bluuebunny/crossref_metadata_2025 huggingface dataset:
Specification of a Borderplex Econometric Forecasting Model
Authors: Fullerton Thomas M.
Published: July 2003

Historically linked by geography, trade, and culture, border areas of the United States and Mexico are becoming even more closely integrated by the elimination of trade and investment barriers under the North American Free Trade Agreement. Greater economic integration raises the question of whether the traditional approach to regional econometric modeling is applicable to border metropolitan areas. This article examines this issue with respect to the El Paso-Ciudad Juárez borderplex by specifying and estimating an econometric model and then simulating it under different currency conditions. Simulation output from the model is also compared and contrasted with extrapolations from a Bayesian vector autoregressive model. Results indicate that the traditional framework provides a viable means for analyzing international border region business trends.
Specialized Markets and the Behavior of Firms: Evidence from the United Kingdom’s Regional Economies
Authors: Athreye Suma S. , Keeble David
Published: July 2003

A key feature of the South East regional economy in recent decades has been the development of several intermediate markets in specialized business services. This article investigates whether the greater development of specialized markets in the South East is associated with different competitive and technological behaviors of innovative firms in this region when compared with firms in the Industrial Heartland regions of the West Midlands, North West England, and York-shire and Humberside. We find greater buying and selling of technology by firms and the presence of technological externalities in the South East, even when the services-intensive nature of the region’s production is accounted for. Industrial Heartland firms, in contrast, more frequently collaborate with domestic suppliers who are also an important source of technology. They also have greater collaboration with higher education institutes.
Metropolitan Innovation Systems: A Comparison between Barcelona, Stockholm, and Vienna
Authors: DIEZ Javier Revilla
Published: July 2003

This article uses data from the European Regional Innovation Survey to provide insights into the innovative activity and innovation networking of the most important innovation actors, namely manufacturing firms, producer service firms, and research institutes. The innovation capacities of the metropolitan innovation systems differ markedly. In respect to cooperation partners, vertical relationships predominate. Only in Stockholm do research institutes play a significant role in assisting innovation processes in manufacturing firms. Spatial proximity of cooperation partners is very important, confirming the concept of territorially based systems of innovation. At the same time, the actors surveyed cooperate intensively with cooperation partners outside the region.
Missing Elements in the Analysis of Agglomeration Economies
Authors: Parr John B.
Published: July 2003

The concept of agglomeration economies continues to represent an important aspect of locational analysis and regional economics. However, the term agglomeration economies is frequently used as a jargon or shorthand, leading to the obvious dangers of misspecification and misinterpretation. Treating agglomeration economies as cost savings to the individual firm, it is argued that these may be seen as particular forms of internal economies and also as particular forms of external economies. It is further argued that each group of economies (internal or external) can be examined in terms of the dimensions of scale, scope, and complexity. Such an approach forms the basis for a classification of agglomeration economies. This classification, which contains an important parallelism of form, is then used to consider a neglected aspect of the analysis—namely, the coexistence of different types of agglomeration economy.
Who Moves to Depressed Regions? An Analysis of Migration Streams in Finland in the 1990s
Authors: Kauhanen Merja , Tervo Hannu
Published: July 2003

Depressed regions typically lose a large number of migrants but simultaneously are destination regions for some migrants. This study analyzes those people who decided to move to depressed regions in Finland in 1993-1996. The analysis is based on a 1 percent sample drawn from the Finnish longitudinal census. The results show that migration into depressed regions is also a selective process. Return migration is only one part of this migration. However, the more educated an individual is, the more likely she or he is to move to a flourishing region. The process of concentration of human capital is reinforced by interregional migration.
Immigration, Intended Settlement Patterns, and their Dynamics in the United States, 1980-1990
Authors: Newbold K. Bruce , Achjar Nuzul
Published: July 2003

The intended destination pattern of immigrant settlement is a potentially dynamic choice, with fiscal and adjustment implications for both immigrants and the receiving area. Using yearly data from the Immigration and Naturalization Service, the intended immigrant settlement pattern is examined within a pooled cross-section time-series framework, focusing on the twenty-five largest U.S. metropolitan areas between 1980 and 1990. Trends in settlement patterns differentiate between the immigration streams from various sources and immigrant classes. Although no systematic differences were found across national origin groups, the results show that the choice of the intended destination is a dynamic process. Characteristics and determinants of settlement choice, particularly with respect to family and friends effects (as opposed to economic effects), change over time.
Impacts of Employed Spouses on Job-Moving Behavior
Authors: van Ommeren Jos , Rietveld Piet , Nijkamp Peter
Published: July 2003

This article tests the hypothesis that on-the-job moving behavior differs for the type of household to which the worker belongs. In particular, the authors distinguish between the presence of a spouse and the presence of an employed spouse. They find that female workers with spouses, particularly when they belong to two-earner households, tend to change jobs less often than do other workers. The empirical results do not indicate that job mobility strongly depends on the spouse’s workplace location.
Regional Convergence in Productivity and Productive Structure: The Spanish Case
Authors: Cuadrado-Roura Juan R. , García-Greciano Begoña , Raymond José Luis
Published: July 2003

This article analyzes the evolution of regional differences in Spain and emphasizes the importance of a disaggregate analysis at a sectoral level. In particular, the authors observe convergence in productivity at the aggregate regional level but not at the sectoral level. Aggregate convergence seems to be due to the gradual homogenization of regional productive structures. This result may modify some of the conclusions drawn in the recent literature regarding the mechanisms that have generated convergence. In addition, we examine the so-called beta convergence hypothesis using a fixed-effects model. The results show the importance of regional specificity captured by the fixed effects and have implications that are very different from those of beta convergence analyses with cross-section data.
Population Forecasting with Endogenous Migration: An Application to Trans-Tasman Migration
Authors: Gorbey Susi , James Doug , Poot Jacques
Published: July 2003

Official population projections are often based on cohort component methods in which migration levels or rates enter exogenously. When net migration accounts for a large proportion of population change and fluctuates strongly, more reliable population forecasts can be derived by explicitly forecasting migration first. This article focuses on forecasting migration between Australia and New Zealand (trans-Tasman migration), which is largely visa-free and therefore resembles internal migration. Net trans-Tasman migration is a major component of New Zealand population change and is embedded in this article in a Bayesian or unrestricted vector autoregression (VAR) model, which includes foreign and domestic economic variables. When time series of net migration are available, this approach provides a useful input into forecasting population growth in the short run in the absence of major policy changes. This conclusion applies equally to interregional migration and to unrestricted international migration between economically integrated nations.
Overcoming the Adverse Effects of Geography: Infrastructure, Health, and Agricultural Policies
Authors: Henderson J. Vernon
Published: July 2003

Geography strongly affects development, but geography is not destiny. Public infrastructure investments, health policy, and agricultural policies can help overcome the adverse effects of geography on economic growth. A close relationship exists between climate and development, but human capital investment and health policy seem key to economic development in tropical areas. Likewise, strong relationships exist among coastal locations, urbanization, and growth, but investment in transportation and communication infrastructure linking coastal and hinterland areas facilitates hinterland development. Access to hinterland resources is a geographic challenge to be overcome by infrastructure investment. The failure of hinterland development in some countries is partly due to insufficient transportation and communication investment.
But Why Does Geography Matter, and Which Geography Matters?
Authors: Venables Anthony J.
Published: July 2003

This comment on Gallup, Sachs, and Mellinger welcomes their research on economic geography and calls for further work to identify the underlying sources of geographical advantage and disadvantage.
The Role of Geography in Development
Authors: Krugman Paul
Published: July 2003

This article assesses how the tension between centripetal forces (such as forward and backward linkages in production and increasing returns in transportation) and centrifugal forces (such as factor immobility and land rents) can produce a process of self-organization in which symmetric locations end up playing very different economic roles. The article discusses geographic models of the division of the world into industrial and developing countries, of the emergence of regional inequality within developing countries, and of the emergence of giant urban centers. It argues that the conflict between “predestination” and “self-organizing” approaches to economic geography may be more apparent than real and briefly discusses policy—mainly in terms of why it is so hard to draw policy conclusions from economic geography models.
Comments on the Federal Reserve Board’s Study of Community Reinvestment Act Profitability and Performance
Authors: Dietrich Jason
Published: July 2003

The Board of Governors recently surveyed approximately 500 institutions as part of a comprehensive study of Community Reinvestment Act-related lending. The data, which characterize the current supply of credit to low-and moderate-income borrowers, suggest that Community Reinvestment Act-related lending is profitable in general and that community organizations play an important role in identifying and counseling potential borrowers. The next step now is to use these data, in concert with demand-side data, to focus on causal relationships, such as whether it is the Community Reinvestment Act or market forces that are actually driving lending to low- asnd moderate-income borrowers.
Small Commercial Banks and the Federal Home Loan Bank System
Authors: Collender Robert N. , Frizell Julie A.
Published: July 2003

Increased competition within the financial services industry has raised concerns about the ability of small banks to adequately fund local rural development. To address these concerns, the Gramm-Leach-Bliley Act of 1999 broadened small-bank access to Federal Home Loan Bank (FHLB) financing. Statistical analyses indicate that the following factors were significantly associated with the decisions of small banks headquartered in nonmetropolitan counties to obtain FHLB membership: bank size, affiliation with a bank holding company, exposure to interest rate risk, loan portfolio quality, liquidity pressure, dividend rates on FHLB stock, and binding membership requirements related to residential real estate-related assets. Many, but not all, of these factors were also significantly associated with the membership decisions of small banks headquartered in metropolitan counties. The decisions of both nonmetropolitan and metropolitan banks to use FHLB funding is significantly related to interest rate risk exposure, liquidity pressure, and net interest margins. Neither population trend nor rural county type variables are consistently significant in explaining either which small banks join FHLBs or which member banks borrow from FHLBs.
Community Reinvestment Act Enforcement and Changes in Targeted Lending
Authors: Dahl Drew , Evanoff Douglas D. , Spivey Michael F.
Published: July 2003

The Community Reinvestment Act (CRA) encourages banks and savings and loan associations to meet the credit needs of local communities. Controversies surrounding implementation of the CRA, however, have challenged its effectiveness as a tool for increasing loan activity. To determine whether the CRA influences lending, the authors compare the low-income mortgage loans of banks that experience CRA downgrades to those of other banks that are not downgraded. The authors find no evidence consistent with the hypothesis that downgraded banks, in an attempt to reestablish an acceptable rating, increase lending.
Using Focus Groups to Assess Primary Care Patients’ Satisfaction
Authors: Schwarz Miriam , Landis Suzanne E. , Rowe John E. , Janes Cynthia L. , Pullman Naomi
Published: July 2003

The present report describes the use of patient focus groups by a primary health care facility. We review our rationale for using focus groups and the process we used to prepare for and conduct them. We then highlight the results and lessons learned through this experience. Focus groups can be an excellent method for primary care practices to assess the complexities of patient satisfaction issues and engage patients in the continuous quality improvement process. Focus groups can uncover unanticipated issues that surveys fail to identify. Our experience demonstrated that this benefit can be critical in identifying and prioritizing quality of care improvements and that focus group results can be used to make immediate improvements in the quality of care, even though this type of study is not intended to generalize.
Implementation of the Methadone Treatment Quality Assurance System
Authors: Ducharme Lori J. , Luckey James W.
Published: July 2003

This article describes the development and large-scale testing of the Methadone Treatment Quality Assurance System (MTQAS). MTQAS originated as a NIDA (National Institute on Drug Abuse) funded study to assess the feasibility and utility of implementing a performance-based feedback reporting system for narcotic addiction treatment programs. After several years of research to identify a set of valid, reliable, and clinically useful indicators of program performance using patients’ in-treatment outcomes, MTQAS was tested in a feasibility study with more than 70 methadone treatment clinics in seven states. For each of nine quarters, participating clinics received a report summarizing their patient outcomes; reports also included summary data permitting comparisons across states, across clinics within a state, and within a clinic over time. In addition, MTQAS included a case-mix adjustment strategy that permitted fair comparisons of performance among programs with systematically different patient caseloads. The structure and operation of MTQAS, selected analyses of the data, and lessons for future performance measurement systems are discussed.
Quality Improvement in a School Health Program
Authors: Klostermann Brenda K. , Perry Cynthia S. , Britto Maria T.
Published: July 2003

A process evaluation of a school health program designed to improve students’ health and educational success is presented. The program included a pediatric nurse practitioner and two nurses placed in three high-risk, urban intervention schools. It is a part of a larger multidimensional pilot intervention project (The Children First Plan). Implemented services and the implementation process are described. Key components for a successful implementation included obtaining buy-in, learning the school culture, defining roles, and keeping a sense of humor. Collaborative efforts among the nursing team, other children-first plan providers, and the school staff improved service delivery. Lack of communication was the primary barrier. In addition, differing philosophies among systems (education, social services, health), problems with referral and feedback, and lack of appropriate providers hampered service delivery. Recommendations for continued program improvement and replication projects are provided.
Chronic Fatigue Syndrome
Authors: Jason Leonard A. , Taylor Renee R. , Kennedy Cara L. , Jordan Karen , Song Sharon , Johnson Danielle E. , Torres Susan R.
Published: July 2003

Most chronic fatigue syndrome (CFS) studies are based on information about patients from primary or tertiary care settings. These patients might not be typical of patients in the general population. This investigation involved examinations of individuals with CFS from a community-based study. A random sample of 18,675 in Chicago was inter-viewed by telephone. Individuals with chronic fatigue and at least four minor symptoms associated with CFS were given medical and psychiatric examinations. A group of physicians then diagnosed individuals with CFS, who were then subclassified based on three sociodemographic categories—gender, ethnicity, and work status. Sociodemographic subgroups were analyzed amid symptom severity, functional disability, coping, optimism, perceived stress, and psychiatric comorbidity. Women, minorities, and nonworking individuals with CFS reported greater levels of functional disability, symptom severity, and poorer psychosocial functioning than men, Caucasians, and working individuals, suggesting sociodemographic characteristics may be associated with poorer outcomes in urban, community-based samples of CFS individuals.
Key Elements for Implementing Comprehensive Health Care Models for Persons with HIV
Authors: Melchior Lisa A. , Panter A. T. , Larson Trudy A. , Meredith Karen L. , Richardson-Nassif Karen , Huba G. J.
Published: July 2003

A semistructured interview was conducted with 69 stakeholders in three university-based health care projects that were funded to provide an integrated continuum of care for persons living with HIV/AIDS. Data from the key informant interviews yielded composite indicators of familiarity with the service model, the importance of the elements in the service model, and the perceived quality of services provided by these innovative HIV service demonstration projects. Ratings of service quality were related to ratings of the respondent’s knowledge of the service demonstration project, the importance of the various elements in the service continuum, and several indicators of stakeholder characteristics using the data modeling method titled Exhaustive CHAID (Chi-squared Automatic Interaction Detector). The groups of stakeholders most likely to give the highest quality or success ratings for these projects are identified. The implications of these findings for developing collaborative and comprehensive service models for persons with HIV/AIDS are discussed.
The Effects of Clinical Decision Making on Nurse Practitioners’ Clinical Productivity
Authors: Chumbler Neale R. , Geller Jack M. , Weier Andrew W.
Published: July 2003

The degree of clinical decision making and clinical productivity among nurse practitioners (NPs) is of great interest to policy makers and planners involved in providing appropriate outpatient primary care services. The authors performed a statewide mailed survey of all NPs practicing either full-time or part-time in Wisconsin (response rate of 72.1%) to address the following research questions: Do the demographic characteristics, practice attributes, and primary practice settings of NPs impact their level of clinical decision making (e.g., the autonomy to order laboratory and radiological tests or to refer a patient to a physician specialist other than their collaborating physician)? Do NPs’ levels of clinical decision making correlate with their outpatient clinical productivity, adjusting for demographic characteristics, practice attributes, and primary practice settings? The multiple linear regression results indicated that having more years in practice as an NP, practicing in the family specialty area (vs. a combined other category, which included pediatrics, acute care, geriatrics, neonatal, and school), treating patients according to clinical guidelines, practicing in settings with a fewer number of physicians, and practicing in a multispecialty group practice versus a single-specialty group practice were associated with greater levels of clinical decision making. However, NPs who primarily practiced in a hospital/facility-based practice, as compared with a single-specialty group practice, had lower levels of clinical decision making. After adjusting for demographic characteristics, practice attributes, and primary practice settings, NPs with greater clinical decision-making authority had greater outpatient clinical productivity. The conclusions discuss the policy implications of the findings.
Health-Related Physical Fitness Knowledge of Student Allied Health Professions
Authors: Miller Michael G. , Berry David C.
Published: July 2003

Each allied-health profession has their own particular expertise but also shares some commonalities. One such commonality should be knowledge of health-related physical fitness relating to the health and well-being of individuals. Although the benefits of health-related physical fitness has been well documented, few studies have examined the level of health-related physical fitness knowledge among allied-health professions. Therefore, the purpose of this investigation was to assess the health-related physical fitness knowledge of three allied-health professions using a 40 item multiple-choice test designed to assess knowledge in five domains of health-related physical fitness. Results indicated that student athletic trainers scored significantly higher on the post-test versus pre-test. On the post-test, athletic training and physical therapy groups scored significantly higher than the nursing group. The information from this study may be valuable in aiding educators in developing appropriate curriculums to better prepare students for their role as allied-health professionals.
An Eclectic Model for Evaluating Web Based Continuing Medical Education Courseware Systems
Authors: Curran Vernon R.
Published: July 2003

World Wide Web and compact disc–read only memory technologies have introduced new prospects for delivering continuing medical education (CME) to rural and remote physicians. However, evidence concerning the effectiveness of these technologies in providing CME, and approaches to their evaluation, is limited. The rationale for this study was to design a model for evaluating the effectiveness of computer-mediated CME courseware. An eclectic, evaluation-planning matrix was designed by selecting various concepts from the literature and was used in planning and developing the evaluation model. The model was field-tested by evaluating a computermediated courseware program on dermatological office procedures, and a meta-evaluation was conducted to assess the effectiveness of the evaluation methods and procedures. The findings suggest that the model was useful in collecting data to inform decision making and to improve the instructional product. The field test results revealed that computer-mediated instruction was effective in delivering CME at a distance.
Student Attitudes toward Same-Gender versus Mixed-Gender Partnering in Practicing Physical Examination Skills
Authors: Barnette J. Jackson , Kreiter Clarence D. , Schuldt Sandra S.
Published: July 2003

Students were surveyed to assess perceptions with regard to the use of same-gender and mixed-gender partnering in practicing physical examinations. There was support for this arrangement, with students reporting that the practice provided an important learning experience with reasonable levels of comfort and no loss of thoroughness and rigor. Students did express some concerns. Females tended to have lower comfort levels, particularly when they were in the role of patient. Many of the concerns expressed could be addressed with procedural changes during the assignment of partners, and the benefits of continuing this practice seem to outweigh any negative aspects.
Medicaid Managed Care
Authors: Highsmith Nicolette , Somers Stephen A.
Published: July 2003

Medicaid managed care is a work in progress. This article provides a brief historical overview of Medicaid managed care from the early 1980s to the late 1990s and offers insight into some of the major operational, fiscal, and political realities of implementing managed care in a Medicaid context. This article also attempts to show that a major advantage of managed care is having a more accountable health care system. Accountability can bring quality improvements to a system that often lacked the ability to measure performance and results under Medicaid fee-for-service. Subsequent articles in this journal demonstrate how states working together with managed care organizations and quality review organizations can better define, measure, and use quality information to improve their Medicaid managed care programs.
Effect of Different Types of Medicaid Managed Care on Childhood Immunization Rates
Authors: Cotter J. James , McDonald Kathy A. , Parker Dawn A. , McClish Donna K. , Pugh Carol B. , Bovbjerg Viktor E. , Tipton Gary A. , Rossiter Louis F. , Smith Wally R.
Published: July 2003

Medicaid managed care can improve access to prevention services, such as immunization, for low-income children. The authors studied immunization rates for 7,356 children on Medicaid in three managed care programs: primary care case management (PCCM; n = 4,605), a voluntary HMO program (n = 851), and a mandatory HMO program (n = 1,900). Immunization rates (3:3:1 series) in PCCM (78%) exceeded rates in the voluntary HMO program (71%), which in turn exceeded those in the mandatory HMO program (67%). Adjusting for race, urban residence, and gender, compared to children in PCCM, children in the voluntary HMO program were less likely to complete the 3:3:1 series (OR = 0.75, CI = 0.63, 0.90), and children in the mandatory HMO program were even less likely to complete the series (OR = 0.59, CI = 0.51, 0.68). Results differed by individual HMOs. Monitoring of outcomes for all types of managed care by Medicaid agencies is imperative to assure better disease prevention for low-income children.
The Status of Prenatal Care among Medicaid Managed Care Patients in Connecticut
Authors: van Hoof Thomas J. , Casey Barbara A. , Tate Janet P. , Linnane James J. , Petrillo Marcia K. , Meehan Thomas P.
Published: July 2003

Providing quality prenatal care to high-risk, pregnant adolescents represents an important challenge to health care providers and health plans. Using national prenatal care guidelines, this study sought to evaluate the quality of important processes and outcomes of prenatal care delivered to women age 21 years and younger enrolled in three health plans serving the Connecticut Medicaid population. Some important findings include 93% compliance with recommended processes of prenatal care, an 11% C-section rate, an average length of hospital stay of 4.0 days for women having a C-section, and a 10% premature delivery rate. Opportunities for improvement include 40% failing to begin prenatal care in the first trimester, 31% not receiving the recommended number of prenatal care visits, and 8% delivering a low-birth-weight infant. This study provides important descriptive information on processes and outcomes of care for pregnant adolescents within Medicaid Managed Care and also identifies opportunities for improvement.
Outpatient Utilization Patterns and Quality Outcomes after First Acute Episode of Mental Health Hospitalization
Authors: Huff Edwin D.
Published: July 2003

Access to outpatient services within the first 30 days after an inpatient mental health episode may influence relapse risk. A retrospective cohort of 3,755 adult Medicaid mental health inpatients discharged from their first managed care acute episode of care from July 1, 1996, through May 20, 1998, were studied. Results showed patients’ utilization of any psychotherapy (OR=. 43), medication management (OR=. 41), or diagnostic evaluation services (OR=. 61), relative to no utilization, was associated with significantly lower 30-day readmission rates, and longer times in remission. However, patients receiving above the median total number of ambulatory services, or having contact with more providers showed significantly greater likelihood of 30-day readmission, and shorter time in remission. Findings heighten the need for the availability of timely risk-reducing mental health outpatient services, the continuity and risk of fragmentation of therapeutic relationships, as well as crisis planning before an inpatient discharge.
An Assessment of Maryland Medicaid’s Rare and Expensive Case Management Program
Authors: Pandey Sanjay K. , Mussman Mary G. , Moore Harriet W. , Folkemer John G. , Kaelin John J.
Published: July 2003

The Rare and Expensive Case Management Program provides intensive case management services to an especially vulnerable population comprised of primarily pediatric beneficiaries. This study examines the effect of the case management program on the pattern of costs. With its emphasis on obviating the need for acute care services and providing the necessary medical and assistive services in a timely manner, the case management program is expected to change the pattern of expenditures by category of service. Due to the low prevalence of conditions covered by the program, constituting a comparison group for the evaluation posed a major challenge. Employing an innovative methodological approach, a historical comparison group was modeled using statewide Medical Assistance claims files. The study design included a retrospective comparison of Medicaid beneficiaries enrolled in the program with a similar group before the case management program was implemented. The results bear out the anticipated pattern of shifts in cost of care from acute care to nonacute care services.
The Effects of Variations in Mode of Delivery and Monetary Incentive on Physicians’ Responses to a Mailed Survey Assessing STD Practice Patterns
Authors: Kasprzyk Danuta , Montaño Daniel E. , St. Lawrence Janet S. , Phillips William R.
Published: July 2003

High response rates from physicians are key to obtaining valid and generalizable data regarding their sexually transmitted disease (STD) diagnosis, treatment, and control practices. A factorial (3 × 2) study was designed using varying cash incentives ($0, $15, $25) and delivery modes (Federal Express, U.S. mail). Surveys, with three follow-up mailings, were sent to a national probability sample of 311 physicians in OB-GYN, family practice, internal and emergency medicine, and pediatrics specialties. Overall, 156 physicians returned completed surveys (56% overall response rate). Significant effects for incentive level (F = 28.2, df =2, p < .01) and delivery mode (F = 4.1, df =1, p < .05) existed. Highest response was among physicians in the $25-FedEx condition (81%). High response rates from busy practicing physicians can be achieved if surveys are relevant to clinical practice, sponsored by a reputable organization (the Centers for Disease Control and Prevention), include a monetary incentive, and are delivered by courier.
Examining the Generalizability of Ratings across Clerkships Using a Clinical Evaluation Form
Authors: Kreiter Clarence D. , Ferguson Kristi J.
Published: July 2003

It is necessary to average multiple clinical evaluation form (CEF) observations to obtain a reliable score. Combining CEF observations across clerkships will provide more observations per student, but it is unknown how an across-clerkship generalization affects reliability. The authors conducted generalizability studies on balanced stratified random samples to examine the impact of averaging across clerkships. The study detected a student by clerkship interaction. Although the interaction magnitude was small, it had a large negative impact on the reliability of the mean score. The authors conclude that averaging across clerkships for the purpose of evaluating global clinical skills will produce a less reliable measure for a fixed number of observations than averages calculated within a clerkship for evaluating clerkship specific skills. The content specificity of clinical skills as measured by the CEF may resemble that found using other measurement methods.
Cost-Effectiveness of a Lottery for Increasing Physicians’ Responses to a Mail Survey
Authors: Baron Geneviève , De Wals Philippe , Milord François
Published: July 2003

To evaluate the cost-effectiveness of a lottery on physicians’ responses to a mail survey, a randomized controlled trial was conducted with a random sample of 1,000 members of the Quebec Federation of General Practitioners in 1997. For the first mailing of this survey, each respondent was randomly assigned to the control or experimental group, which was offered participation in a lottery upon return of the questionnaire. Response rate was 41.2% in the experimental group and 34.8% in the control group, a 6.4% difference (CI95%: 0.6% – 12.6%). The additional cost of the lottery was about Can$500, giving an incremental cost of Can$16 per questionnaire returned. In conclusion, a lottery resulted in a small but statistically significant increase in the response rate of physicians to a mail survey. This method may be a cost-effective option when applied to large surveys.
Comparison of Resident and Medical Student Evaluation of Faculty Teaching
Authors: Williams Brent C. , Pillsbury Matthew S. , Stern David T. , Grum Cyril M.
Published: July 2003

Recognizing and rewarding teaching faculty are increasingly important to medical schools and are often hampered by low perceived reliability and validity of measures of teaching ability. The purpose of this study was to cross-validate two independently generated measures of teaching from medical students and residents. A total of 2,318 medical student and 4,425 resident scores for single-item measures of teaching ability for 129 teaching faculty members of a department of internal medicine over a 6-year period were compared. Results showed that average teaching scores were higher for medical students than residents. Rank order of faculty were within 2 quintiles for the two groups for over 90% of faculty. Highly discordant evaluations were seen for only 8% of faculty. The authors conclude the general concordance of two independent measures of teaching ability adds evidence to the existing literature of the validity of single-item measures of teaching ability from two different types of learners.
The Loss of Student Idealism in the 3rd-Year Clinical Clerkships
Authors: Griffith Charles H. , Wilson John F.
Published: July 2003

The purpose of this study was to specify how student attitudes toward different types of patients and the profession change during clinical rotations. A questionnaire was given to all medical students prior to 3rd-year rotations regarding their attitudes toward the medical profession and patient types. It was given again after students completed their l6-week medicine-surgery clerkship. Eighty-eight of 96 students responded to preand posttests. Students became less idealistic toward two patient groups: the elderly and people with chronic pain. After clerkship, students believed a greater percentage of the elderly were demented (26% increasing to 35%, p = .09 and that a greater percentage of patients with chronic pain are drug seekers (l5% increasing to 24%, p = .004). The authors conclude that in the 3rd year of medical school students become less idealistic toward elderly patients, those with chronic pain, and the profession.
Supporting Children with Serious Health Care Needs
Authors: Roberts Greg
Published: July 2003

Effective and efficient service delivery to children who rely on medical technology or ongoing medical care will become increasingly critical as technology and medical know-how grow more sophisticated. Presently, technology’s development and application threaten to outpace systems of service delivery. This article explores the present state of affairs by considering the challenges involved in planning and evaluating programs for children with special health care needs and their families. A cost-benefit model is suggested as a meaningful framework for considering challenges related to providing service in this arena and evaluating its effectiveness.
The Use of Numbers Needed to Treat Derived from Systematic Reviews and Meta-Analysis
Authors: Ebrahim Shah
Published: July 2003

Numbers needed to treat (NNTs) may be used to present the effects of treatment and are the reciprocal of the absolute difference between treatment and control groups in a randomized controlled trial. NNTs are sensitive to factors that change the baseline risk of trial participants: the outcome considered; characteristics of patients; secular trends in incidence and case-fatality; and clinical setting. NNTs derived from pooled absolute risk differences in meta-analyses are commonly presented and easily calculated by meta-analytic software but may be seriously misleading because of heterogeneity between trials included in meta-analyses. Meaningful NNTs are obtained by applying the pooled relative risk reductions calculated from meta-analyses or individual trials to the baseline risk relevant to specific patient groups. This process will give a range of NNTs depending on whether patients are at high, low, or intermediate levels of risk, rather than a potentially misleading single number.
Using Bayesian Inference to Perform Meta-Analysis
Authors: Schmid Christopher H.
Published: July 2003

Bayesian modeling offers an elegant approach to meta-analysis that efficiently incorporates all sources of variability and relevant quantifiable external information. It provides a more informative summary of the likely value of parameters after observing the data than do non-Bayesian approaches. This leads to direct probabilistic inference about model parameters such as the average treatment effect, the between-study variance, and individual study treatment effects. The latter are weighted averages of the common mean and individual study means with weights reflecting the amount of information provided by each study relative to the others. Homogeneity among these posterior study estimates indicates that pooling these studies is appropriate; heterogeneity suggests that some cause of between-study variation should be explored. The author describes the construction of such models and shows how to use them to estimate a common mean and regression slopes. Two examples illustrate the additional inferences available with the Bayesian methodology.
Examining Theoretical Models through Research Synthesis
Authors: Becker Betsy Jane
Published: July 2003

Quantitative research synthesis methods can be used to examine theoretical models for substantive research questions. Model-driven syntheses can address more complex questions than have typically been addressed in quantitative reviews in a more systematic and organized manner than in a traditional narrative review. A rationale and set of objectives for syntheses involving models are reviewed. The author describes how to incorporate models into each stage of a review, outlining problems and limitations that may arise at each stage. Examples from several model-driven syntheses illustrate the points made in the article.
Simple Pooling versus Combining in Meta-Analysis
Authors: Bravata Dena M. , Olkin Ingram
Published: July 2003

The simple pooling of data is often used to provide an overall summary of subgroup data or data from a number of related studies. In simple pooling, data are combined without being weighted. Therefore, the analysis is performed as if the data were derived from a single sample. This kind of analysis ignores characteristics of the subgroups or individual studies being pooled and can yield spurious or counterintuitive results. In meta-analysis, data from subgroups or individual studies are weighted first, then combined, thereby avoiding some of the problems of simple pooling. The purpose of this article is to describe how simple pooling differs from meta-analysis, provide a detailed analysis of why simple pooling can be a poor procedure, and show that combining by meta-analytic methods avoids such problems.
Missing Predictors in Models of Effect Size
Authors: Pigott Therese D.
Published: July 2003

Missing data occur frequently in meta-analysis. Reviewers inevitably face decisions about how to handle missing data, especially when predictors in a model of effect size are missing from some of the identified studies. Commonly used methods for missing data such as complete case analysis and mean substitution often yield biased estimates. This article briefly reviews the particular problems missing predictors cause in a meta-analysis, discusses the properties of commonly used missing data methods, and provides suggestions for ways to handle missing predictors when estimating effect size models. Maximum likelihood methods for multivariate normal data and multiple imputation hold the most promise for handling missing predictors in meta-analysis. These two model-based methods apply to a broad set of data situations, are based on sound statistical theory, and utilize all information available to obtain efficient estimators.
The Growth of Health-Related Meta-Analyses Published from 1980 to 2000
Authors: Lee Wen-Lin , Bausell R. Barker , Berman Brian M.
Published: July 2003

A MEDLINE search was conducted to estimate trends in the growth of health-related meta-analyses published during the past two decades. Employing a more specific than sensitive search strategy, and not supplementing these results with known sources of published meta-analyses or manual search strategies, 3,025 probable meta-analyses were selected from the 5,128 citations identified. The data showed a definitive upward (and generally linear) trend across time with no evidence for this genre of research either leveling off or decreasing.
Using Intervention Theory to Model Factors Influencing Behavior Change
Authors: Fishbein Martin , Hennessy Michael , Kamb Mary , Bolan Gail A. , Hoxworth Tamara , Iatesta Michael , Rhodes Fen , Zenilman Jonathan M. ,   Project Respect Study Group
Published: July 2003

Project RESPECT was a multisite randomized trial comparing three clinic-based interventions’ ability to increase condom use and prevent infection with HIV and sexually transmitted diseases. Because Project RESPECT had guiding concepts that determined the content of the sessions, the authors investigated how the intervention operated using these theoretical variables. Growth curve analysis and structural equation modeling estimated the correlation between intentions toward condom use and self-reports of condom use and isolated the treatment effects on mediating variables—attitudes, self-efficacy, and social norms—that predict intentions. The correlations between intentions and behavior exceeded .70 for both genders, justifying the emphasis on intentions. Project RESPECT was effective through changing attitudes and self-efficacy for females in both counseling interventions. For males, only enhanced counseling had significant effects on these two mediator variables.
Location of Death in Canada
Authors: Wilson Donna M. , Northcott Herbert C. , Truman Corrine D. , Smith Susan L. , Anderson Marjorie C. , Fainsinger Robin L. , Stingl Michael J.
Published: July 2003

This report compares 20th-century Canadian hospital and nonhospital location-of-death trends and corresponding population mortality trends. One of the chief findings is a hospitalization-of-death trend, with deaths in hospital peaking in 1994 at 80.5% of all deaths. The rise in hospitalization was more pronounced in the years prior to the development of a national health care program (1966). Another key finding is a gradual reduction since 1994 in hospital deaths, with this reduction occurring across all sociodemographic variables. This suggests nonhospital care options are needed to support what may be an ongoing shift away from hospitalized death and dying.
The Impact of a Community-Wide Self-Care Information Project on Self-Care and Medical Care Utilization
Authors: Hibbard Judith H. , Greenlick Merwyn , Jimison Holly , Capizzi Jeffrey , Kunkel Lynn
Published: July 2003

This study assesses the effects of the Healthwise Communities Project (HCP) on use of self-care resources and health care utilization. The intervention included the distribution of the Healthwise Handbook, the provision of a telephone advice line, and a Web site. All of these products use a symptom-based approach and are aimed at a general population. A quasi-experimental design was used with two comparison communities. Measurements over time assessed the effects of the HCP while controlling for secular trends. Survey and utilization data are used to assess the effect of the intervention. Findings indicate that the community intervention increased the use of self-care resources. Users believe that these products help them make better decisions regarding when to seek care and how to self-treat problems. Most believe that using the self-care resources saved them from seeking unnecessary care. The findings from the utilization data provide some evidence to support this conclusion.
Impact of an Online Analytic Skills Course
Authors: Farel Anita , Umble Karl , Polhamus Barbara
Published: July 2003

This article describes the effect of an online analytic skills training course on professional development and practice and discusses recommendations for using this training modality in the public health workforce. The Enhancing Data Utilization Skills Through Information Technology initiative trained professionals in maternal and child health from 13 Southern-tier state and local health departments to collect, analyze, and interpret data via a year-long Web-based course. The evaluation of this initiative was based on a model of change for health professionals that holds that training influences behavior by increasing knowledge, influencing beliefs related to the behavior, enhancing self-efficacy, and improving skills. Participants’ knowledge, beliefs, and self-efficacy all increased significantly during the course. Participants’ self-assessed skill levels increased significantly for each of 12 selected skills and overall for all skills combined. Distance learning is potentially an effective means for professionals to advance their skills while continuing to fulfill their work-related responsibilities.