What explains the quality and price of GP services? An investigation using linked survey and administrative data

We examine patient socioeconomic status, the strength of the patient-doctor relationship and local area competition as determinants of the quality and price of GP services. We exploit a large-sample patient data set in Australia and its linkage to administrative databases. The sample contains over 260 000 patients and over 12 600 GPs, observed between 2005 and 2010. Controlling for GP fixed effects and patient health, we find no strong evidence that quality differs by patient age, gender, country of origin, health concession card status and income, but quality is increased by stronger patient-doctor relationship. Using a competition measure that is defined at the individual GP level and not restricted to a local market, we find that competition lowers quality. Price is increasing in patient income, whereas competition has a small impact on price. Copyright © 2014 John Wiley & Sons, Ltd

Does self-assessed health measure health?

Despite concerns about reporting biases and interpretation, self-assessed health (SAH) remains the measure of health most used by researchers, in part reflecting its ease of collection and in part the observed correlation between SAH and objective measures of health. Using a unique Australian data set, which consists of survey data linked to administrative individual medical records, we present empirical evidence demonstrating that SAH indeed predicts future health, as measured by hospitalizations, out-of-hospital medical services and prescription drugs. Our large sample size allows very disaggregate analysis and we find that SAH predicts more serious, chronic illnesses better than less serious illnesses. Finally, we compare the predictive power of SAH relative to administrative data and an extensive set of self-reported health measures; SAH does not add to the predictive power of future utilization when the administrative data is included and improves prediction only marginally when the extensive survey-based health measures are included. Clearly there is value in the more extensive survey and administrative health data as well as greater cost of collection

Geographic Differences in Hospital Waiting Times

Access to elective surgery in Australian public hospitals is rationed using waiting lists. In this article, we undertake a DiNardo-Fortin-Lemieux reweighting approach to attribute variation in waiting time to clinical need or to discrimination. Using data from NSW public patients in 2004-2005, we find the discrimination effect dominates clinical need especially in the upper tail of the waiting time distribution. We find evidence of favourable treatment of patients who reside in remote areas and discrimination in favour of patients residing in particular Area Health Services. These findings have policy implications for the design of equitable quality targets for public hospitals. © 2012 The Economic Society of Australia

Whole exome sequencing of extreme morbid obesity patients: translational implications for obesity and related disorders

Whole-exome sequencing (WES) is a new tool that allows the rapid, inexpensive and accurate exploration of Mendelian and complex diseases, such as obesity. To identify sequence variants associated with obesity, we performed WES of family trios of one male teenager and one female child with severe early-onset obesity. Additionally, the teenager patient had hypopituitarism and hyperprolactinaemia. A comprehensive bioinformatics analysis found de novo and compound heterozygote sequence variants with a damaging effect on genes previously associated with obesity in mice (LRP2) and humans (UCP2), among other intriguing mutations affecting ciliary function (DNAAF1). A gene ontology and pathway analysis of genes harbouring mutations resulted in the significant identification of overrepresented pathways related to ATP/ITP (adenosine/inosine triphosphate) metabolism and, in general, to the regulation of lipid metabolism. We discuss the clinical and physiological consequences of these mutations and the importance of these findings for either the clinical assessment or eventual treatment of morbid obesity.Gilberto Paz-Filho, Margaret C.S. Boguszewski, Claudio A. Mastronardi, Hardip R. Patel, Angad S. Johar, Aaron Chuah, Gavin A. Huttley, Cesar L. Boguszewski, Ma-Li Wong, Mauricio Arcos-Burgos and Julio Licini

Antimicrobial Effect of Mouthwashes in Patients Undergoing Orthodontic Treatment

Objective: The purpose of the study was to determine the efficacy of three different mouthwashes in patients undergoing fixed orthodontic treatment for prevention of white spot lesions Methods: The study was conducted on 30 patients undergoing fixed orthodontic treatment between the ages of 15-25years. Patients were divided into 3groups - Group 1 control group, Group 2 using freshclor for 30 sec twice daily and group 3 using HiOra mouth wash for 30sec twice daily. Samples from tooth surfaces were collected at 1st day, 30th day and 90th day interval and were incubated for 48 hours. Colonies were counted using digital colony counter. Results: Freshclor and HiOra mouthwashes showed the maximum potential for the control of pathogenic organisms, and prevention of gingivitis and bacterial plaque inhibition than patients those were not using mouthwash

Admixture has obscured signals of historical hard sweeps in humans (advance online)

The role of natural selection in shaping biological diversity is an area of intense interest in modern biology. To date, studies of positive selection have primarily relied on genomic datasets from contemporary populations, which are susceptible to confounding factors associated with complex and often unknown aspects of population history. In particular, admixture between diverged populations can distort or hide prior selection events in modern genomes, though this process is not explicitly accounted for in most selection studies despite its apparent ubiquity in humans and other species. Through analyses of ancient and modern human genomes, we show that previously reported Holocene-era admixture has masked more than 50 historic hard sweeps in modern European genomes. Our results imply that this canonical mode of selection has probably b een underappreciated in the evolutionary history of humans and suggest that our current understanding of the tempo and mode of selection in natural populations may be inaccurat

Sex-related differences in oncologic outcomes, operative complications and health-related quality of life after curative-intent oesophageal cancer treatment: multicentre retrospective analysis.

Oesophageal cancer, in particular adenocarcinoma, has a strong male predominance. However, the impact of patient sex on operative and oncologic outcomes and recovery of health-related quality of life is poorly documented, and was the focus of this large multicentre cohort study. All consecutive patients who underwent oncological oesophagectomy from 2009 to 2015 in the 20 European iNvestigation of SUrveillance after Resection for Esophageal cancer study group centres were assessed. Clinicopathologic variables, therapeutic approach, postoperative complications, survival and health-related quality of life data were compared between male and female patients. Multivariable analyses adjusted for age, sex, tumour histology, treatment protocol and major complications. Specific subgroup analyses comparing adenocarcinoma versus squamous cell cancer for all key outcomes were performed. Overall, 3974 patients were analysed, 3083 (77.6%) male and 891 (22.4%) female; adenocarcinoma was predominant in both groups, while squamous cell cancer was observed more commonly in female patients (39.8% versus 15.1%, P < 0.001). Multivariable analysis demonstrated improved outcomes in female patients for overall survival (HRmales 1.24, 95% c.i. 1.07 to 1.44) and disease-free survival (HRmales 1.22, 95% c.i. 1.05 to 1.43), which was caused by the adenocarcinoma subgroup, whereas this difference was not confirmed in squamous cell cancer. Male patients presented higher health-related quality of life functional scores but also a higher risk of financial problems, while female patients had lower overall summary scores and more persistent gastrointestinal symptoms. This study reveals uniquely that female sex is associated with more favourable long-term survival after curative treatment for oesophageal cancer, especially adenocarcinoma, although long-term overall and gastrointestinal health-related quality of life are poorer in women

College students perception on physical education classes during their high school days

This purpose of this study is to identify and investigate whether there are similarities or differences between genders regarding the perceptions on physical activities of college university students in one of the largest University in Kuala Lumpur, Malaysia. The focus was on three main categories, namely general knowledge, physical education and scientific basis of physical activities. Each category contained questions which serve to evaluate their perceptions about physical activities. The questionnaire was adapted from a journal article on a study done by Mowatt, DePauw and Hulac (1988). This study investigates the perceptions of 113 students (55 males; 65 females) aged between 19 and 25 about physical activities, using the above-mentioned categories. Results of the t-test showed significant differences for general knowledge, t(23) = 3.9, p0.05 no significant differences in means were found between the male and female students