90 research outputs found
Why choice of metric matters in public health analyses: a case study of the attribution of credit for the decline in coronary heart disease mortality in the US and other populations.
No full textBACKGROUND: Reasons for the widespread declines in coronary heart disease (CHD) mortality in high income countries are controversial. Here we explore how the type of metric chosen for the analyses of these declines affects the answer obtained.
METHODS: The analyses we reviewed were performed using IMPACT, a large Excel based model of the determinants of temporal change in mortality from CHD. Assessments of the decline in CHD mortality in the USA between 1980 and 2000 served as the central case study.
RESULTS: Analyses based in the metric of number of deaths prevented attributed about half the decline to treatments (including preventive medications) and half to favourable shifts in risk factors. However, when mortality change was expressed in the metric of life-years-gained, the share attributed to risk factor change rose to 65%. This happened because risk factor changes were modelled as slowing disease progression, such that the hypothetical deaths averted resulted in longer average remaining lifetimes gained than the deaths averted by better treatments. This result was robust to a range of plausible assumptions on the relative effect sizes of changes in treatments and risk factors.
CONCLUSIONS: Time-based metrics (such as life years) are generally preferable because they direct attention to the changes in the natural history of disease that are produced by changes in key health determinants. The life-years attached to each death averted will also weight deaths in a way that better reflects social preferences
Why my disease is important: metrics of disease occurrence used in the introductory sections of papers in three leading medical journals in 1993 and 2003
No full textBACKGROUND: We assessed the metrics used in claims about disease importance made in the introductory sections of scientific papers published in 1993 and 2003. We were interested in the choice of metric in circumstances where establishing the relative social importance of a disease was, presumptively, a primary objective. METHODS: This study consisted of a textual examination of the introductory statements from papers retrieved from MEDLINE. Papers were published in the New England Journal of Medicine, The Lancet, and the Journal of the American Medical Association during the first halves of 1993 and 2003, and were selected on the basis of keywords found in a pilot study to be associated with claims about disease importance. RESULTS: We found 143 papers in 1993 and 264 papers in 2003 included claims about disease importance in their introductory sections, and characteristics of these claims were abstracted. Of the quotes identified in the papers and articles examined, most used counts, prevalence, or incidence measurements. Some also used risk estimates and economic quantities to convey the importance of the disease. There was no change in the types of metrics used between 1993 and 2003. Very few articles, even in 2003, used metrics that weighted disease onsets by the expected consequent loss of healthy time -- such as years of life lost, quality-adjusted life years, and/or disability-adjusted life years. CONCLUSIONS: Claims about the relative importance of diseases continued to be overwhelmingly expressed in terms of counts (of deaths and disease onsets) and comparisons of counts, rates, and risks. Where the aim is to convey the burden that a given disease imposes on a society, "event-based" metrics might be less fit for the purpose than "time-based" metrics. More attention is needed to how the choice of metric should relate to the purpose at hand
Policy analysis of water management for the Netherlands. Vol XIX: Models for salt intrusion in the Rhine Delta
No full textSalt intrusion into the Rotterdamsche Waterweg plays a major role in the water management of the Netherlands. The objective of the modeling described in this volume is to estimate the salt concentration caused by salt intrusion from the sea of water at various points. Chapter 2 gives an overview of the modeling. The sources of the data used are reviewed in Chap. 3. Chapters 4 and 5 describe the development of the Rotterdam Salt Wedge Model and the Gouda Inlet Salinity Model, respectively. The Rotterdam Salt Wedge Model's applicability to PAWN is demonstrated in Chap. 6. Chapter 7 discusses both models' limitations and sensitivity. Two supporting appendixes present listings of computer programs.PAW
The science of epidemiology and the methods needed for public health assessments: a review of epidemiology textbooks
No full textObjectives. Epidemiology is often described as 'the science of public health'. Here we aim to assess the extent that epidemiological methods, as covered in contemporary standard textbooks, provide tools that can assess the relative magnitude of public health problems and can be used to help rank and assess public health priorities. Study Design. Narrative literature review. Methods. Thirty textbooks were grouped into three categories; pure, extended or applied epidemiology, were reviewed with attention to the ways the discipline is characterised and the nature of the analytical methods described. Results: Pure texts tend to present a strict hierarchy of methods with those metrics deemed to best serve aetiological inquiry at the top. Extended and applied texts employ broader definitions of epidemiology but in most cases, the metrics described are also those used in aetiological inquiry and may not be optimal for capturing the consequences and social importance of injuries and disease onsets. Conclusions: The primary scientific purpose of epidemiology, even amongst 'applied' textbooks, is aetiological inquiry. Authors do not readily extend to methods suitable for assessing public health problems and priorities
Measuring quality of maternal and newborn care in developing countries using demographic and health surveys
No full textBackground One of the greatest obstacles facing efforts to address quality of care in low and middle income countries is the absence of relevant and reliable data. This article proposes a methodology for creating a single "Quality Index" (QI) representing quality of maternal and neonatal health care based upon data collected as part of the Demographic and Health Survey (DHS) program. Methods Using the 2012 Indonesian Demographic and Health Survey dataset, indicators of quality of care were identified based on the recommended guidelines outlined in the WHO Integrated Management of Pregnancy and Childbirth. Two sets of indicators were created; one set only including indicators available in the standard DHS questionnaire and the other including all indicators identified in the Indonesian dataset. For each indicator set composite indices were created using Principal Components Analysis and a modified form of Equal Weighting. These indices were tested for internal coherence and robustness, as well as their comparability with each other. Finally a single QI was chosen to explore the variation in index scores across a number of known equity markers in Indonesia including wealth, urban rural status and geographical region. Results The process of creating quality indexes from standard DHS data was proven to be feasible, and initial results from Indonesia indicate particular disparities in the quality of care received by the poor as well as those living in outlying regions. Conclusions The QI represents an important step forward in efforts to understand, measure and improve quality of MNCH care in developing countries
Health information systems and disability in the Lao PDR: a qualitative study
No full textThe Convention on the Rights of Persons with Disabilities provides an opportunity to strengthen disability-related health information. This study analysed the health information system in Lao PDR and sought evidence of interventions to improve disability-related health information. The study was based on a literature review and key informant interviews (N = 17) informed by the Health Metrics Network's Framework and Standards and the Performance of Routine Information System Management framework. The Lao health information system is in an embryonic stage with health data often incomplete, inaccurate and poorly used. Indicators related to disability or functioning are not included, and capacity to diagnose the health condition of disability is limited. No studies of health information interventions were found. As a State Party to the CRPD, the Lao PDR has a legal obligation to collect health-related information on people with disabilities. Given the nascent stage of development of the health information system in the Lao PDR and diagnostic capacity, indicators related to basic functioning and access to services should be integrated into household level surveys. As the health information system further develops, small, incremental changes in the type of disability information and rehabilitation and the way it is collected can be implemented
Quality Index score by Wealth Quintile (National).
No full textQuality Index score by Wealth Quintile (National).</p
Correlation between quintiles using different Quality Indexes.
No full textCorrelation between quintiles using different Quality Indexes.</p
Ethical and social issues affecting the implementation of verbal autopsy interviews in Papua New Guinea
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