A Fuzzy Approach to the Measurement of Leakages for North American Health Systems

This paper uses a fuzzy-fuzzy stochastic dominance approach to compare patients’ leakages in the Canadian and the U.S. health care systems. Leakages are defined in terms of individuals who are in bad health and could not have access to health care when needed. To carry his comparison we rely on the assumption that Canada is a strong counterfactual for the U.S. We first develop a class of fuzzy leakages indices and incorporate them in a stochastic dominance framework to derive the dominance criterion. We then use the derived criterion to perform inter-country comparisons on the global level. To provide more insight, we decompose the analysis with respect to gender, ethnicity, income and education. Intra-country comparisons reveal the presence of income based leakage inequalities in both countries yet, gender, ethnic and education based disparities appear to be present in the U.S. only. As for inter-country comparisons, results are in general consistent with the hypothesis that leakages are less important under the Canadian health care system.Health care resources, Fuzzy sets, Leakage

Equivalence Scales and Housing Deprivation Orderings: An Example Using Lebanese Data

Housing deprivation orderings raise challenges as far as measurement is concerned. The first challengeresides in the identification of an adequate variable that characterizes housing services consumed byhouseholds. Another challenge may arise in the comparisons of housing services consumption betweenhouseholds of different sizes and composition. The last challenge may arise in the choice of a deprivationline and of a deprivation index. In this paper we address theoretically those challenges. An empirical illustration is offered using Lebanese data.Housing, Deprivation, Stochastic dominance, Equivalence scales, Lebanon

Equivalence Scales and Housing Deprivation Orderings: an Example Using Lebanese Data

Housing deprivation orderings raise challenges as far as measurement is concerned. The first challenge resides in the identification of an adequate variable that characterizes housing services consumed by households. Another challenge may arise in the comparisons of housing services consumption between households of different sizes and composition. The last challenge may arise in the choice of a deprivation threshold and of a deprivation index. In this paper we address theoretically those challenges. An empirical illustration is offered using Lebanese data.Housing, Deprivation, Stochastic dominance, Equivalence scales, Lebanon

A Fuzzy Approach to the Measurement of Leakages for North American Health Systems

This paper uses a fuzzy-fuzzy stochastic dominance approach to compare patients' leakages in the Canadian and the U.S health care systems. Leakages are defined in terms of individuals who are in bad health and could not have access to health care when needed. To carry this comparison we rely on the assumption that Canada is a strong counterfactual for the U.S. We first develop a class of fuzzy leakages indices and incorporate them in a stochastic dominance framework to derive the dominance criterion. We then use the derived criterion to perform inter-country comparisons on the global level. To provide more insight, we decompose the analysis with respect to gender, ethnicity, income and education. Intra-country comparisons reveal the presence of income based leakage inequalities in both countries yet, gender, ethnic and education based disparities appear to be present in the U.S only. As for inter-country comparison, results are in general consistent with the hypothesis that leakages are less important under the Canadian health care system.Health care resources, Fuzzy sets, Leakage

What do health professionals think about patient safety?

Artikkel som besrkiver en studie hvor hensikten var å undersøke helsepersonell sitt syn på pasientsikkerhet i sykehus i Romania, og sammenligne funnene med resultater fra Norge, Sverige, Singapor og Australia.Patient safety is a main determinant of the quality of healthcare services. The literature shows that the occurrence of medical errors is quite important in countries where it has been measured. Various actions like legislative measures, financial, or educational measures may help, but they are not always effective in controlling the level of avoidable errors. That happens because patient safety is strongly related to the culture specific to healthcare organizations. This study is aimed at getting some perspective on the organizational culture in Romanian hospitals in regard to patient safety. Objectives: the main objectives are (1) to identify the views of healthcare professionals about patient safety in Romanian hospitals and compare them with other countries, (2) to identify to which extent the views about patient safety relate to the specific organizational culture in healthcare, and (3) find out if there are differences in perceptions of professional categories about their own work and that of the clinical team. Method: a survey was conducted, based on a questionnaire. The questionnaire was aimed at realizing a screening of the problem, to get some specific views of respondents from their work experience, and eventually to get suggestions on how to improve patient safety. The same questionnaire has been previously applied in four other countries: Australia, Singapore, Sweden and Norway. Overall views of hospital professionals from Romania were compared to those from the other countries. Also, views per professional categories —clinical vs. non-clinical staff, doctors vs. nurses, and senior vs. junior staff—were compared. Results: answers from 100 respondents from Romania indicate that patient safety is a major concern of hospital professionals, and it should be improved. Basically, they show as much interest and willingness to improve as observed in the other countries. This indicates that no major differences in the organizational culture exist in regard to patient safety. However, differences among professional categories have been noticed; for example, nurses are more aware than doctors on the need to take action for improving patient safety. Conclusions: patient safety is a major concern of health policy in many countries. In Romania, this study shows concern of professionals about patient safety, although they are facing many barriers such as inadequate leadership, lack of communication between professional categories, between senior and junior staff, and most of all with the patients. This is a problem of organizational culture, which requires complex, multi-level strategies, targeting a longterm change. Results of this initial study should be viewed as a baseline for a larger study

Income-related health transfers principles and orderings of joint distributions of income and health

The objective of this article is to provide the analyst with the necessary tools that allow for a robust ordering of joint distributions of health and income. We contribute to the literature on the measurement and inference of socioeconomic health inequality in three distinct but complementary ways. First, we provide a formalization of the socioeconomic health inequality-specific ethical principle introduced by Erreygers et al. (2012). Second, we propose new graphical tools and dominance tests for the identification of robust orderings of joint distributions of income and health associated with this new ethical principle. Finally, based on both pro-poor and pro-extreme ranks ethical principles we address a very important aspect of dominance literature: the inference. To illustrate the empirical relevance of the proposed approach, we compare joint distributions of income and a health-related behavior in the United States in 1997 and 2014

Kinematic Evaluation of 4 Pediatric Collars and Distribution of Cervical Movement Between Primary and Coupled Angles

Background: Primary and coupled angle restrictions, when neck collars are used, have been investigated mainly in adults and not yet in children. Purpose: To evaluate the efficiency of 4 pediatric collars in reducing cervical range of motion (ROM) in primary and coupled planes. Methods: Thirty asymptomatic children (16 boys and 14 girls) aged 6 to 12 years participated in the study. A motion analysis system was used to evaluate the ROM of the cervical spine during flexion/extension, left and right lateral bending, and left and right axial rotation. Primary and coupled ROM were evaluated in unbraced and braced conditions. Four cervical collars were tested: Philadelphia, Miami Jr, Necloc, and the conventional Hard Collar. Thirteen subjects were tested 2 times to evaluate the repeatability of the parameters. The ROM in each plane was normalized to the sum of the ROM in the 3 planes, for each movement, to estimate the percentage of the movement in each plane (normalized ROM), in braced and unbraced conditions. The analysis of variance and post hoc Benferroni tests were applied on raw and normalized ROM. Results: ROM collected in collars showed a significant difference compared with the unbraced condition. ROM obtained in Necloc and Miami Jr showed a significant difference compared with Philadelphia and conventional Hard Collar. The primary plane is activated at 80% during flexion-extension and left-right axial rotation; however, 55% of the total movement was completed in the frontal plane during left-right lateral bending in unbraced condition. Statistical differences in the normalized ROM were found between the braced and unbraced conditions and among collars. Conclusions: Necloc and Miami Jr presented the highest limitation of movement in the primary and secondary planes. The distribution strategy of a movement, between primary and coupled angles, is different between the braced and unbraced conditions

Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK

Background Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting.Methods 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey.Results 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD.Conclusion We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting