The aim of this study was to describe changes in demand and utilization of dental services according to family income among adults in Norway from 1983 to 1987. The analysis was performed on two sets of national data, which were representative of the Norwegian population aged 20 years and above. The sample size was 1,289 individuals in 1983 and 1,166 individuals in 1987. The data were analyzed according to a two-part model. The first part determined the probability of whether the consumer had demanded the services or not during the last year. The second part estimated how expenditure depended on income, given some expenditure. Family size, number of teeth present, age, gender and education were entered into the analysis as control variables. For edentulous people, and people with few remaining teeth, there were marked differences in demand and utilization of dental services according to family income both in 1983 and in 1987. During this period, there has been an increase in demand, while utilization has stayed constant. In the population as a whole, the turnover of dental services has increased by the equivalent of 80 "dentists' years work" from 1983 to 1987 due to the increase in demand.
IMPACT is an epidemiological model that has been used to estimate how increased treatment uptakes affect mortality and related outcomes. The model calculations require the use of case fatality rate estimates under no treatment. Due to the lack of data, rates where treatment is partially present are often used instead, introducing bias. A method that does not rely on no-treatment case fatality rate estimates is needed.
Potential Impact Fraction (PIF) measures the proportional reduction in the disease or mortality risk, when the distribution of a risk factor changes. Here, we first describe a probabilistic framework for interpreting quantities used in the IMPACT model, and then we show how this is connected with PIF, facilitating its use for the estimation of the relative reduction of mortality caused by treatment uptake increase. We compare the proposed and standard methods to estimate the reduction of cardiovascular disease deaths in Ontario, if utilization of coronary heart disease interventions was increased to the level of 90%.
Using the proposed method, we estimated that increasing treatment to benchmark levels uptake results in a reduction of 22.5% in cardiovascular mortality. The standard method gives a reduction of 20.8%.
Here we present an alternative method for the estimation of the effect of treatment uptake change on mortality. Our example suggests that the bias associated with the standard method may be substantial. This approach offers a useful tool for epidemiological and health care research and policy.
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We examine the effect of copayment on the utilization of the GP service in Norway. We use a regression discontinuity design to study two key aspects of the policy. First, we examine the overall effect of copayments on total utilization of the GP service. Second, we look at how this effect varies across different patient groups according to medical necessity. Data consists of 5,5 million GP visits for youths aged 10-20 over the 6 year period 2009-2014. We find that the introduction of a co-payment leads to an overall reduction of GP visits of 10-15%. The effect is heterogeneous across patient groups. Patients with an acute condition exhibit low price sensitivity. Patients with general complaints and symptoms, chronic diseases and psychological diseases all react strongly to the copayment. The two latter groups capture patients with conditions that typically warrant medical attention. This paper thus suggests that the current flat fee copayment policy is inefficient at targeting unnecessary use of the GP service at the cost of patients with real medical concerns.
The prevalence of functional constipation is highly variable among epidemiological surveys and may relate to the definitions applied. We estimated the population prevalence of self-reported, Rome I-defined, and Rome II-defined constipation in Canada and determined the variables that best predicted health care seeking.
A research firm was employed to conduct a random digit dial national survey, inviting household members at least 18 yr of age to participate in a study assessing personal health issues. The sample was stratified to ensure that each region of Canada was represented. Data collection involved three stages: 1) recruitment of participants by phone, 2) mailing of the questionnaire, and 3) data retrieval through a follow-up phone call. The Rome II questionnaire was used to derive the prevalence of functional constipation using both Rome I and Rome II criteria.
Of the 1149 participants, 27.2% self-reported constipation within the past 3 months, and 16.7% and 14.9% had functional constipation according to Rome I and II, criteria, respectively. For all three definitions, the rate for women was close to twice that for men. Approximately 34% of those with self-reported constipation had visited a physician for it, versus 26.3% of Rome II subjects. In a regression model, subjects self-reporting in the past 3 months were more likely to have seen a doctor for their constipation (odds ratio 2.47, p
The rare cases of tetanus that have occurred in Canada were in adults whose vaccination was not up-to-date. The objective of this study was to estimate the vaccine coverage in Canadian adults.
1,002 individuals 18 years of age and older selected by random digit dialing were interviewed by telephone in February 2002. Information was collected about their vaccination status, the circumstances of their vaccination, and their opinion about the duration of the protection of the tetanus vaccine and the recommended interval between booster doses.
The participation rate was 38%. Overall, 54% of participants reported having received one dose of tetanus vaccine during the last 10 years: 58% for men and 51% for women. The vaccine coverage was lower in adults > or =60 years of age than in those under 60 (38% vs. 59%). Most doses (57%) were administered as part of treatment for a wound. 30% of participants thought they were protected for life by their childhood immunization against tetanus, whereas 52% knew they had to receive a booster dose each 6-10 years.
Vaccine coverage against tetanus is insufficient in adults, especially those > or =60 years of age. As most doses are administered as part of wound treatment, it is not likely that this situation will improve without developing specific interventions.
To estimate the association between past medical contacts and the risk of vehicle collision in a population of older drivers from the province of Quebec, Canada.
111 699 older drivers involved in at least one vehicle collision between January 1988 and December 2000.
For each driver, the risk of having a vehicle collision while exposed and not exposed to a medical contact was compared. Separate conditional logistic regression analyses were conducted for all drivers and in four diagnostic-specific subgroups.
The study found a weak but statistically significant increased risk of all collisions being associated with a medical contact within 1 month before the collision, for all drivers (OR=1.10, 95% CI 1.08 to 1.11) and for drivers with diabetes (OR=1.07, 95% CI 1.03 to 1.11).
Older drivers who have a collision are more likely to have been in contact with a physician shortly before the collision. These findings suggest that there might be an opportunity to detect medical conditions that put older drivers at higher risk of collision; however, further research is needed to assess the potential effectiveness and practical modalities of screening.