Christopher J. Mansfield

The doctor as God's mechanic? Beliefs in the Southeastern United States.

Spiritual practice and beliefs related to healing are described using data from a telephone survey. Questions in the survey address the practice of prayer and spiritual beliefs related to healing. Questions explore belief in miracles, that God acts through religious healers, the importance of Gods will in healing, and that God acts through physicians. Questions also ask whether people discuss spiritual concerns with their physician and whether they would want to if seriously ill. We create a composite index to compare religious faith in healing across race, gender, education, income denomination, and health status. Logistic regression predicts types of patients who believe God acts through physicians and those inclined to discuss spiritual concerns when ill. The most important findings are that: 80% of respondents believe God acts through physicians to cure illness, 40% believe Gods will is the most important factor in recovery, and spiritual faith in healing is stronger among women. African-Americans, Evangelical Protestants, the poorer, sicker, and less educated. Those who believe that God acts through physicians are more likely to be African-American than White (OR = 1.9) and 55 or older (OR = 3.5). Those who discuss spiritual concerns with a physician are more likely to be female (OR = 1.9) and in poor health (OR = 2.1). Although 69% say they would want to speak to someone about spiritual concerns if seriously ill, only 3% would choose to speak to a physician. We conclude that religious faith in healing is prevalent and strong in the southern United States and that most people believe that God acts through doctors. Knowledge of the phenomena and variation across the population can guide inquiry into the spiritual concerns of patients.

Premature mortality in the United States: the roles of geographic area, socioeconomic status, household type, and availability of medical care.

OBJECTIVES This study examined premature mortality by county in the United States and assessed its association with metro/urban/rural geographic location, socioeconomic status, household type, and availability of medical care. METHODS Age-adjusted years of potential life lost before 75 years of age were calculated and mapped by county. Predictors of premature mortality were determined by multiple regression analysis. RESULTS Premature mortality was greatest in rural counties in the Southeast and Southwest. In a model predicting 55% of variation across counties, community structure factors explained more than availability of medical care. The proportions of female-headed households and Black populations were the strongest predictors, followed by variables measuring low education, American Indian population, and chronic unemployment. Greater availability of generalist physicians predicted fewer years of life lost in metropolitan counties but more in rural counties. CONCLUSIONS Community structure factors statistically explain much of the variation in premature mortality. The degree to which premature mortality is predicted by percentage of female-headed households is important for policy-making and delivery of medical care. The relationships described argue strongly for broadening the biomedical model.

Beyond the BMI: The Search for Better Guidelines for Bariatric Surgery

The application of the BMI of ≥35 as the major prerequisite for access to bariatric surgery is no longer appropriate because the index, now incorporated in the requirements of Medicare, Medicaid and most private carriers, does not reflect the degree or distribution of adiposity, it discriminates unfairly on the basis of gender, race, age, fitness, and body fat composition. Further, with increasing evidence that bariatric surgery can also induce full and durable remission of such comorbidities as type 2 diabetes even in patients with BMIs <30, new guidelines must be pursued.

Cost-effectiveness of low-molecular-weight heparin in the treatment of proximal deep vein thrombosis

AbstractOBJECTIVE: To estimate the cost-effectiveness of low-molecular-weight heparin (LMWH) in the treatment of proximal lower extremity deep venous thrombosis. DESIGN: Cost-effectiveness analysis that includes the treatment of the index case and simulated 3-month follow-up. SETTING: Acute care facility. PATIENTS AND PARTICIPANTS: Hypothetical cohorts of 1,000 patients who present with proximal deep venous thrombosis. INTERVENTIONS: Intravenous unfractionated heparin (UH), LMWH (40% at home, 60% in hospital), or selective UH/LMWH (UH for hospitalized patients and LMWH for patients treated at home). MEASUREMENTS AND MAIN RESULTS: The outcomes were recurrent thrombosis, mortality, direct medical costs, and marginal cost-effectiveness ratios from the payer’s perspective. At the base-case and under most assumptions in the sensitivity analysis, the LMWH and the selective UH/LMWH strategies dominate the UH strategy i.e., they result in fewer cases of recurrent thrombosis and fewer deaths, and they save resources. The savings occur primarily by decreasing the length of stay. The LMWH strategy resulted in lower costs as compared with the UH strategy when the proportion of patients treated at home was more than 14%. Treating 1,000 patients with the LMWH strategy as compared with the UH/LMWH strategy would result in 10 fewer cases of recurrent thrombosis, 1.2 fewer deaths, at an additional cost of

Health Policy and Economics

96,822; the cost-effectiveness ratio was

Impacts of a Flood Disaster on an Ambulatory Pediatric Clinic Population

9,667 and

Disease, Death, and the Body Politic: An Areal Interpolation Example for Political Epidemiology

80,685 per recurrent thrombosis or death prevented, respectively. CONCLUSIONS: Treatment with LMWH leads to savings and better outcomes as compared with UH in patients with lower extremity deep venous thrombosis. The selective UH/LMWH strategy is an alternative option.

Oral Health in North Carolina Relationship With General Health and Behavioral Risk Factors

Mr. Olds, a patient of Dr. Wellman’s with Alzheimer’s disease, had a fall in the nursing home from what a nurse suggested might be a minor stroke. Dr. Wellman thought an MRI would be useful to confirm that possibility. He was advising Mr. Olds’s daughter, Jane, about treatment options when she broke into tears. Jane stated that she is overwhelmed by problems in her life. Dr. Wellman had provided prenatal care and delivered her two children but had seen neither the children nor Jane in the last 4 years. In exploring the nature of her distress, he discovered that Jane divorced shortly after the birth of her last child. She has been working full time since then at the local minimart and “making do the best I can.” Jane feels guilty that she can visit her father only on Sundays. She is worried about a lump on her breast and her 4-year-old who still suffers from frequent earaches. Dr. Wellman asks her to make an appointment for herself. Jane has postponed seeing a physician because she doesn’t have health insurance. Jane asks Dr. Wellman how much the visit will cost.

Breaking the barriers: strategies for a comprehensive u.s. Tobacco control program.

gory II storm, made landfall on the North Carolina coast. Over the course of 2 days, the hurricane dropped 21 inches of rain on a region of the state that had been drenched by a tropical storm 1 week earlier. These storms led to the worst flood disaster in the states history. Sixtysix counties in eastern North Carolina were affected by the hurricane and flooding. The flood claimed 52 lives. More than 7,000 homes were destroyed, 17,000 were left uninhabitable, and 55,000 were damaged. An estimated 50,000 people sought refuge in shelters during the height of the disaster. Many busi-

Increased Mortality and Health Risk Behaviors of Midlife White North Carolinians: A Marked Contrast to Nonwhites

More than a trillion dollars of public money is spent annually on health care in the United States. In order to inform policymakers, health advocacy groups, tax-paying constituents, and beneficiaries, it would be useful to present and analyze health outcome and health-related data at the U.S. congressional district level. Presently, health event data are not reported at this political unit; however, recent interest and advances in areal interpolation techniques are beginning to transcend the inherent limitations imposed by legacy data collection and analyses systems. In this paper, the authors use the dasymetric approach to illustrate how this areal interpolation technique can be used to transfer county-level mortality rate data from several causes of death to the U.S. congressional district level. The study’s primary goal is to promote areal interpolation techniques in the absence of a systematic and comprehensive national program for geocoding health events.