Related Articles

Under Norway's prospective payment system, which was in existence from 1972 to 1980, hospital costs increased 15.8 percent annually, compared with 15.3 percent in the United States. In 1980 the Norwegian national government started paying for all institutional services according to a population-based, morbidity-adjusted formula. Norway's prospective payment system provides important insights into problems of controlling hospital costs despite significant differences, including ownership of medical facilities and payment and spending as a percent of GNP. Yet striking similarities exist. Annual real growth in health expenditures from 1972 to 1980 in Norway was 2.2 percent, compared with 2.4 percent in the United States. In both countries, public demands for cost control were accompanied by demands for more services. And problems of geographic dispersion of new technology and distribution of resources were similar. Norway's experience in the 1970s demonstrates that prospective payment is no panacea. The annual budget process created disincentives to hospitals to control costs. But Norway's changes in 1980 to a population-based methodology suggest a useful approach to achieve a more equitable distribution of resources. This method of payment provides incentives to control variations in both admissions and cost per case. In contrast, the Medicare approach based on Diagnostic Related Groups (DRGs) is limited, and it does not affect variations in admissions and capital costs. Population-based methodologies can be used in adjusting DRG rates to control both problems. In addition, the DRG system only applies to Medicare payments; the Norwegian experience demonstrates that this system may result in significant shifting of costs onto other payors.

This paper focuses on the incremental impacts of coal ash and flue gas desulfurization (FGD) wastes associated with increased coal usage by utilities and industry under the National Energy Plan (NEP). In the paper, 1985 and 2000 are the assessment points using the baseline data taken from the Annual Environmental Analysis Report (AEAR, September 1977). In each EPA region, the potential mix of disposal options has been broadly estimated and impacts assessed therefrom. In addition, future use of advanced combustion techniques has been taken into account. The quantities of coal ash and FGD wastes depend on ash and sulfur content of the coal, emission regulations, the types of ash collection and FGD systems, and operating conditions of the systems and boiler. The disposal of these wastes is (or will be) subject to Federal and State regulations. The one key legal framework concerning environmental impact on land is the Resource Conservation and Recovery Act (RCRA). RCRA and related Federal and State laws provide a sufficient statutory basis for preventing significant adverse health and environmental impacts from coal ash and FGD waste disposal. However, much of the development and implementation of specific regulations lie ahead. FGD wastes and coal ash and FGD wastes are currently disposed of exclusively on land. The most common land disposal methods are inpoundments (ponds) and landfills, although some mine disposal is also practiced. The potential environmental impacts of this disposal are dependent on the characteristics of the disposal site, characteristics of the coal ash and FGD wastes, control method and the degree of control employed. In general, the major potential impacts are ground and surface water contamination and the "degradation" of large quantities of land. However, assuming land is available for disposal of these wastes, control technology exists for environmentally sound disposal. Because of existing increases in coal use, the possibility of significant environmental impacts, both regionally and nationally, exists regardless of whether the NEP scenario develops or not. Existing baseline data indicate that with sound control technology and successful development and implementation of existing regulatory framework, regional scale impacts are likely to be small; however, site-specific impacts could be significant and need to be evaluated on a case-by-case basis. Both Federal and privately-funded programs are developing additional data and information on disposal of FGD sludges and coal ash. Continuation of these programs will provide additional vital information in the future. However, further information in several areas if desirable: further data on levels of radionuclides and trace metals in these wastes: studies on biological impacts of trace metals; and completion of current and planned studies on disposal problems associated with advanced combustion techniques like fluid bed combustion.

Doll, R., Vessey, M. P., Beasley, R. W. R., Buckley, A. R., Fear, E. C., Fisher, R. E. W., Gammon, E. J., Gunn, W., Hughes, G. O., Lee, K., and Norman-Smith, Beatrice (1972).Brit. J. industr. Med.,29, 394-406. Mortality of gasworkers—final report of a prospective study. The mortality experience of selected groups of gasworkers employed by four area Gas Boards and observed over a period of eight years was described by us in a report in 1965. The present paper adds a further four years' data to those previously collected for men having regular exposure in coal carbonizing plants and for men having exposure only to by-products of the gas-making process. To these we have added data relating to men employed by four additional area Gas Boards who have been observed over periods of seven to eight years.

The new data provide confirmation that exposure to the products of coal carbonization can give rise to cancer of the lung and leave little doubt that the risk of bladder cancer is also increased. Two additional deaths from scrotal cancer have been observed; there is evidently still a need for vigilance if this disease is to be treated at a stage early enough to prevent death. With respect to all these cancers, work as a topman appears to be particularly hazardous.

The additional data included in the present report fail to settle the question whether the risk of lung cancer is especially associated with the conditions of work in one particular type of retort house; if there are any differences, however, they are likely to be small.

In our original report, a highly significant association between death from bronchitis and exposure to the coal carbonizing process was described. The more recent data for the four original Gas Boards offer only limited support to the view that bronchitis is a specific occupational hazard of gasworkers, and the data for the four additional Gas Boards provide no further support whatsoever. The explanation for these discrepancies is obscure, but they may be due to the major changes that have been occurring in the industry during the last decade.

No evidence was obtained that by-products workers experience any risk of dying as a result of their occupation.

Images

SYNOPSIS

Objectives

We examined elevated mortality rates in Appalachian coal mining areas for 1979–2005, and estimated the corresponding value of statistical life (VSL) lost relative to the economic benefits of the coal mining industry.

Methods

We compared age-adjusted mortality rates and socioeconomic conditions across four county groups: Appalachia with high levels of coal mining, Appalachia with lower mining levels, Appalachia without coal mining, and other counties in the nation. We converted mortality estimates to VSL estimates and compared the results with the economic contribution of coal mining. We also conducted a discount analysis to estimate current benefits relative to future mortality costs.

Results

The heaviest coal mining areas of Appalachia had the poorest socioeconomic conditions. Before adjusting for covariates, the number of excess annual age-adjusted deaths in coal mining areas ranged from 3,975 to 10,923, depending on years studied and comparison group. Corresponding VSL estimates ranged from $18.563 billion to $84.544 billion, with a point estimate of $50.010 billion, greater than the $8.088 billion economic contribution of coal mining. After adjusting for covariates, the number of excess annual deaths in mining areas ranged from 1,736 to 2,889, and VSL costs continued to exceed the benefits of mining. Discounting VSL costs into the future resulted in excess costs relative to benefits in seven of eight conditions, with a point estimate of $41.846 billion.

Conclusions

Research priorities to reduce Appalachian health disparities should focus on reducing disparities in the coalfields. The human cost of the Appalachian coal mining economy outweighs its economic benefits.

Liddell, F. D. K. (1973).Brit. J. industr. Med.,30, 15-24. Mortality of British coal miners in 1961. In an earlier enquiry, a sizeable proportion of deaths officially ascribed to coalmining occupations was shown to have been in men who had worked in the industry but not in jobs specific to coalmining, or who had left the mines and taken up other employment. This led to overstatement of mortality among miners, and particularly among face workers.

A new coding of occupations was introduced in 1960, and the present investigation was concerned with all 5 362 men aged 20 to 64 who died in 1961 and were recorded as having last worked in a coalmining occupation or for the National Coal Board. The occupation at the time of last employment was determined from colliery records or after special enquiry by medical officers of health, and again was found to be at considerable variance with that on the death certificate. `Promotion' into coalmining occupations existed in all coalfields and depended on age at death and year of last appearance at work. `Promotion' to the face was particularly marked; however, more men had been working in the industry than were recorded as in specifically coalmining occupations. The effect of retirement from the coalface to other mining work was investigated.

In occupied miners underground, mortality was less than in all occupied and retired males, substantially so at the face. Miners generally had high rates of deaths from accidents and pneumoconiosis, and low rates for lung cancer. For most other causes, face workers had very low rates, while other underground workers and surface workers had rates below and above the national rates for occupied and retired males. Death rates were higher in Scotland than in the other British coalfields.

BACKGROUND: The number of asthma related treatment periods in hospital has increased in many countries, particularly among children. The aim of the present investigation was to describe the use made of hospital services by asthmatic patients over a wide range in Finland. METHODS: A total of 255,387 treatment periods for asthma that had occurred between 1972 and 1986 was collected from the discharge register maintained by the National Board of Health (diagnosis 493, International Classification of Diseases). The numbers of admissions, days in hospital, and new occurrences of asthma were calculated by sex and age in relation to the total population at the end of each year. RESULTS: Asthma induced treatment periods in hospital in Finland were 12,860 (277 treatment periods per 100,000 inhabitants) in 1972 and 20,000 (406 per 100,000 inhabitants) in 1986. The annual increase in the number of such periods was 4.7% for men (95% confidence interval (95% CI) 3.5 to 5.9%) and 3.4% for women (2.1 to 4.7%) in relation to population. The most pronounced change was found in those aged 65 years and over, in which the number of treatment periods was found to increase annually by 7.5% (6.0 to 9.0%) for men and 4.9% (3.4 to 6.5%) for women, whereas the smallest increase was found among persons under 15 years with an annual change of 1.3% (0.2 to 2.3%) for boys and 1.1% (-0.1 to 2.4%) for girls. Although the number of asthma related treatment periods increased, that of new patients with asthma did not. An average of 114 new male asthmatic patients per 100,000 men were treated in hospitals annually between 1977 and 1986, whereas the figure for women was 115; the annual change during this 10 year period was 0.2% (-0.8 to 1.2%) for men and -0.8% (-1.8 to 0.2%) for women. CONCLUSIONS: The increase in the number of asthma related hospital treatment periods seemed attributable to the frequent treatment of the same patients. Treatment periods for persons aged 40 years or over were found to increase most, suggesting that the treatment of these asthmatic patients should be optimised and its organisation improved.

As part of the Periodic X-ray Scheme of the National Coal Board (NCB), a comparison is made between the previous and new films of all miners who were face-workers on the former occasion, five years earlier. This assessment is made by distributing the films randomly to all the NCB readers. This paper compares the rank of coal mined in each colliery with each colliery's percentage prevalence of pneumoconiosis of at least ILO category 1 in the films of previous face-workers obtained during the third survey round (1969-73). Of the NCB's 291 collieries in Britain, information enabling a rank classification to be made was available for 250, employing 62 362 face-workers. In these 250 mines a progressive and five-fold increase in prevalence was observed from collieries mining low-rank (bituminous) coal to those mining coal of high ranks (anthracite and high-grade steam and coking coal). A possible reason for this is that, in the past, high-rank collieries may have had the highest mass-concentrations of respirable dust.

The association between exposure to dust and pulmonary function was studied by longitudinal and cross sectional analyses in a group of United States underground coal miners beginning work in or after 1970. Quantitative estimates of exposure to respirable coal mine dust were derived from air samples taken periodically over the entire study period. The cohort included 977 miners examined both in round 2 (R2) (1972-5) and round 4 (R4) (1985-8) of the National Study of Coal Workers' Pneumoconiosis. Multiple linear regression models were developed for both cross sectional (pulmonary function at R2 and R4) and longitudinal (change in pulmonary function between R2 and R4) analyses with exposure partitioned into pre-R2 and post-R2 periods and controlled for covariates including smoking history. The results indicate a rapid initial (at R2) loss of FVC and FEV1 in association with cumulative exposure of the order of 30 ml per mg/m3-years. Between R2 and R4 (about 13 years) no additional loss of function related to dust exposure was detected although the percentage of predicted FVC and FEV1 did decline over the period. After some 15 years since first exposure (at R4), a statistically significant association of cumulative exposure with FEV1 of about -5.9 ml per mg/m3-years was found. These results indicate a significant non-linear effect of exposure to dust on pulmonary function at dust concentrations present after regulations took effect. The initial responses in both the FVC and FEV1 are consistent with inflammation of the small airways in response to exposure to dust.

After nearly a decade as the seventh Surgeon-in-Chief (1963–1972) of The Hospital for Special Surgery (HSS), Robert Lee Patterson, Jr., MD (1907–1994) retired, having repaired adverse relations between HSS and the New York Hospital-Cornell Medical Center. Patterson, who had first joined the staff of The Hospital for the Ruptured and Crippled in 1936 as a Visiting Surgeon, was able to accomplish this very challenging task mainly through his close relationship with Preston Wade, MD (1901–1982), a general surgeon who had served with Patterson as Co-Chief of the combined New York Hospital-HSS Fracture service. The Board of Trustees of the New York Society for the Relief of the Ruptured and Crippled appointed Philip D. Wilson, Jr. MD, as the eighth Surgeon-in-Chief of The Hospital for Special Surgery. He assumed that office on July 1, 1972. Wilson, who had joined the staff as an Orthopaedic Surgeon to the Out-Patient Department in 1951, had trained as an orthopaedic resident at HSS from 1948 to 1950 and in 1951, finished his residency at the University of California Hospital Medical Center, San Francisco. During his 17 years as Surgeon-in-Chief, he led the hospital into the advanced field of implant research and development and building a world-class center for patient care. Additionally, many other orthopaedic services such as Sports Medicine, Scoliosis and Metabolic Bone Diseases became the leaders in their fields. Supporting Departments of Rheumatology, Anesthesia and others were likewise recognized foremost in the country.

Background

Board certification is an important professional qualification and a prerequisite for credentialing, and the Accreditation Council for Graduate Medical Education (ACGME) assesses board certification rates as a component of residency program effectiveness. To date, research has shown that preresidency measures, including National Board of Medical Examiners scores, Alpha Omega Alpha Honor Medical Society membership, or medical school grades poorly predict postresidency board examination scores. However, learning styles and temperament have been identified as factors that 5 affect test-taking performance. The purpose of this study is to characterize the learning styles and temperaments of pediatric residents and to evaluate their relationships to yearly in-service and postresidency board examination scores.

Methods

This cross-sectional study analyzed the learning styles and temperaments of current and past pediatric residents by administration of 3 validated tools: the Kolb Learning Style Inventory, the Keirsey Temperament Sorter, and the Felder-Silverman Learning Style test. These results were compared with known, normative, general and medical population data and evaluated for correlation to in-service examination and postresidency board examination scores.

Results

The predominant learning style for pediatric residents was converging 44% (33 of 75 residents) and the predominant temperament was guardian 61% (34 of 56 residents). The learning style and temperament distribution of the residents was significantly different from published population data (P  =  .002 and .04, respectively). Learning styles, with one exception, were found to be unrelated to standardized test scores.

Conclusions

The predominant learning style and temperament of pediatric residents is significantly different than that of the populations of general and medical trainees. However, learning styles and temperament do not predict outcomes on standardized in-service and board examinations in pediatric residents.

The National Energy Plan proposed by President Carter provides for the rapid development of coal resources in the United States, particularly in the West. The potential consequences for health of this development were considered by the Advisory Committee on Health and Environmental Effects of Increased Coal Utilization, reporting to the Department of Energy. Their report recommended rigid adherence to pertinent existing regulations, improved environmental monitoring, expanded research in selected relevant topics and development of procedures for selecting the sites of new coal-fired power plants. Although the report was a major exercise in technology assessment, it is fundamentally a cautious document that proposes no new solutions or approaches. A review of occupational and community health problems associated with coal mining and coal utilization suggests that lessons from past experiences, especially in Appalachia, cannot be applied to the West uncritically. The two regions are fundamentally different in scale, topography and social development. In the West, future problems related to coal are likely to derive from unknown risks associated with coal processing technologies, land reclamation and water quality at the sites of power generation, and extensive social and demographic changes at centers of industrial activity that may have secondary effects on health. Additional considerations should supplement the recommendations of the Advisory Committee report.

The correlation of the medical and environmental data (i.e. the derivation of the dosage-response relationship) in a study such as the National Coal Board's Pneumoconiosis Field Research (P.F.R.) is subject to many complicating factors compared with the more conventional types of biological assay. Several methods have been developed within the Research to overcome these difficulties, and the new procedures are described. Each is concerned with the estimation of the direct relation between the radiological abnormality associated with simple pneumoconiosis and some single measure of the past hazard, but the basic techniques are sufficiently general to be applicable in other fields of study.

The first development involves the definition of an underlying continuous scale of radiological abnormality. This prepares the way for the derivation of the “quantitative” relation between exposure and response, to replace the “semi-quantal” relation which is inherent in the use of a small number of discrete categories of radiological abnormality. The effect of errors of observation of dosage and response on the corresponding quantitative and quantal relationships is then determined.

The second development concerns the use of a “multi-dimensional” representation of past hazard. Most of the men under observation had worked in a number of different mining occupations before their first chest radiograph was taken, but this exposure cannot be assessed in terms of dust concentrations, for which reliable data are not available. Nevertheless, it is shown that past hazard can usefully be represented by three “dimensions” corresponding to the periods spent in three main types of environment—(a) the coal-face (coal-getting shift), (b) the coal-face (preparation shift) and (c) elsewhere underground. Each man's past exposure up to the time of his first chest radiograph can be expressed in terms of these three dimensions and the effect of each environment separately can be determined.

The third development extends the multi-dimensional approach to cover not only the working history before the first medical examination, but also the recorded exposure (in terms of measured dust concentrations), to which each man has been subject between the first and subsequent “follow-up” surveys. This measured exposure is regarded as one dimension of the man's total exposure up to the time of his second (or later) examination, and it is possible in this way to determine the direct relation between radiological abnormality and measured exposure, even when this component represents only part of the total hazard to which the man has been subject.

The application of the methods is illustrated by the analysis of some of the data which have been obtained in the Pneumoconiosis Field Research.

Introduction

Tropical regions have been shown to exhibit different influenza seasonal patterns compared to their temperate counterparts. However, there is little information about the burden of annual tropical influenza epidemics across time, and the relationship between tropical influenza epidemics compared with other regions.

Methods

Data on monthly national mortality and population was obtained from 1947 to 2003 in Singapore. To determine excess mortality for each month, we used a moving average analysis for each month from 1950 to 2000. From 1972, influenza viral surveillance data was available. Before 1972, information was obtained from serial annual government reports, peer-reviewed journal articles and press articles.

Results

The influenza pandemics of 1957 and 1968 resulted in substantial mortality. In addition, there were 20 other time points with significant excess mortality. Of the 12 periods with significant excess mortality post-1972, only one point (1988) did not correspond to a recorded influenza activity. For the 8 periods with significant excess mortality periods before 1972 excluding the pandemic years, 2 years (1951 and 1953) had newspaper reports of increased pneumonia deaths. Excess mortality could be observed in almost all periods with recorded influenza outbreaks but did not always exceed the 95% confidence limits of the baseline mortality rate.

Conclusion

Influenza epidemics were the likely cause of most excess mortality periods in post-war tropical Singapore, although not every epidemic resulted in high mortality. It is therefore important to have good influenza surveillance systems in place to detect influenza activity.

As with the delivery of any medical service, abortion has definite public health effects that should be evaluated. The Center for Disease Control (CDC) has monitored the impact of abortion in three ways: (a) conducting epidemiologic surveillance of legally induced abortion beginning in 1969. (b) funding a multicenter study of abortion morbidity beginning in 1971, and (c) undertaking surveillance of abortion-related mortality beginning in 1972. These activities are intended to identify health problems related to abortion, to assess the magnitude of these problems, and to make recommendations directed at eliminating the problems. In addition to the Programmatic uses of abortion data, the CDC statistics have also provided a basis for both legislative and judicial decisions that have had national and local impact. The CDC and the National Center for Health Statistics are currently working collectively to strengthen the reporting of national abortion statistics so that the public health need for abortion statistics can be met.

Liddell, F. D. K. (1974).British Journal of Industrial Medicine,31, 185-195. Assessment of radiological progression of simple pneumoconiosis in individual miners. The studies reported aimed to determine the best method of assessing radiological progression of simple pneumoconiosis in the individual, so that his progression score could be related to other known information about him. The main concern was with subjects for whom three serial posteroanterior chest radiographs were available at approximately quinquennial intervals.

As in other investigations, the 12-point scale of the National Coal Board elaboration led to markedly lower observer error and variability than did the 4-point International Labour Office classification, without distorting levels of progression.

Side-by-side reading led to substantially lower observer error and variability than did independent reading. Although the levels of progression in side-by-side reading were on average a little lower than in independent reading, the effect varied between readers and sessions, being frequently reversed.

Of the three possible methods of side-by-side assessment, the only one without contraindictions was that in which all three films for each subject were viewed together, and there were some specific indications for this approach. Viewing only the first and last films led to some loss of information; viewing all three possible pairs was very expensive of time, both in organization and in actual reading, and was not entirely consistent (additive); and disguise of temporal order of the films proved impractical.

It is concluded that the method of choice for assessing progression in the individual from serial films at roughly quinquennial intervals is to view all films together in known temporal order, recording into the most detailed classification available.

Lloyd Davies, T. A., Doig, A. T., Fox, A. J., and Greenberg, M. (1973).British Journal of Industrial Medicine,30, 227-231. A radiographic survey of monumental masonry workers in Aberdeen. A survey of radiographic appearances of the lungs of monumental masonry workers in Aberdeen was carried out to determine the present prevalence of abnormalities and to serve as a standard for future comparisons in view of changes in methods of working. No major change could be detected in the status of these granite workers in Aberdeen over the past 20 years but the different methods of survey used by Mair in 1951 and by the present study did not allow of strict comparison. Chest radiographs were reported on by three readers independently using the National Coal Board elaboration of the ILO classification and a score was given to each film using Oldham's method. Multiple regression analysis showed that ϰ-ray changes were related to years in granite but progression was slow in comparison with foundry workers. The prevalence of radiographic appearances of category 1 or greater was 3·0% overall and 4·6% for workers in dusty jobs. Evidence of pneumoconiosis was not observed in workers exposed for less than 20 years.

With the environmental control attained the threshold limit values for respirable dust were not often much exceeded.

An investigation into the effect of variations in radiographic technical quality on pneumoconiosis reading standards in the Pneumoconiosis Field Research of the National Coal Board is reported. From the group of men for whom retake films had been obtained because of unsatisfactory technique of the originals, a trial series of pairs and triplets of films showing differing technique was assembled.

A total of 778 films was read for pneumoconiosis and assessed for technical quality by four readers. The quality was assessed in terms of three separate factors, viz., density (at high, medium, and low levels), contrast (satisfactory and unsatisfactory), and definition (satisfactory and unsatisfactory). The intra and inter observer consistency of this assessment was estimated, and the effect of techical quality on the reading of pneumoconiosis category was determined. A tendency for lower pneumoconiosis readings to be recorded on films with unsatisfactory technique was demonstrated.

A random 10% sample of the best available films (those on which routine pneumoconiosis readings have been made) for all men examined since the beginning of the research was also read for technical quality. Of the total of 4,188 films, 80% were considered satisfactory. It appeared that films taken on second surveys were, in general, of rather better quality than those taken on first surveys.

The physical attributes of the men examined had some effect on the technical standards, the proportion of unsatisfactory films rising with increasing values of the weight/sitting height ratio and being greater in men with pneumoconiosis categories 1 and A and in the middle age group.

The tendency for lower pneumoconiosis readings to be recorded on films with unsatisfactory technique is in contrast to the results of work previously published. Different criteria for the selection of films and the assessment of technical quality, and possibly differing reading conventions, make comparison with other work difficult.

This study constitutes one part of a program for assessing the impact of coal-fired power plants on the surrounding communities. A questionnaire was mailed to a total of 12,000 subjects living in six areas with coal-fired plants and in matched reference areas. The participation rate was 77.3%. In one coal-fired plant/reference area pair, a more detailed medical examination was carried out among subjects who reported symptoms of the respiratory tract. The match between coal-fired plant and reference areas was successful primarily in three pairs. Neither respiratory symptoms nor disease rates were increased among adults or children near any of these plants, but one plant seemed to give rise to annoyance. For the remaining coal-fired plants, consistently higher prevalences of respiratory tract symptoms and annoyance were observed in the surrounding population. The effects cannot, however, conclusively be related to the coal-fired plants. It should be pointed out that the air pollution levels were relatively low, also in the vicinity of most of the plants in this study.

Bergman, I., and Casswell, C. (1972).Brit. J. industr. Med.,29, 160-168. Lung dust and lung iron contents of coal workers in different coalfields in Great Britain. Lung dust analyses from seven coalfields are studied and it is found that the average dust composition varies significantly with the rank of coal. The higher the rank, the higher the coal percentage and the lower the quartz percentage of the lung dust. This holds for all coalfields except in Scotland, where the lung dust contains mainly soot instead of coal.

Samples of airborne dust collected at the coalface in different coalfields show a similar but small variability of composition with rank of coal, and the results from Scotland are in good agreement with the results from other coalfields.

The amount of iron in simple pneumoconiosis lungs is related to their mineral and coal contents and to the factor `years underground'. The strongest relationship is with coal and mineral for coalface workers from England. For pit accident cases (all simple pneumoconiosis) mineral is important as well as years underground, while for simple pneumoconiosis cases from Scotland, years underground is the most important factor.

At the time this paper was written a unique trial project for disseminating medical literature to physicians had been in operation for six months (October 1971-April 1972) at the Virginia Medical Information System. Doctors in the state who referred patients to the Medical College of Virginia received short lists of references relevant to the problems of their patients as described in referral letters sent them by MCV consultants. Doctors receiving such lists were offered free photocopies of the articles cited if they could not obtain them locally. Of some 700 reference lists sent out, VAMIS received 12½ percent direct responses, and 22 percent of respondents to a questionnaire reported obtaining articles elsewhere. Ninety percent of the respondents favored the service and approved of its method. Funding problems necessitated revision of the service in the summer of 1972. Presently the service is provided only on request of the referring physician.

Hypertension (high blood pressure) is 1 of 15 health priorities of the Public Health Service set forth in the report, "Promoting Health/Preventing Disease: Objectives for the Nation." The nine objectives for hypertension include improved health status, reduced risk factors, increased public-professional awareness, improved services and protection, and improved surveillance-evaluation systems. A number of Federal agencies, coordinated by the National Heart, Lung, and Blood Institute, are working to reach the hypertension objectives in cooperation with State, local, and voluntary agencies and organizations. A great deal of progress has been made toward the objectives, as reflected by a variety of indicators. By 1980, for example, 34.1 percent of the population with hypertension had their blood pressure controlled at less than 160/95 mm Hg, but in 1972 only 16.5 percent were so controlled. Since 1972, the age-adjusted death rate has dropped 42 percent for stroke and 27 percent for coronary heart disease. Data indicate that the national goal for sodium ingestion (3-6 grams daily) may already have been met. Fifty-one percent of the population understand that hypertension may lead to stroke, meeting another objective. Public knowledge about hypertension as a "major likely cause of heart trouble" almost doubled in the 6-year period for which data are available. In 1982, 30 percent of processed food in grocery stores had sodium content labeling and almost 50 percent had calorie labeling, according to studies conducted by the Bureau of Foods of the Food and Drug Administration. Efforts are underway to develop a methodology for assessing incidence of hypertension and categories of hypertension control, a need spelled out in another objective.

In recent years, the behavioral sciences have contributed tremendously tot he education of future physicians, dentists, nurses, and other health care professionals. With the inclusion of the behavioral sciences component in the National Board Examination (1972), many medical schools have revised their curricula to include sociology in the training of the future physician. However, the tremendous shortage of qualified social scientists made it difficult to meet the needs of medical schools and health programs in the country.

In view of this problem, this paper will present a single conceptual model that can be used as an organizational device for teaching some basic social science concepts to health care students and to assist them in the comprehension of the impact of society-culture-personality (SCP) on the health care institution as a whole. Uses of this model have been presented elsewhere.1,2

Background

Accurate nationally representative statistics on total and cause-specific mortality in Vietnam are lacking due to incomplete capture in government reporting systems. This paper presents total and cause-specific mortality results from a national verbal autopsy survey conducted first time in Vietnam in conjunction with the annual population change survey and discusses methodological and logistical challenges associated with the implementation of a nation-wide assessment of mortality based on surveys.

Verbal autopsy interviews, using the WHO standard questionnaire, were conducted with close relatives of the 6798 deaths identified in the 2007 population change survey in Vietnam. Data collectors were health staff recruited from the commune health station who undertook 3-day intensive training on VA interview. The Preston-Coale method assessed the level of completeness of mortality reporting from the population change survey. The number of deaths in each age-sex grouping is inflated according to the estimate of completeness to produce an adjusted number of deaths. Underlying causes of death were aggregated to the International Classification of Diseases Mortality Tabulation List 1. Leading causes of death were tabulated by sex for three broad age groups: 0-14 years; 15-59 years; and 60 years and above.

Findings

Completeness of mortality reporting was 69% for males and 54% for females with substantial regional variation. The use of VA has resulted in 10% of deaths being classified to ill-defined among males, and 15% among females. More ill-defined deaths were reported among the 60 year or above age group. Incomplete death reporting, wide geographical dispersal of deaths, extensive travel between households, and substantial variation in local responses to VA interviews challenged the implementation of a national mortality and cause of death assessment based on surveys.

Conclusions

Verbal autopsy can be a viable tool to identify cause of death in Vietnam. However logistical challenges limit its use in conjunction with the national sample survey. Sentinel population clusters for mortality surveillance should be tested to develop an effective and sustainable option for routine mortality and cause of death data collection in Vietnam.

The results are presented from an investigation into the mortality of miners and ex-miners employed by the National Coal Board, from a comprehensive survey of respiratory disease in a Welsh mining community, and from a study of the comparative mortality from lung cancer in Welsh mining and non-mining towns. These results, together with previously published data which have been reviewed, show that in Great Britain the death rate of coal-miners from cancer of the lung is appreciably lower than the national rate for men of comparable age.

This occupational trend is not explicable by any of the factors which are known to influence the prevalence of the disease in the general population. In particular there is much evidence that the cigarette consumption of miners at least equals that of men in other occupations. The exclusion of this and other recognized aetiological factors suggests that the reduced mortality of miners from this disease is a specific effect of their occupation.

This effect might be a consequence of the inhalation of coal-dust, for there is some evidence that the incidence of death from lung cancer is lowest among miners whose exposure to coal-dust has been greatest.

This is a statistical survey of the trends in biophysical research as reflected by papers presented at four Biophysical Society (BPS) annual meetings between 1958 and 1972 and by the funding sources of the reported projects. The study reveals that biophysical research has grown quite substantially, particularly since 1968. Although biophysics is truly interdisciplinary, since 1968 there has been more pronounced emphasis on biomedically oriented problems and a tendency toward more specific and more highly specialized problems. Between 1958 and 1972, most biophysicists were academic researchers, 50% of whom were biomedical scientists. Over three quarters of the ongoing biophysical research projects during this period were supported by governmental agencies, and among them, the National Institutes of Health was the largest single funding source.