Measuring and decomposing inequity in self-reported morbidity and self-assessed health in Thailand

BACKGROUND In recent years, interest in the study of inequalities in health has not stopped at quantifying their magnitude; explaining the sources of inequalities has also become of great importance. This paper measures socioeconomic inequalities in self-reported morbidity and self-assessed health in Thailand, and the contributions of different population subgroups to those inequalities. METHODS The Health and Welfare Survey 2003 conducted by the Thai National Statistical Office with 37,202 adult respondents is used for the analysis. The health outcomes of interest derive from three self-reported morbidity and two self-assessed health questions. Socioeconomic status is measured by adult-equivalent monthly income per household member. The concentration index (CI) of ill health is used as a measure of socioeconomic health inequalities, and is subsequently decomposed into contributing factors. RESULTS The CIs reveal inequality gradients disadvantageous to the poor for both self-reported morbidity and self-assessed health in Thailand. The magnitudes of these inequalities were higher for the self-assessed health outcomes than for the self-reported morbidity outcomes. Age and sex played significant roles in accounting for the inequality in reported chronic illness (33.7 percent of the total inequality observed), hospital admission (27.8 percent), and self-assessed deterioration of health compared to a year ago (31.9 percent). The effect of being female and aged 60 years or older was by far the strongest demographic determinant of inequality across all five types of health outcome. Having a low socioeconomic status as measured by income quintile, education and work status were the main contributors disadvantaging the poor in self-rated health compared to a year ago (47.1 percent) and self-assessed health compared to peers (47.4 percent). Residence in the rural Northeast and rural North were the main regional contributors to inequality in self-reported recent and chronic illness, while residence in the rural Northeast was the major contributor to the tendency of the poor to report lower levels of self-assessed health compared to peers. CONCLUSION The findings confirm that substantial socioeconomic inequalities in health as measured by self-reported morbidity and self-assessed health exist in Thailand. Decomposition analysis shows that inequalities in health status are associated with particular demographic, socioeconomic and geographic population subgroups. Vulnerable subgroups which are prone to both ill health and relative poverty warrant targeted policy attention

Effects of the New Cooperative Medical Scheme on village doctor’s prescribing behaviour in Shandong Province

Objective: To assess the effects of China’s new community health insurance, the New Cooperative Medical Scheme (NCMS), on village doctors’ prescribing behaviour. NCMS began in 2003. Method, In 2005 we conducted a quasi-experimental case-control study in Shandong Province, and collected information from 2,271 patient visits in 30 village health stations. Results, NCMS has adversely influenced prescribing behaviour of village doctors. Average number of drugs prescribed, percentage of prescriptions containing antibiotics, number of antibiotics per prescription, percentage of patients given injections, and average per prescription cost were consistently higher in NCMS village health stations than non-NCMS. Within NCMS villages, prescribing behaviour towards insured patients was significantly different to the uninsured. Conclusion, Over-prescribing is common in villages with and without health insurance, with grave concerns for service quality and drug-use safety. Policy implications are NCMS should be redesigned to exert more influence on health providers, with incentives for cost containment and service quality. Stricter regulatory environment for prescriptions is necessary to counter irrational drug-use and ensure people’s access to effective care at reasonable cost.

Demographic disequilibrium in early twentieth century Thailand: Falling mortality, rising fertility, or both?

Estimates of Thai crude birth and death rates date from 1920, when the former was around 20 per thousand higher than the latter, implying natural increase of two per cent per annum. Such disequilibrium cannot have been the norm over the long-term historical past, when population growth must have been comparatively slow. This paper explores the bases for likely past relative equilibrium between Siamese birth and death rates, then seeks to explain the disequilibrium apparent by 1920. Classic demographic transition theory postulates initially high birth and death rates, this equilibrium eventually being broken by falling mortality. In Thailand, however, there is likely to have been both significant mortality decline and appreciable fertility increase after 1850, as the virtual elimination of indigenous warfare, rapid growth of the export rice economy and the demise of slavery and corvee labour created a new domestic environment. Characterized by more dispersed, often frontier, settlement, this environment was unprecedentedly sedate and settled, afforded ordinary households a previously unknown level of control over their resources of labour, and generated optimism about prospects for the next generation

Nonequilibrium and Nonlinear Dynamics in Geomaterials I : The Low Strain Regime

Members of a wide class of geomaterials are known to display complex and fascinating nonlinear and nonequilibrium dynamical behaviors over a wide range of bulk strains, down to surprisingly low values, e.g., 10^{-7}. In this paper we investigate two sandstones, Berea and Fontainebleau, and characterize their behavior under the influence of very small external forces via carefully controlled resonant bar experiments. By reducing environmental effects due to temperature and humidity variations, we are able to systematically and reproducibly study dynamical behavior at strains as low as 10^{-9}. Our study establishes the existence of two strain thresholds, the first, epsilon_L, below which the material is essentially linear, and the second, epsilon_M, below which the material is nonlinear but where quasiequilibrium thermodynamics still applies as evidenced by the success of Landau theory and a simple macroscopic description based on the Duffing oscillator. At strains above epsilon_M the behavior becomes truly nonequilibrium -- as demonstrated by the existence of material conditioning -- and Landau theory no longer applies. The main focus of this paper is the study of the region below the second threshold, but we also comment on how our work clarifies and resolves previous experimental conflicts, as well as suggest new directions of research.Comment: 14 pages, 15 figure

Episodic X-ray Emission Accompanying the Activation of an Eruptive Prominence: Evidence of Episodic Magnetic Reconnection

We present an X-ray imaging and spectroscopic study of a partially occulted C7.7 flare on 2003 April 24 observed by RHESSI that accompanied a prominence eruption observed by TRACE. (1) The activation and rise of the prominence occurs during the preheating phase of the flare. The initial X-ray emission appears as a single coronal source at one leg of the prominence and it then splits into a double source. Such a source splitting happens three times, each coinciding with an increased X-ray flux and plasma temperature, suggestive of fast reconnection in a localized current sheet and an enhanced energy release rate. In the late stage of this phase, the prominence displays a helical structure. These observations are consistent with the tether-cutting and/or kink instability model for triggering solar eruptions. (2) The eruption of the prominence takes place during the flare impulsive phase. Since then, there appear signatures predicted by the classical CSHKP model of two-ribbon flares occurring in a vertical current sheet trailing an eruption. These signatures include an EUV cusp and current-sheet-like feature (or ridge) above it. There is also X-ray emission along the EUV ridge both below and above the cusp, which in both regions appears closer to the cusp at higher energies in the thermal regime. This trend is reversed in the nonthermal regime. (3) Spectral analysis indicates thermal X-rays from all sources throughout the flare, while during the impulsive phase there is additional nonthermal emission which primarily comes from the coronal source below the cusp. This source also has a lower temperature, a higher emission measure, and a much harder nonthermal spectrum than the upper sources.Comment: 8 pages, 5 figures, submitted to Ap

Conjugate Hard X-ray Footpoints in the 2003 October 29 X10 Flare: Unshearing Motions, Correlations, and Asymmetries

We present a detailed imaging and spectroscopic study of the conjugate hard X-ray (HXR) footpoints (FPs) observed with RHESSI in the 2003 October 29 X10 flare. The double FPs first move toward and then away from each other, mainly parallel and perpendicular to the magnetic neutral line, respectively. The transition of these two phases of FP unshearing motions coincides with the direction reversal of the motion of the loop-top (LT) source, and with the minima of the estimated loop length and LT height. The FPs show temporal correlations between HXR flux, spectral index, and magnetic field strength. The HXR flux exponentially correlates with the magnetic field strength, which also anti-correlates with the spectral index before the second HXR peak's maximum, suggesting that particle acceleration sensitively depends on the magnetic field strength and/or reconnection rate. Asymmetries are observed between the FPs: on average, the eastern FP is 2.2 times brighter in HXR flux and 1.8 times weaker in magnetic field strength, and moves 2.8 times faster away from the neutral line than the western FP; the estimated coronal column density to the eastern FP from the LT source is 1.7 times smaller. The two FPs have marginally different spectral indexes. The eastern-to-western FP HXR flux ratio and magnetic field strength ratio are anti-correlated only before the second HXR peak's maximum. Neither magnetic mirroring nor column density alone can explain the totality of these observations, but their combination, together with other transport effects, might provide a full explanation. We have also developed novel techniques to remove particle contamination from HXR counts and to estimate effects of pulse pileup in imaging spectroscopy, which can be applied to other RHESSI flares in similar circumstances.Comment: 22 pages, 14 figures, 4 tables; ApJ 2009, in pres

Competitive stochastic noises in coherently driven two-level atoms and quantum interference

A system of coherently-driven two-level atoms is analyzed in presence of two independent stochastic perturbations: one due to collisions and a second one due to phase fluctuations of the driving field. The behaviour of the quantum interference induced by the collisional noise is considered in detail. The quantum-trajectory method is utilized to reveal the phase correlations between the dressed states involved in the interfering transition channels. It is shown that the quantum interference induced by the collisional noise is remarkably robust against phase noise. This effect is due to the fact that the phase noise, similarly to collisions, stabilizes the phase-difference between the dressed states.Comment: accepted for publication in J. Opt.