No abstract

To identify factors associated with improved performance of health care workers who treat ill children in developing countries, the authors analyzed a sample of consultations of children with malaria (defined as any fever) from a national health facility survey conducted in the Central African Republic from December 1995 to January 1996. Twenty-eight health care workers and 204 children were studied. A univariate analysis revealed the following significant predictors of correct treatment, as defined by the Central African malaria control program: high fever (odds ratio (OR) = 3.25, 95% confidence interval (CI): 1.47, 7.17); correct health care worker diagnosis (OR = 2.59, 95% CI: 1.39, 4.85); and the caregiver's reporting the child's fever to the health care worker (OR = 2.18, 95% CI: 1.32, 3.62). There was an unexpected inverse association between the presence of a fever treatment chart and correct treatment (OR = 0.19, 95% CI: 0.04, 0.91). Correct treatment was marginally associated with a longer consultation time (p value for trend = 0.058). Neither in-service training in the treatment of fever nor supervision was significantly associated with correct treatment. For child health programs to improve, targeted studies are needed to understand which factors, alone or in combination, improve health care worker performance.

Both alcohol and tobacco use are accepted risk factors for laryngeal cancer. The authors used case-control data from previous studies to estimate the value of a previously proposed index of interaction between these two risk factors. In addition to the weighting procedure over exposure categories that was previously proposed for estimating a summary index, they applied maximum-likelihood techniques to facilitate the estimation. Overall, they found moderate synergy between alcohol and tobacco in increasing the risk of laryngeal cancer, in that exposure to both factors increased the risk about 50% more than the increase predicted if the effects of tobacco and alcohol were simply additive.

No abstract

Patient attributes associated with increased risk for mortality vary widely among dialysis facilities. Adjustment for these differences did not, however, substantially change either the degree of variation in mortality risks or the relative ranking of a facility's mortality.