利亚公共卫生保健发展的影响,并强调了尼日利亚联邦政府对该国卫生部门进行重组和重新定位的必要性,以实现有效和高效的卫生服务提供。本研究采用二手数据来源。关注将尼日利亚转变为医疗旅游吸引中心的公共行政人员和保健从业人员可能会认为,首先应审查本研究中提出的问题,以便为卫生部门启动一个良好的政策框架。该研究的结论是,对卫生部门的巨额投资可以大大减少出境医疗旅游,使所有尼日利亚人都负担得起卫生保健服务,并利用外汇发展尼日利亚经济的其他相关部门。
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引用次数: 2
Linking Dynamic Capabilities and Healthcare Innovations: A Case Study Approach 链接动态能力和医疗保健创新:案例研究方法
Pub Date : 2018-08-31 DOI: 10.2139/ssrn.3242224
Saravana Govindasamy, S. Wattal
This study explores the relationship between dynamic capabilities and different types of innovations in healthcare industry. It utilizes a case study approach by conducting semi-structured interviews with clinicians and hospital administrators from two types of hospitals—academic and community. The main findings are: 1) the learning, coordinating, and integrating capabilities are associated with product/service and process innovations in academic hospitals; 2) the learning and integrating capabilities are associated with product/service and process innovations in community hospitals; 3) the barrier internal resources contention act as a moderator between the dynamic capabilities and innovations. This paper concludes by outlining propositions for additional research that would contribute to a more complete understanding of relationship between dynamic capabilities and different types of innovations in hospitals setting.
本研究探讨医疗保健行业动态能力与不同类型创新之间的关系。它采用案例研究的方法,对来自两种类型医院——学术医院和社区医院的临床医生和医院管理人员进行半结构化访谈。研究发现:1)学术型医院的学习能力、协调能力和整合能力与产品/服务创新和流程创新相关;2)社区医院的学习和整合能力与产品/服务和流程创新相关;(3)内部资源竞争壁垒在动态能力与创新之间起调节作用。本文最后概述了进一步研究的建议,这些建议将有助于更全面地理解医院环境中动态能力与不同类型创新之间的关系。
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引用次数: 1
Who Is an Efficient and Effective Physician? Evidence From Emergence Medicine 谁是高效的医生?来自急救医学的证据
Pub Date : 2018-08-07 DOI: 10.2139/ssrn.3227873
S. Saghafian, Raha Imanirad, S. Traub
Improving the performance of the healthcare sector requires an understanding of the effectiveness and efficiency of care delivered by providers. Although this topic is of great interest to policymakers, researchers, and hospital managers, rigorous methods of measuring effectiveness and efficiency of care delivery have proven elusive. Through Data Envelopment Analysis (DEA), we make use of evidence from care delivered by emergency physicians, and develop scores that gauge physicians' performance in terms of effectiveness and efficiency. In order to validate our DEA scores, we independently use various Machine Learning (ML) algorithms, including Support Vector Machines (SVM), K-Nearest Neighbors (KNN), Classification and Regression Trees (CART), Random Forest (RF), a Generalized Linear Model (GLM), and Least Absolute Shrinkage and Selection Operator (LASSO). After validating our DEA scores via comparison with predictions made by these algorithms, we make use of them to identify the distinguishing behaviors of highly effective and efficient physicians. We find that highly effective physicians order less tests compared to their peers and maintain their effectiveness when working under high workloads. We also observe that highly efficient physicians order less tests on average and become even more efficient during high-volume shifts. Importantly, our results indicate a statistically significant positive relationship between a physician's effectiveness and efficiency scores suggesting that, contrary to conventional wisdom, effectiveness and efficiency in care delivery should be viewed as compliments not substitutes. In addition, we find that effectiveness is lower among physicians who have higher job tenure or average test order count. Efficiency, however, is lower among physicians with less experience (measured in number of years after graduation from medical school) or high average test order count. Furthermore, our results indicate an increase in a physician's average efficiency and a decrease in his/her average effectiveness when faced with high workloads. Finally, we find evidence of peer influence on a focal physician's effectiveness and efficiency, which suggests an opportunity to improve system performance by taking physician characteristics into account when determining the set of physicians that should be scheduled during the same shifts.
改善医疗保健部门的绩效需要了解提供者提供的护理的有效性和效率。尽管政策制定者、研究人员和医院管理者对这个话题非常感兴趣,但事实证明,衡量医疗服务有效性和效率的严格方法是难以捉摸的。通过数据包络分析(DEA),我们利用急诊医生提供的护理证据,并制定分数来衡量医生在有效性和效率方面的表现。为了验证我们的DEA分数,我们独立使用各种机器学习(ML)算法,包括支持向量机(SVM)、k近邻(KNN)、分类和回归树(CART)、随机森林(RF)、广义线性模型(GLM)和最小绝对收缩和选择算子(LASSO)。通过与这些算法的预测相比较,验证了我们的DEA评分后,我们利用它们来识别高效和高效医生的区别行为。我们发现,与同行相比,高效的医生要求更少的检查,并且在高工作量下工作时保持效率。我们还观察到,效率高的医生的平均检查次数更少,而且在高工作量轮班时效率更高。重要的是,我们的研究结果表明,医生的有效性和效率得分之间存在统计学上显著的正相关关系,这表明,与传统观念相反,医疗服务的有效性和效率应被视为赞美而不是替代。此外,我们发现,效能较低的医生谁拥有较高的任期或平均测试订单数。然而,在经验较少(以从医学院毕业后的年数衡量)或平均测试订单数较高的医生中,效率较低。此外,我们的研究结果表明,当面对高工作量时,医生的平均效率会提高,而他/她的平均效率会降低。最后,我们发现了同行影响焦点医生的有效性和效率的证据,这表明在确定应在同一班次安排的医生集时,考虑到医生的特征,有机会提高系统性能。
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引用次数: 1
Cleaning for Your Life: How a Medical Revolution Swept Into Canadian Homes Between 1854 and 1898 为你的生活清洁:1854年至1898年间,一场医学革命如何席卷加拿大的家庭
Pub Date : 2018-06-27 DOI: 10.2139/ssrn.3203876
N. Cooke
The last half of the nineteenth century constituted a medical revolution as scientists identified agents of disease. This study looks specifically to Canadian household manuals, bookended by the watershed publications of Catharine Parr Traill in 1854 and Adelaide Hoodless in 1898, to identify what knowledge emerging from the medical revolution known as the construction of germ theory makes its way to Canadian cookbook authors and, in turn, to Canadian homes. In doing so, it also sheds first light on some of Canada's early cookbooks, which have to date received deserved bibliographical attention but not yet close analytical scrutiny.
19世纪后半叶是一场医学革命,科学家们发现了致病因子。这项研究特别关注加拿大家庭手册,以1854年catherine Parr Traill和1898年Adelaide Hoodless的分水岭出版物为结束,以确定医学革命中被称为细菌理论构建的知识如何进入加拿大烹饪书作者,进而进入加拿大家庭。在这样做的过程中,它也首次揭示了加拿大早期的一些烹饪书,这些书迄今为止得到了应有的书目关注,但尚未进行仔细的分析审查。
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引用次数: 0
The 19th Century Net Nutrition Transition from Free to Bound Labor: A Difference-in-Decompositions Approach 19世纪净营养从自由劳动到束缚劳动的转变:分解方法的差异
Pub Date : 2018-03-14 DOI: 10.2139/ssrn.3172005
S. Carson
The body mass index (BMI) reflects current net nutrition and health during economic development. This study introduces a difference-in-decompositions approach to show that although 19th century African-American current net nutrition was comparable to working class whites, it was made worse-off with the transition to free-labor. BMI reflects net nutrition over the life-course, and like stature, slave children’s BMIs increased more than whites as they approached entry into the adult slave labor force. Agricultural worker’s net nutrition was better than workers in other occupations but was worse-off under free-labor and industrialization. Within-group BMI variation was greater than across-group variation, and white within-group variation associated with socioeconomic status was greater than African-Americans.
身体质量指数(BMI)反映了经济发展过程中当前的净营养和健康状况。这项研究引入了一种分解差异的方法,表明尽管19世纪非洲裔美国人目前的净营养与工人阶级的白人相当,但随着向自由劳动的过渡,情况变得更糟了。身体质量指数反映了整个生命过程中的净营养状况,就像身高一样,奴隶儿童的身体质量指数在接近成年奴隶劳动力时比白人增加得更多。农业工人的净营养状况好于其他职业的工人,但在自由劳动和工业化条件下较差。组内BMI变异大于组间变异,白人与社会经济地位相关的组内变异大于非裔美国人。
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引用次数: 0
Medical Malpractice: How Legal Liability Affects Medical Decisions 医疗事故:法律责任如何影响医疗决策
Pub Date : 2017-08-01 DOI: 10.2139/ssrn.3014555
P. Bertoli, V. Grembi
In health care, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouses concerns about possible implications for patients' health, and for the healthcare system in terms of both costs and access to medical care. Medical liability plays a dominant role among the elements that can affect these deviations. Therefore, a remarkable economic literature studies how medical decisions are influenced by different levels of liability. In particular, identifying the relation between liability and treatments selection, as well as disentangling the effect of liability from other incentives that might be in place, is a task for sound empirical research. Several studies have already tried to tackle this issue, but much more needs to be done. In the present chapter, we offer an overview of the state of the art in the study of the relation between liability and treatments selection. First, we reason on the theoretical mechanisms underpinning the relationship under investigation by presenting the main empirical predictions of the related literature. Second, we provide a comprehensive summary of the existing empirical evidence and its main weaknesses. Finally, we conclude by offering guidelines for further research.
在卫生保健方面,药物治疗的过度使用和使用不足同样危险地偏离了最佳使用平衡,并引起人们对患者健康和卫生保健系统在费用和获得医疗保健方面可能产生的影响的关注。在影响这些偏差的因素中,医疗责任起着主导作用。因此,一篇杰出的经济学文献研究了医疗决策如何受到不同责任水平的影响。特别是,确定责任与治疗选择之间的关系,以及将责任的影响与可能存在的其他激励因素分开,是一项可靠的实证研究任务。一些研究已经试图解决这个问题,但需要做的还有很多。在本章中,我们概述了责任与处理选择之间关系的研究现状。首先,我们通过提出相关文献的主要实证预测来论证支撑所调查关系的理论机制。其次,我们对现有的经验证据及其主要不足进行了全面的总结。最后,为进一步的研究提供了指导。
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引用次数: 9
A Study on Growth and Development of Health Insurance in India in the Post Privatization Era 后私有化时代印度医疗保险的成长与发展研究
Pub Date : 2017-03-05 DOI: 10.29121/granthaalayah.v5.i3.2017.1783
J. Rath
Health Insurance in India emerges in the year 1999 with the introduction of IRDA bill in the floor of Parliament. In the post-privatization era, health insurance segment developed slowly and steadily. The penetration of insurance sector in Non-Life insurance is kept on increasing since 2001. In order to portray the journey of health insurance sector in India, it is required to show the growth and development of this sector in the country. The present study is intended to evaluate the growth and development of the health insurance sector in India in the post-privatization era. Data are collected mainly from secondary sources. Such data are analyzed and represented suitable through the help of tables, diagrams and charts. From the study, it is concluded that there is a significant upward trend in the growth of health insurance industry in India both at public and private sector after privatization. If this trend continues by keeping other factors constant, then the health insurance business would touch to Rs 20000 crores in the financial year 2016-17 contributed at least 60% by public sector and rest 40% by both private insurers and standalone health insurers.
印度的健康保险于1999年出现,并在议会提出了《印度健康保险法案》。后私有化时代,医疗保险行业发展缓慢而稳定。自2001年以来,保险业在非寿险的渗透率持续上升。为了描绘印度健康保险部门的历程,需要展示该国该部门的增长和发展。本研究旨在评价私有化后印度医疗保险部门的增长和发展。数据主要是从二手来源收集的。通过表格、图表和图表对这些数据进行适当的分析和表示。从研究中得出的结论是,私有化后,印度公共和私营部门的健康保险行业的增长都有显著的上升趋势。如果保持其他因素不变,这一趋势继续下去,那么医疗保险业务将在2016-17财政年度达到200亿卢比,其中至少60%由公共部门贡献,其余40%由私营保险公司和独立医疗保险公司贡献。
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引用次数: 2
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