Coding in Stroke and Other Cerebrovascular Diseases

Accurate coding is critical for clinical practice and research. Ongoing changes to diagnostic and billing codes require the clinician to stay abreast of coding updates. Payment for health care services, data sets for health services research, and reporting for medical quality improvement all require accurate administrative coding. This article provides an overview of coding principles for patients with strokes and other cerebrovascular diseases and includes an illustrative case as a review of coding principles in a patient with acute stroke.

WHO essential medicines policies and use in developing and transitional countries: an analysis of reported policy implementation and medicines use surveys

BACKGROUND

Suboptimal medicine use is a global public health problem. For 35 years the World Health Organization (WHO) has promoted essential medicines policies to improve quality use of medicines (QUM), but evidence of their effectiveness is lacking, and uptake by countries remains low. Our objective was to determine whether WHO essential medicines policies are associated with better QUM.

METHODS AND FINDINGS

We compared results from independently conducted medicines use surveys in countries that did versus did not report implementation of WHO essential medicines policies. We extracted survey data on ten validated QUM indicators and 36 self-reported policy implementation variables from WHO databases for 2002-2008. We calculated the average difference (as percent) for the QUM indicators between countries reporting versus not reporting implementation of specific policies. Policies associated with positive effects were included in a regression of a composite QUM score on total numbers of implemented policies. Data were available for 56 countries. Twenty-seven policies were associated with better use of at least two percentage points. Eighteen policies were associated with significantly better use (unadjusted p<0.05), of which four were associated with positive differences of 10% or more: undergraduate training of doctors in standard treatment guidelines, undergraduate training of nurses in standard treatment guidelines, the ministry of health having a unit promoting rational use of medicines, and provision of essential medicines free at point of care to all patients. In regression analyses national wealth was positively associated with the composite QUM score and the number of policies reported as being implemented in that country. There was a positive correlation between the number of policies (out of the 27 policies with an effect size of 2% or more) that countries reported implementing and the composite QUM score (r=0.39, 95% CI 0.14 to 0.59, p=0.003). This correlation weakened but remained significant after inclusion of national wealth in multiple linear regression analyses. Multiple policies were more strongly associated with the QUM score in the 28 countries with gross national income per capita below the median value (US$2,333) (r=0.43, 95% CI 0.06 to 0.69, p=0.023) than in the 28 countries with values above the median (r=0.22, 95% CI -0.15 to 0.56, p=0.261). The main limitations of the study are the reliance on self-report of policy implementation and measures of medicine use from small surveys. While the data can be used to explore the association of essential medicines policies with medicine use, they cannot be used to compare or benchmark individual country performance.

CONCLUSIONS

WHO essential medicines policies are associated with improved QUM, particularly in low-income countries. Please see later in the article for the Editors' Summary.

Intergenerational transmission of reproductive behavior during the demographic transition

New evidence from the Utah Population Database (UPDP) reveals that at the onset of the fertility transition, reproductive behavior was transmitted across generations - between women and their mothers, as well as between women and their husbands' family of origin. Age at marriage, age at last birth, and the number of children ever born are positively correlated in the data, most strongly among first-born daughters and among cohorts born later in the fertility transition. Intergenerational ties, including the presence of mothers and mothers-in-law, influenced the hazard of progressing to a next birth. The findings suggest that the practice of parity-dependent marital fertility control and inter-birth spacing behavior derived, in part, from the previous generation and that the potential for mothers and mothers-in-law to help in the rearing of children encouraged higher marital fertility.

Composition, concentration and deprivation: exploring their association with social cohesion among different ethnic groups in the UK

Although studies in the US have shown an association between the ethnic residential composition of an area and reports of decreased social cohesion among its residents, this association is not clear in the UK, and particularly for ethnic minority groups. The current study analyses a merged dataset from the 2005 and 2007 Citizenship Survey to assess the evidence for an association between social cohesion and ethnic residential concentration, composition and area deprivation across different ethnic groups in the UK. Results of the multilevel regression models show that, after adjusting for area deprivation, increased levels of social cohesion are found in areas of greater ethnic residential heterogeneity. Although different patterns emerge across ethnic groups and the measure of social cohesion used, findings consistently show that it is area deprivation, and not ethnic residential heterogeneity, which erodes social cohesion in the UK.

Who lives and dies on death row? Race, ethnicity, and post-sentence outcomes in Texas

A substantial body of research has explored the extent to which the race of offenders and victims influences who receives a death sentence for capital crimes. Little is known about how race and ethnicity might pattern death-row outcomes. Drawing upon evidence from male offenders sentenced to death in Texas during the years 1974 through 2009, we extend recent research by examining whether the race and ethnicity of offenders and victims and a number of offender, victim, and crime attributes influence the likelihood of executions and sentence relief (whereby prisoners leave death row). Cox regression analyses are used in conjunction with a multiple-imputation method for handling a modest amount of missing data. The results show that cases involving minorities—with black or Latino offenders or victims—have lower hazards of execution than cases in which both offenders and victims are white. Victim and offender race and ethnicity have little to no independent effect upon the hazard of sentence relief.

Population decline in Polish and Czech cities during post-socialism? Looking behind the official statistics

The evolving debate on "urban shrinkage" mirrors an increasing interest in demographic phenomena on the part of urban scholars. This paper discusses ambiguous evidence about recent population decline in the large cities of Poland and the Czech Republic, with a particular focus on Łódz and Brno in general and their inner cities more specifically. By applying a mixed-method approach, the paper identifies indications of inner-city repopulation and socio-demographic diversification which are not yet apparent in register or census data. It is argued that there are indications of a silent transformation of traditional residential patterns and neighbourhoods in east central Europe. In the inner cities, this is reflected, amongst other things, by the presence of new households that may be called "transitory urbanites".

Child-care availability and fertility in Norway

The child-care and fertility hypothesis has been in the literature for a long time and is straightforward: As child care becomes more available, affordable, and acceptable, the antinatalist effects of increased female educational attainment and work opportunities decrease. As an increasing number of countries express concern about low fertility, the child-care and fertility hypothesis takes on increased importance. Yet data and statistical limitations have heretofore limited empirical tests of the hypothesis. Using rich longitudinal data and appropriate statistical methodology, We show that increased availability of child care increases completed fertility. Moreover, this positive effect of child-care availability is found at every parity transition. We discuss the generalizability of these results to other settings and their broader importance for understanding variation and trends in low fertility.

China's below-replacement fertility: government policy or socioeconomic development?

The article challenges the notion that below-replacement fertility and its local variation in China are primarily attributable to the government's birth planning policy. Data from the 2000 census and provincial statistical yearbooks are used to compare fertility in Jiangsu and Zhejiang, two of the most developed provinces in China, to examine the relationship between socioeconomic development and low fertility. The article demonstrates that although low fertility in China was achieved under the government's restrictive one-child policy, structural changes brought about by socioeconomic development and ideational shifts accompanying the new wave of globalization played a key role in China's fertility reduction.

The politics of hope and despair: the effect of presidential election outcomes on suicide rates

OBJECTIVES

This article examines the effect of election outcomes on suicide rates by combining the theory of social integration developed by Durkheim with the models of rational choice used in economics.

METHODS

Theory predicts that states with a greater percentage of residents who supported the losing candidate would tend to exhibit a relative increase in suicide rates. However, being around others who also supported the losing candidate may indicate a greater degree of social integration at the local level, thereby lowering relative suicide rates. We therefore use fixed-effects regression of state suicide rates from 1981 to 2005 on state election outcomes during presidential elections to determine which effect is stronger.

RESULTS

We find that the local effect of social integration is dominant. The suicide rate when a state supports the losing candidate will tend to be lower than if the state had supported the winning candidate-4.6 percent lower for males and 5.3 percent lower for females.

CONCLUSION

Social integration works at many levels; it not only affects suicide risk directly, but can mediate other shocks that influence suicide risk.

All connected? Geographies of race, death, wealth, votes and births

In January 2010 we learnt that within London the best-off 10th of the population each had recourse to 273 times the wealth of the worse-off 10th of that population (Hills et al. 2010, An anatomy of economic inequality in the UK Report of the National Equality Panel, Government Equalities Office, London). It is hard to find any city in an affluent country that is more unequal. This wealth gap did not include the assets of the UK super-rich, who mostly live in or near London. In April 2010 the Sunday Times newspaper reported the wealth of the richest 1000 people in the UK had risen by an average of £77 million each in just one year, to now stand at £335.5 billion. Today in the UK we are again as unequal as we were around 1918. For 60 years we became more equal, but for the last 30 years, more unequal. Looking at inequality trends it is very hard, initially, to notice when the party of government changed. However, closer inspection of the time series suggests there were key times when the trends changed direction, when the future was much less like the past and when how people voted and acted appeared to matter more than at other times. With all three main parties offering what may appear to be very similar solutions to the issue of reducing inequality it seems unlikely that voting in 2010 will make much of a difference. However, today inequalities are now at unsustainable extremes. Action has been taken such that some inequalities, especially in education, have begun to shrink. The last two times that the direction of trends in inequalities changed, in the 1920s and 1970s, there were several general elections held within a relatively short time period. Inequality is expensive. The UK is not as well-off as it once was. It could be time for a change again. Which way will we go?

The effects of racial/ethnic segregation on Latino and Black homicide

Racial/ethnic residential segregation has been shown to contribute to violence and have harmful consequences for minority groups. However, research examining the segregation–crime relationship has focused almost exclusively on blacks and whites while largely ignoring Latinos and other race/ethnic groups and has rarely considered potential mediators (e.g., concentrated disadvantage) in segregation–violence relationships. This study uses year 2000 arrest data for California and New York census places to extend segregation–crime research by comparing the effects of racial/ethnic residential segregation from whites on black and Latino homicide. Results indicate that (1) racial/ethnic segregation contributes to both Latino and black homicide, and (2) the effects for both groups are mediated by concentrated disadvantage. Implications for segregation–violence relationships, the racial-invariance position, and the Latino paradox are discussed.

Pharmacoeconomics and immunotherapy

Pharmacoeconomics is a relatively new discipline whose scope is to describe, measure and compare costs and outcomes of alternative healthcare programmes from a variety of perspectives. This article is aimed at describing the various types of pharmacoeconomics analyses, indicating what types of costs and outcomes could be measured within each type of study, summarising the value of modelling techniques in pharmacoeconomics studies and finally suggesting what kind of pharmacoeconomic research can usefully be conducted in order to appreciate the burden of respiratory allergic disease and to evaluate the economic impact of health technologies that can effectively be used to manage it. Pharmacoeconomics is a relatively recent discipline whose use has been spread by the necessity of decision makers in most industrialised countries, to gain understanding of the economic effect of medical technologies in parallel with their clinical performance: only a wider use of the techniques of pharmacoeconomics analysis, together with an increasing willingness of the scientific community to understand the mechanics and appreciate the added value of pharmacoeconomics analysis, can help the discipline to proceed and provide further improvement to the healthcare system and to the society.

Cost of organ procurement and transplantation network data collection for a large transplant center

Collection of data on transplant candidates and recipients for the Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR) is a burden that falls primarily on the transplant centers. We examined the cost of data collection at one large transplant center. The average number of forms per year submitted more than 3 years was 5245. For the 3 years, 2.46 full time equivalents (FTEs) were committed to this data collection. Annual salaries in addition to benefits (calculated at 22% of salary) for these FTEs were US dollars 143026.22. The calculated annual cost per form submitted amounted to US dollars 27.27. Collection of data on transplant candidates and recipients is expensive and the cost of data collection should be understood before the institution of new data collection requirements for the transplant centers.

Statistics and "sufficiency": toward an intellectual history of Russia's rural crisis

The article examines the impact of the ‘rise of statistical thinking’ and statistical measurement on elite perceptions of the condition of the Russian Empire's post-emancipation peasant economy. Using archival and published sources, it argues that the increased use of statistical measurement did much to concretize in numerical (‘objective’) terms the idea of rural crisis. In particular, the combination of traditional paternalistic concerns about the sufficiency of peasant resources and the use of cadastre measurement yielded an image of the peasant household economy in which the value (the income-producing capabilities) of post-emancipation peasant allotments nearly always fell short of subsistence requirements and tax/payment obligations. Thus, because of how observers measured peasant well-being, it appeared as if peasants had been over-changed for their post-emancipation land allotments and were doomed to exist in a permanent state of crisis.

Estimating the employment and earnings costs of mental illness: recent developments in the United States

Substantial attention has recently been focused on both the prevalence and consequences of mental illness. Generally, public interest in the costs of mental illness has been limited to the direct costs of treating the mentally ill. In this paper, we consider the magnitude and importance of a major component of the indirect costs of mental illness: employment and earnings losses. We first describe the technical difficulties involved in estimating these costs. We then describe new data and recent advances in the United States that have improved our ability to make such estimates. Our conclusions from the recent research are that each year in the United States 5-6 million workers between the ages of 16 and 54 lose, fail to seek, or cannot find employment as a consequence of mental illness. Among those who do work, we estimate that mental illness decreases annual income by an amount between $3,500 and $6,000. We then discuss an emerging challenge to the traditional method for arriving at such estimates: the friction cost approach. We describe both the conceptual and technical differences between the friction cost method and the traditional human capital approach. We conclude that while economic context has much to do with whether one relies on human capital or friction cost estimates, each can offer useful information about labor market losses due to mental illness.

Divorce and the elite household in late medieval Cairo

This article examines the rate and causes of divorce among the elite households of late fifteenth-century Cairo. By using a unique contemporary chronicle, it is possible to estimate that a third of all marriages ended in divorce. Wives initiated divorces at least as often as their husbands. They did so by reaching a divorce settlement with their husbands for a financial compensation, or, in the case of desertion, by using the courts to impose a judicial divorce. In the vast majority of the cases, the causes for the divorce were grounded in marital relations. In spite of the importance of marriage alliances for the elite household, these marriages did eventually hinge on the mutual consent of the two individuals concerned.