Decile Groups Research Articles

Predicting risk of hospitalisation or death: a retrospective population-based analysis

ObjectivesDevelop predictive models using an administrative healthcare database that provide information for Patient-Centred Medical Homes to proactively identify patients at risk of hospitalisation for conditions that may be impacted through...

Is Korea Number One in Human Capital Accumulation?: Education Bubble Formation and Its Labor Market Evidence

This paper proposes a new conceptual framework of “education bubble” in analyzing the human capital investment and formation. We apply this concept to the Korean experience. Sixty years ago Korea was destitute not only of income but also of all sorts of education, but now it is one of the leading countries in educational attainment as well as in other conventional measures of human capital investment indices such as the PISA tests and the number of researchers. We argue, however, that such phenomenal expansion of these quantitative measures involved the problems of enormous burden of private tutoring and the mass production of low-quality higher education institutions, which did not contribute to increasing the effective unit of human capital particularly since the 1990s. We find that despite rapid increase in private educational expenditure for college entrance, the college wage premiums for the bottom two decile groups of 4-year college graduates and the bottom half of 2-year college graduates are both negative. This striking evidence from the microeconomic data suggests that such phenomenal expansion in aggregate quantity of human capital indices of Korea could be a bubble. We learn from this evidence that the quantitative expansion of education may not be good enough for sustainable development, which would guide the design of human capital policy not only for Korea but also for other developing countries.

A population-based approach to define body-composition phenotypes

Abnormal body compositions such as high adiposity (HA), low muscle mass (LM), or a combination of the 2 [high adiposity with low muscle mass (HA-LM)] are relevant phenotypes, but data on their prevalence and impact on health are still limited. This is largely because of a lack of a consensus definition for these conditions. Of particular interest is the HA-LM phenotype, also termed "sarcopenic obesity," which may confer greater health risk. We propose a new approach for operationalizing abnormal body-composition phenotypes in a representative adult population. Whole-body dual-energy X-ray absorptiometry data obtained from the 1999-2004 NHANES were analyzed for 13,236 subjects aged ≥18 y (maximum weight and height of 136 kg and 1.96 m, respectively). Sex- and body mass index (BMI)-specific decile groups of appendicular skeletal muscle index (ASMI; kg/m²) and fat mass index (FMI; kg/m²) were developed. Cutoffs for HA and LM were incorporated into a diagnostic framework to characterize 4 specific body-composition phenotypes-low adiposity with high muscle mass, high adiposity with high muscle mass, low adiposity with low muscle mass, and HA-LM-and a subclassification of the phenotypes into classes I, II, and III. Abnormal phenotypes were prevalent across the age spectrum and BMI categories. The association between ASMI or FMI and age was modified by sex and BMI. The prevalence of HA-LM in the whole sample was 10.3% in women and 15.2% in men. The prevalence of all subclasses of HA-LM in obese women and men was 14.7% and 22.9%, respectively. HA-LM class III was more prevalent in obese men (2.3%) than in obese women (0.3%). We developed sex- and BMI-specific reference curves to harmonize the classification of body-composition phenotypes. The application of this classification will be particularly useful in the identification of cases of sarcopenic obesity. The association of these phenotypes with metabolic deregulation and increased disease risk awaits verification.

Holstein-Friesian calves selected for divergence in residual feed intake during growth exhibited significant but reduced residual feed intake divergence in their first lactation

Residual feed intake (RFI), as a measure of feed conversion during growth, was estimated for around 2,000 growing Holstein-Friesian heifer calves aged 6 to 9mo in New Zealand and Australia, and individuals from the most and least efficient deciles (low and high RFI phenotypes) were retained. These animals (78 New Zealand cows, 105 Australian cows) were reevaluated during their first lactation to determine if divergence for RFI observed during growth was maintained during lactation. Mean daily body weight (BW) gain during assessment as calves had been 0.86 and 1.15kg for the respective countries, and the divergence in RFI between most and least efficient deciles for growth was 21% (1.39 and 1.42kg of dry matter, for New Zealand and Australia, respectively). At the commencement of evaluation during lactation, the cows were aged 26 to 29mo. All were fed alfalfa and grass cubes; it was the sole diet in New Zealand, whereas 6kg of crushed wheat/d was also fed in Australia. Measurements of RFI during lactation occurred for 34 to 37 d with measurements of milk production (daily), milk composition (2 to 3 times per week), BW and BW change (1 to 3 times per week), as well as body condition score (BCS). Daily milk production averaged 13.8kg for New Zealand cows and 20.0kg in Australia. No statistically significant differences were observed between calf RFI decile groups for dry matter intake, milk production, BW change, or BCS; however a significant difference was noted between groups for lactating RFI. Residual feed intake was about 3% lower for lactating cows identified as most efficient as growing calves, and no negative effects on production were observed. These results support the hypothesis that calves divergent for RFI during growth are also divergent for RFI when lactating. The causes for this reduced divergence need to be investigated to ensure that genetic selection programs based on low RFI (better efficiency) are robust.

Development and validation of a prediction algorithm for use by health professionals in prediction of recurrence of major depression.

BackgroundThere exists very little evidence to guide clinical management for preventing recurrence of major depression. The objective of this study was to develop and validate a prediction algorithm for recurrence of major depression.MethodsWave 1 and wave 2 longitudinal data from the U.S. National Epidemiological Survey on Alcohol and Related Condition (2001/2002–2003/2004) were used. Participants with a major depressive episode at baseline and who had visited health professionals for depression were included in this analysis (n = 2,711). Mental disorders were assessed based on the DSM-IV criteria.ResultsWith the development data (n = 1,518), a prediction model with 19 unique factors had a C statistics of 0.7504 and excellent calibration (P = .23). The model had a C statistics of 0.7195 in external validation data (n = 1,195) and 0.7365 in combined data. The algorithm calibrated very well in validation data. In the combined data, the 3-year observed and predicted risk of recurrence was 25.40% (95% CI: 23.76%, 27.04%) and 25.34% (95% CI: 24.73%, 25.95%), respectively. The predicted risk in the 1st and 10th decile risk group was 5.68% and 60.21%, respectively.ConclusionsThe developed prediction model for recurrence of major depression has acceptable discrimination and excellent calibration, and is feasible to be used by physicians. The prognostic model may assist physicians and patients in quantifying the probability of recurrence so that physicians can develop specific treatment plans for those who are at high risk of recurrence, leading to personalized treatment and better use of resources.

Wage Mobility of Foreign-Born Workers in the United States

This paper presents new evidence on whether foreign-born workers assimilate. While the existing literature focuses on the convergence / divergence of average wages, this study extends the analysis to the distribution of wages by looking at wage mobility. We measure the foreign-native gap in year-to-year transition probabilities from one decile group to another of a wage distribution, where the deciles are determined by native samples. Our results, based on the Current Population Survey for 1996-2008, suggest that immigrants in middle and bottom decile groups, who are the majority of immigrants, tend to fall behind relative to natives in the same decile groups.

Abstract P4-12-05: Enrichment of aldosterone synthase (CYP11B2) gene C-allele carriers in women at high risk in the OncoVue® polyfactorial risk model

Abstract Background: Models for accurately assessing breast cancer risk are utilized for guiding clinical decisions regarding early detection and prevention. We developed a polyfactorial risk model (PFRM; OncoVue) from analysis of a large case-control database including both functional gene polymorphism and clinical factor data. A multivariate logistic regression based statistical protocol was used to derive a single risk model consisting of 22 single nucleotide polymorphisms (SNPs) in 19 genes and 5 traditional risk factors. Several studies have shown that the PFRM is significantly improved in individualized risk estimation compared to the Breast Cancer Risk Assessment Tool (BCRAT) or Gail model. Here we have examined the genotype frequencies of women placed in the highest decile of risk by the PFRM compared to both the overall control population and to women in the control population placed at the lowest decile of risk. Materials and Methods: Analyses were performed on 1671 breast cancer cases and 3351 controls that enrolled in a case-control study conducted in six regions of the United States. DNAs were genotyped for the 22 genetic polymorphisms and combined with clinical risk factor information to calculate PFRM risk estimates for the individual participants. The PFRM lifetime scores were used to stratify the upper and lower deciles of risk. The genotype frequencies for these stratified risk groups were determined and compared to the overall control population and to each other (upper vs. lower decile). Odds Ratios (OR) were determined for the CYP11B2 genotypes because they exhibited the largest differences in frequency among the groups. Results: For CYP11B2 comparison of the genotype frequencies in the highest decile risk group to the overall genotype frequencies of controls identified significant enrichment of the C-allele carriers in the highest risk group. The OR for C-allele carriers (C/C+C/T) compared to the most common T/T genotype was 3.0 (1.9, 4.8; 95% C.I.) with a p-value <0.0001. Similarly for the upper decile risk group compared to the lower decile risk group the association of C-allele carriers was even stronger with OR = 11.0 (6.6,18.4; p <0.0001). In the upper decile of risk 86% of the individuals were C-allele carriers compared to only 38% in the lower decile of risk. Conclusions: Our previous studies have shown an age dependent association of the CYP11B2 C/C and C/T genotypes with breast cancer risk. The enrichment of these genotypes in women in the upper decile risk group as determined by the PFRM further reinforces the role of this genotype in influencing breast cancer risk and suggests that intervention in the aldosterone synthase pathway be explored as a method of breast cancer prevention. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-12-05.

Increases in support structures for healthy eating especially in low decile schools in New Zealand

To compare two surveys conducted in 2007 and 2009, of the food and nutrition environment in New Zealand primary schools. A sample of primary schools was asked about foods and beverages provided or sold to students or used for fundraising, and nutrition-related policies and procedures. Comparisons were made between school decile groups and between years. Of primary schools selling food or beverages, 34% sold 'everyday' items once or more a day (39% in 2007) and 25% sold 'occasional' items once or more a day (36% in 2007). Two-thirds of schools sold food or beverages for fundraising, generally once a term or less. About half the schools had written policies about food (increased from 2007). There have been some improvements in the food and nutrition environment, with primary schools from lower deciles more likely to be making changes. The reduction in funding for nutrition-related programs in primary schools may hinder the sustainability of the changes seen, especially in low decile schools.

Czynniki determinujące poziom wynagrodzenia

Labor market researches carried out by public statistics, research institutions, scientific centers provide information about the level and structure of remuneration, their spatial distribution and development. Often these studies are aimed towards identifying the factors affecting the amount of wages. One of the most useful tools in the study of this type is an econometric model that identifies significant factors affecting the level of wages and determines the direction of the magnitude of this effect. The paper presents an econometric model of factors affecting the amount of wages. The amount of wages has been presented as a categorical variable. Categories has been determined by the decile groups. The data used to estimation of the model come from surveys on structure of wages and salaries by occupation.

Descemet's Stripping Automated Endothelial Keratoplasty: The Tenuous Relationship between Donor Thickness and Postoperative Vision

To determine whether preoperative donor thickness has a relationship with postoperative visual acuity after Descemet's stripping automated endothelial keratoplasty (DSAEK). Retrospective correlation and comparative analysis of an interventional case series. A total of 418 eyes of 292 patients undergoing DSAEK surgery for Fuchs' endothelial dystrophy without visual loss from comorbidities. Descemet's stripping automated endothelial keratoplasty was performed in 548 eyes with Fuchs' dystrophy, and preoperative graft thickness (GT) was recorded. After exclusion of patients with confounding variables that would affect postoperative visual acuity, postoperative best spectacle-corrected visual acuity (BSCVA) was measured at 6 months in 418 eyes. Pearson's correlation analysis was performed between preoperative GT and BSCVA. Cases were split into deciles on the basis of GT and BSCVA and then compared with 1-way analysis of variance (ANOVA) and chi-square test. Best spectacle-corrected visual acuity at 6 months postoperatively. Mean GT of the series was 162.9±29.0 μm (range, 80-265 μm), and mean Snellen BSCVA was 20/28 with a range of 20/16 to 20/70. There was a weak correlation between GT and BSCVA that was significant (R = 0.236, P<0.001) but only accounted for 5% of the visual outcome (R(2) = 0.056). Visual outcome was best within the thinnest decile group of 45 donors (GT range, 80-124), with a mean Snellen BSCVA of 20/25 (range, 20/20-20/50), and worst within the thickest decile group of 41 donors (GT range, 200-265), with a mean Snellen BSCVA of 20/33 (range, 20/20-20/70). Post hoc comparison of BSCVA between the thickest and thinnest groups was significant (P = 0.006). Preoperative GT may have a small effect on visual outcome in the extremes of thickness, but not in the common range of 100 to 200 μm. Donor thickness has a tenuous relationship with visual outcome, accounting for only 5% of the variance in vision between patients, and should play a minimal role in surgical planning.

Food consumption and grocery inflation among decile groups in Vologda oblast in 2008–2010

Food consumption by residents of Vologda oblast in 2008–2010 in comparison with rational consumption norms is analyzed in the article. The target income level, providing a food consumption level equal to the level of rational norms, as well as consumer price inflation, is calculated taking into account income differentiation. It shows that the rise in prices mainly concerned the food basket of lower income citizens.

Ambient temperature and spontaneous intracerebral haemorrhage: a cross-sectional analysis in Tainan, Taiwan

ObjectivesAmbient temperature has been reported to play a role in the occurrence of spontaneous intracerebral haemorrhage (ICH). This study aimed to investigate the relation between ambient temperature of onset time...

P3-07-36: Predicting Sentinel Lymph Node Metastasis of a Chinese Breast Cancer Population: Assessment of an Existing Nomogram and a New Predictive Nomogram.

Abstract Background: The Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram to predict the presence of sentinel lymph node (SLN) metastasis in breast cancer patients. In our study, The MSKCC nomogram performance for prediction of SLN metastases was assessed in Chinese breast cancer population. A new model (Shanghai Cancer Center Nomogram, SCC nomogram ) was developed with clinically relevant variables and possible advantages. Methods: Data were collected from 771 patients with successful SLN biopsy who were treated during March 2005 to June 2010. Touch imprint cytology (TIC) and serial section with H&amp;E staining were performed routinely on each sentinel node. 580 SLN biopsy procedures from March 2005to November 2009were used as training group to validate the MSKCC nomogram and assessed with multivariable logistic regression to predict the presence of SLN metastasis in breast cancer. The predictive accuracy of MSKCC nomogram was assessed by calculating the area under the receiver-operating characteristic (ROC) curve (AUC). The SCC nomogram was created from the logistic regression model. The new model was subsequently applied to 191 sequential SLN biopsies from January 2010 to June 2010 as the validation group. Results: It was shown that age, tumor size, tumor type, histological grade, lymphovascular invasion and neural invasion was correlated with the probability of SLN metastasis by univariate analysis (P&amp;lt;0.05). By multivariate analysis, tumor size, histological grade and lymphovascular invasion were identified as independent predictors of SLN metastasis. The SCC nomogram was then developed with four variables associated with SLN metastasis: age, tumor size, histological grade and lymphovascular invasion. The new model was accurate and discriminating, with AUC of 0.773 when applied to the validation group, as compared to the MSKCC nomogram with AUC of 0.754 in the modeling group. The trend of actual probability in various decile groups was comparable to the predicted probability. For predicted probability cut-off points of 7% and 15%, the false-negative rates of SCC nomogram were 0% and 8.1%. Conclusion: As far as we know, this is the first study designed to evaluate the MSKCC nomogram and develop a new nomogram in Chinese early breast cancer population. Compared to the MSKCC nomogram, the SCC nomogram was developed with similar AUC but less variables and lower false-negative rates for low-probability subgroups. It could provide a more acceptable clinical accessory in the preoperative discussion with patients, especially in the very low risk of patients. For those patients, the SCC nomogram could be used to safely avoid a SLN procedure, thereby reducing postoperative morbidity, whereas the rate could be as high as 7% in the literature. Although the SCC nomogram that predicts metastasis of breast cancer in the sentinel lymph node performed well in Chinese breast cancer population, it is imperfect. The SCC nomogram was developed and validated in the single instite. The SCC model should be validated in different patient groups before it is demonstrated to be reproducible and would be applied widely. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-36.

Relative Validity of the 10-Year Cardiovascular Risk Estimate in a Population Cohort of the REGICOR Study

Introduction and objectives Cardiovascular risk screening requires accurate risk functions. The relative validity of the Framingham-based REGICOR adapted function is analyzed and the population distribution of cardiovascular 10-year cardiovascular events is described by risk group. Methods A population cohort of 3856 participants recruited between 1995 and 2000, aged 35 to 74 years from Girona without symptoms of cardiovascular diseases, was followed between 2006 and 2009. Standardized laboratory and blood pressure measurements, questionnaires, and case definitions were used. The follow-up combined cross-linkage of our databases with our regional mortality registry, reexamination, and telephone contact with participants. Coronary disease endpoints alone were considered. Results A total of 27 487 person-years were obtained (mean follow-up 7.1 years), and the follow-up was achieved in 97% of participants (120 coronary disease events). Validity was good: the regression coefficients estimated with the cohort data did not differ from those obtained in the original Framingham function. Function calibration was good: the observed incidence of cardiovascular events in the decile groups of risk did not differ from the function prediction ( P = .127 in women, and P = .054 in men). The C statistic (discrimination) was 0.82 (95% confidence interval, 0.76-0.88) in women, and 0.78 (95% confidence interval, 0.73-0.83) in men. More than 50% of cardiovascular events occurred in participants whose 10-year risk was 5% to 14.9%. Conclusions The studied function accurately predicts coronary disease events at 10 years. Risk stratification could be simplified in 4 groups: low (<5%), moderate (5%-9.9%), high (10%-14.9%) and very high (≥15%).

Validez relativa de la estimación del riesgo cardiovascular a 10 años en una cohorte poblacional del estudio REGICOR

Introduction and objectives Cardiovascular risk screening requires accurate risk functions. The relative validity of the Framingham-based REGICOR adapted function is analyzed and the population distribution of cardiovascular 10-year cardiovascular events is described by risk group. Methods A population cohort of 3856 participants recruited between 1995 and 2000, aged 35 to 74 years from Girona without symptoms of cardiovascular diseases, was followed between 2006 and 2009. Standardized laboratory and blood pressure measurements, questionnaires, and case definitions were used. The follow-up combined cross-linkage of our databases with our regional mortality registry, reexamination, and telephone contact with participants. Coronary disease endpoints alone were considered. Results A total of 27 487 person-years were obtained (mean follow-up 7.1 years), and the follow-up was achieved in 97% of participants (120 coronary disease events). Validity was good: the regression coefficients estimated with the cohort data did not differ from those obtained in the original Framingham function. Function calibration was good: the observed incidence of cardiovascular events in the decile groups of risk did not differ from the function prediction ( P = .127 in women, and P = .054 in men). The C statistic (discrimination) was 0.82 (95% confidence interval, 0.76-0.88) in women, and 0.78 (95% confidence interval, 0.73-0.83) in men. More than 50% of cardiovascular events occurred in participants whose 10-year risk was 5% to 14.9%. Conclusions The studied function accurately predicts coronary disease events at 10 years. Risk stratification could be simplified in 4 groups: low (<5%), moderate (5%-9.9%), high (10%-14.9%) and very high (≥15%). Full English text available from: www.revespcardiol.org

Addressing inequality and poverty with tax instruments

There is a consensus, in both academia and economic policy circles, that the reform of the personal income tax system in Serbia is necessary one. Two frequently discussed reform scenarios are East European style flat tax and the comprehensive income tax model of Western Europe. Most Central and Eastern European (CEE) countries have recently reformed their income tax systems by introducing some form of flat tax scheme, while in numerous countries of Western Europe the possibility of flat tax reform is also seriously considered. Opponents of the reform usually stress the adverse distributional effects of flat tax schemes. The aim of our paper is to contribute to the empirical literature on the distributional effects of alternative tax reform scenarios. The analysis is based on the tax and benefit micro-simulation model for Serbia (SRMOD). The results suggest that redesigning the existing income tax system so as to introduce a uniform tax rate and increase the basic allowance would somewhat reduce inequality and improve vertical inequity in taxation. On the other hand, in the case of the introduction of comprehensive income tax, considerably larger equalizing and progressivity effects would be achieved. At the same time, since in both cases redistribution will not affect the bottom decile group, no significant effects (in either cases) on poverty reduction will be achieved.

Abstract P1-01-20: Validation of MSKCC Nomogram in Predicting Sentinel Lymph Node Metastasis of a Chinese Breast Cancer Population

Abstract Background: The Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram to predict the presence of sentinel lymph node (SLN) metastasis in breast cancer patients. Our study was designed to validate the clinical value of the MSKCC nomogram in Chinese early-stage breast cancer population. Methods: Data were collected from 524 patients with successful SLN biopsy who were treated during 2005 March to 2009 October. Positive SLN metastasis was found in 154 patients. Touch imprint cytology (TIC) and serial section with H&amp;E staining were performed routinely on each sentinel node. Univariate analysis and logistic regressions tested whether a characteristic was correlated with the SLN positivity. MSKCC nomogram was used to estimate probability of SLN involvement and compared with actual probability after grouping into deciles. A ROC curve was drawn and predictive accuracy was assessed by calculating the area under the receiver-operating characteristic (ROC) curve. Results: It was shown that age, tumor size, histological grade and lymphovascular invasion was correlated with the probability of SLN metastasis by univariate analysis (P&amp;lt;0.05). By multivariate analysis, tumor size and lymphovascular invasion were identified as independent predictors of SLN metastasis. The odds ratio (OR) of the lymphovascular invasion was 9.462(95% CI 5.551-16.130)while OR of tumor size was 1.429(95% CI 1.142-1.788). The trend of actual probability in various decile groups was comparable to the predicted probability. Patients in the group with the least probability of a positive SLN predicted by the nomogram (≥10 decile) were all diagnosed with a negative SLN by serial section by H&amp;E staining. Three patients in our collective with extremely high probability (≥90) were all diagnosed as positive SLN by pathology. The area under the ROC curve was 0.757 as compared to 0.754 in the original population. Conclusion: As far as we know, this is the first study designed to evaluated the MSKCC nomogram in Chinese early breast cancer population. The MSKCC nomogram that predicts metastasis of breast cancer in the sentinel lymph node performed good in a Chinese breast cancer population. Though the nomogram cannot be an alternative of SLN biopsy, it could provide a clinical accessory in the preoperative discussion with patients, especially in the very high or very low risk of patients. The nomogram could be used in very low risk patients to safely avoid a SLN procedure, thereby reducing postoperative morbidity, whereas the rate could be as high as 7% in the literature. While for patients with very high risk estimated by the nomogram, axillary lymph node dissection could be recommended directly. The shortcoming of the nomogram is that clinical and pathological parameters include detail histological diagnosis of the primary tumor before the final decision for surgical procedure. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-20.

Relative nasopharyngeal patency index as possible objective indication for adenoidectomy in children with orthodontic problems

Objectives Although the harmful influence of nasopharyngeal obstruction on the facial skeleton has been demonstrated, clear criteria to qualify children with adenoid hypertrophy and malocclusion for adenoidectomy have not been established yet. Methods Retrospective analysis of 148 patients qualified for orthodontic treatment (77 females and 71 males) at the age of 9–11 years (the average age was 10 years and 3 months). X-ray images performed with the use of a cephalostat were scanned and submitted for cephalometric assessment. The study investigated the correlation between standard cephalometric parameters and the value of relative nasopharyngeal flow defined as the ratio of the nasopharyngeal flow to the dimension of the entire nasopharynx. In statistics Bartlett's test, Tukey's test and Pearson's correlation coefficients were used. Results The value of relative nasopharyngeal lumen ranged from 0.0943 to 0.5532 with no significant differences between genders. The subjects were divided into decile groups for investigating the correlation with cephalometric parameters. The study demonstrated statistically significant negative correlations between relative nasopharyngeal flow and the following parameters: the angle between lines NA and NB (ANB), the angle between lines SN and ML (SN/ML), the posterior/anterior facial height ratio (Post.Fac.H./Ant.Fac.H.), the difference between the maxillary and mandibular length (difference maxillary/mandibular), the mandibular length (Co-Gn) and the lower anterior facial height (Sn-Me). The correlations generally referred to middle deciles: from the 40th to 80th decile. An apparent lack of significant correlations in patients located below the 40th decile, which corresponded to the value of relative nasopharyngeal flow up to 18%, may indicate, that this value constitutes a threshold and further decreasing it exceeds adaptive capabilities of the body. Conclusions Relative nasopharyngeal flow below 38% should constitute an indication for adenoidectomy, due to the exceeded adaptive capabilities of the body.

Value of housework time and changes in traditional economic well-being in Finland in 1979-2000

The paper looks at the change, the level and the structure of income distribution and distribution of consumption possibilities at the individual and at the household level between the years 1979 and 2000. I also pay attention to the development of low incomes when the concept of income is expanded to include a monetary measurement of household production. The paper uses Time Use Data, collected by Statistics Finland in 1979, 1987-1988 and 1999-2000. I find that consumption possibilities are more equally distributed than money income. Household production increases the consumption possibilities of all income groups but its effect is most significant in the low income decile groups. As a share of consumption possibilities, household production forms a significantly more important part for low income households than for high income households. By looking at consumption possibilities we can see a different distribution of economic well-being compared to distribution offered by money income measurement alone.

Definition of “Rural” Determines the Placement Outcomes of a Rural Medical Education Program: Analysis of Jichi Medical University Graduates

To show the impact of changing the definition of what is "rural" on the outcomes of a rural medical education program. A cross-sectional sample of 643 graduates under obligatory rural service and 1,699 graduates after serving their obligation, all from Jichi Medical University (JMU), a binding rural education program in Japan, were used as the data source. Communities were divided into decile groups according to population density, and the cut-off for "rural/nonrural" was altered in order to study its impact on the data. The rural practice rate of obliged graduates had its peak in the decile groups with the lowest population densities, while the peak rates of postobligation graduates and non-JMU physicians were at the decile groups with the highest population densities. Rural practice rates of all of the 3 groups of physicians increased with the increase in inclusiveness of rural definition. The ratio of rural practice rate of obliged graduates to that of non-JMU physicians ("relative effectiveness") increased remarkably with the increase in exclusiveness of rural definition. The relative effectiveness of postobligation graduates did not substantially increase after the cut-off exceeded a certain point of exclusiveness. Definition of "rural" largely determined the rural practice rate and relative effectiveness of JMU graduates. The results suggest that results of past outcome studies of rural medical education programs are potentially biased depending on how rural is defined.