Variance estimation for a low-income proportion

Proportions below a given fraction of a quantile of an income distribution are often estimated from survey data in poverty comparisons. We consider the estimation of the variance of such a proportion, estimated from Family Expenditure Survey data. We show how a linearization method of variance estimation may be applied to this proportion, allowing for the effects of both a complex sampling design and weighting by a raking method to population controls. We show that, for 1998-99 data, the estimated variances are always increased when allowance is made for the design and raking weights, the principal effect arising from the design. We also study the properties of a simplified variance estimator and discuss extensions to a wider class of poverty measures

Wayfinding for cycle highways: Assessing e-bike users’ experiences with wayfinding along a cycle highway in the Netherlands.

In many regions, governments are motivating increased bicycle ridership by designing new and improving existing bicycle infrastructure. Cycle highways are an effective and cost-efficient type of bicycle-specific infrastructure that are designed to provide a functional connection between places where people work, go to school and live. One important element of developing high quality cycle highways is the development of an effective wayfinding system which allows current, potential, and new users to clearly identify and navigate a bicycle network. The wayfinding design standards used for conventional bicycle infrastructure may not be compatible for cycle highways, which encourage cyclists to travel at relatively higher speeds. This may warrant introducing specific wayfinding signage compatible for this new type of bicycle infrastructure. This study uses qualitative analysis including field observations, ride-along videos, and semi-structured interviews, to assess electrically assisted pedal bicycle (e-bike) users' opinions and experiences with wayfinding signage along a pilot cycle highway route located between Tilburg and Waalwijk in the Netherlands. In the summer of 2018, base-line observations and interviews were administered with twelve e-bike users who were unfamiliar with the route to assess their experiences with conventional signage for cyclists before changes were made to the wayfinding system. Follow-up observations were held in the fall, after the installation of two new pilot wayfinding systems that were specifically designed to accommodate cycle highway users. Initial findings suggest that the changes made to the location, size and clarity of the signage improve cyclists' overall experiences, and that cyclists' perceptions of the built environment are important. Specifically, it became easier for users to navigate the route, their overall travel related stress decreased, and several participants perceived shorter travel times. Policy makers and transportation planners are likely to be interested in the results of this study as they reveal how specific improvements to wayfinding along cycle highways not only help improve navigation, but also positively influence cyclists' overall comfort and stress

The health benefits of a targeted cash transfer: The UK Winter Fuel Payment.

Each year, the UK records 25,000 or more excess winter deaths, primarily among the elderly. A key policy response is the "Winter Fuel Payment" (WFP), a labelled but unconditional cash transfer to households with a member above the female state pension age. The WFP has been shown to raise fuel spending among eligible households. We examine the causal effect of the WFP on health outcomes, including self-reports of chest infection, measured hypertension, and biomarkers of infection and inflammation. We find a robust, 6 percentage point reduction in the incidence of high levels of serum fibrinogen. Reductions in other disease markers point to health benefits, but the estimated effects are less robust

Urban and river flooding: Comparison of flood risk management approaches in the UK and China and an assessment of future knowledge needs

Increased urbanisation, economic growth, and long-term climate variability have made both the UK and China more susceptible to urban and river flooding, putting people and property at increased risk. This paper presents a review of the current flooding challenges that are affecting the UK and China and the actions that each country is undertaking to tackle these problems. Particular emphases in this paper are laid on (1) learning from previous flooding events in the UK and China, and (2) which management methodologies are commonly used to reduce flood risk. The paper concludes with a strategic research plan suggested by the authors, together with proposed ways to overcome identified knowledge gaps in flood management. Recommendations briefly comprise the engagement of all stakeholders to ensure a proactive approach to land use planning, early warning systems, and water-sensitive urban design or redesign through more effective policy, multi-level flood models, and data driven models of water quantity and quality

Trends in Functional and Activity Limitations among Chinese Oldest‐Old, 1998 to 2008

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108586/1/padr694.pd

A systematic review of the effectiveness and cost-effectiveness of peer education and peer support in prisons.

BACKGROUND: Prisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings. METHODS: A mixed methods systematic review of effectiveness and cost-effectiveness studies, including qualitative and quantitative synthesis was conducted. In addition to grey literature identified and searches of websites, nineteen electronic databases were searched from 1985 to 2012. Study selection criteria were: Population: Prisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs). INTERVENTION: Peer-based interventions Comparators: Review questions 3 and 4 compared peer and professionally led approaches. OUTCOMES: Prisoner health or determinants of health; organisational/ process outcomes; views of prison populations. STUDY DESIGNS: Quantitative, qualitative and mixed method evaluations. RESULTS: Fifty-seven studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients, practically or emotionally. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. CONCLUSIONS: There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ref: CRD42012002349

The equalisation hypothesis and changes in geographical inequalities of age based mortality in England, 2002-2004 to 2008-2010

The equalisation hypothesis argues that during adolescence and early adulthood, inequality in mortality declines and begins to even out. However the evidence for this phenomenon is contested and mainly based on old data. This study proposes to examine how age-specific inequalities in mortality rates have changed over the past decade, during a time of widening health inequalities. To test this, mortality rates were calculated for deprivation quintiles in England, split by individual ages and sex for three time periods (2002–2004, 2005–2007 and 2008–2010). The results showed evidence for equalisation, with a clear decline in the ratio of mortality rates during late adolescence. However this decline was not accounted for by traditional explanations of the hypothesis. Overall, geographical inequalities were shown to be widening for the majority of ages, although there was some narrowing of patterns observed

Home healthcare services in Taiwan: a nationwide study among the older population

<p>Abstract</p> <p>Background</p> <p>Home healthcare services are important in aging societies worldwide. The present nationwide study of health insurance data examined the utilization and delivery patterns, including diagnostic indications, for home healthcare services used by seniors in Taiwan.</p> <p>Methods</p> <p>Patients ≥65 years of age who received home healthcare services during 2004 under the Taiwanese National Health Insurance Program were identified and reimbursement claims were analyzed. Age, gender, disease diagnoses, distribution of facilities providing home healthcare services, and patterns of professional visits, including physician and skilled nursing visits, were also explored.</p> <p>Results</p> <p>Among 2,104,978 beneficiaries ≥65 years of age, 19,483 (0.9%) patients received 127,753 home healthcare visits during 2004 with a mean number of 6.0 ± 4.8 visits per person. The highest prevalence of home healthcare services was in the 75-84 year age group in both sexes. Females received more home healthcare services than males in all age groups. Cerebrovascular disease was the most frequent diagnosis in these patients (50.7%). More than half of home healthcare visits and around half of the professional home visits were provided by community home nursing care institutions. The majority of the home skilled nursing services were tube replacements, including nasogastric tubes, Foley catheter, tracheostomy, nephrostomy or cystostomy tubes (95%).</p> <p>Conclusions</p> <p>Nine out of 1,000 older patients in Taiwan received home healthcare services during 2004, which was much lower than the rate of disabled older people in Taiwan. Females used home healthcare services more frequently than males and the majority of skilled nursing services were tube replacements. The rate of tube replacement of home healthcare patients in Taiwan deserves to be paid more attention.</p

Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

Background An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care