Archive for public health system

ten recommendations from the RSS

Posted in Statistics, University life with tags , , , , , , , , , , , on March 21, 2021 by xi'an

‘Statistics have been crucial both to our understanding of the pandemic and to our efforts to fight it. While we hope we won’t see another pandemic on this scale, we need to see a culture change now – with more transparency around data and evidence, stronger mechanisms to challenge the misuse of statistics, and leaders with statistical skills.’

  • Invest in public health data – which should be regarded as critical national infrastructure and a full review of health data should be conducted
  • Publish evidence – all evidence considered by governments and their advisers must be published in a timely and accessible manner
  • Be clear and open about data – government should invest in a central portal, from which the different sources of official data, analysis protocols and up-to-date results can be found
  • Challenge the misuse of statistics – the Office for Statistics Regulation should have its funding augmented so it can better hold the government to account
  • The media needs to step up its responsibilities – government should support media institutions that invest in specialist scientific and medical reporting
  • Build decision makers’ statistical skills – politicians and senior officials should seek out statistical training
  • Build an effective infectious disease surveillance system to monitor the spread of disease – the government should ensure that a real-time surveillance system is ready for future pandemics
  • Increase scrutiny and openness for new diagnostic tests – similar steps to those adopted for vaccine and pharmaceutical evaluation should be followed for diagnostic tests
  • Health data is incomplete without social care data – improving social care data should be a central part of any review of UK health data
  • Evaluation should be put at the heart of policy – efficient evaluations or experiments should be incorporated into any intervention from the start.

abortion data, France vs. USA

Posted in Kids, Statistics, Travel with tags , , , , , , , , , , , on October 5, 2020 by xi'an

As Le Monde pointed out at a recent report on 2019 abortions in France from Direction de la recherche, des études, de l’évaluation et des statistiques (Drees), showing an consistent rise in the number of abortions in France since 1995, with a rate of 15.6 abortions for 1000 women and the number around a third of the live births that year, I started wondering at the corresponding figures in the USA, given the much more restrictive conditions there. Judging from this on-line report by the Guttmacher Institute, the overall 2017 figures are not so different in both countries: while the abortion rate fell to 13.5‰, and the abortion/life birth ratio to 22%, the recent spike in abortion restrictions for most US States did not seem to impact considerably the rates, even though this is a nationwide average, hiding state disparities (like a 35% drop in Iowa or Alabama [and a 62% drop in Delaware, despite no change in the number of clinics or in the legislation]). In addition, France did not apparently made conditions more difficult recently (most abortions occur locally and the abortion rate is inversely correlated with income) and French (official) figures include off-clinic drug-induced abortions, while the Guttmacher institute census does not. The incoming (hasty) replacement of Judge Ruth Bader Ginsberg in the US Supreme Court may alas induce a dramatic turn in these figures if a clear anti-abortion majority emerges…

scientific Americans abide by Joe

Posted in Books, Travel with tags , , , , , , , , , , , on September 28, 2020 by xi'an

pooling or not pooling

Posted in Books, Kids, pictures, Statistics, University life with tags , , , , , , , , , , on September 22, 2020 by xi'an

A pro-pooling opinion tribune, followed a few days later, by a collection of opinions on pooling PCR samples to absorb the overload in testing laboratories and produce results in a delay that is short enough for public health impacts.  Le Monde is taking sample pooling most seriously! This includes a link to an April article by Christian Grollier and Olivier Gossner (CREST) published in COVID economics (!), recalling the basics of sample pooling and citing a Technion experiment to show the approach is feasible in practice. With a recommended pool of 80 patients if the prevalence is 2%. And of 30 for a prevalence of 5%. Despite the approach being implemented in other countries, and considerable delays in analysing the PCR samples, the conclusion of the French public health authorities is that it is urgent to wait..!

counting COVID-19 deaths (or not)

Posted in Statistics with tags , , , , , , , , , , , on September 7, 2020 by xi'an

Two COVID-19 articles in the recent issue of Nature relating to data gathering issues. One on the difficulty to distinguish direct COVID deaths from indirect ones from the excess deaths, which “to many scientists, it’s the most robust way to gauge the impact of the pandemic” (which I supported). As indeed the COVID pandemic reduced people access to health care, both because health structures were overwhelmed and because people were scared of catching the virus when visiting these structures. The article [by Giuliana Viglione] supports the direct exploitation of death certificates, to improve the separation, quoting Natalie Dean from the University of Florida in Gainesville. Although this creates a strong lag in the reporting and hence in health policy decisions. (Assuming the overall death reporting is to be trusted, which is not the case for all countries.)

“This long-standing neglect has been exacerbated by the lack of national leadership during the pandemic.”

The other article is about the reasons why the COVID-19 crisis in the US is doubled by a COVID-19 data crisis. Mentioning “political meddling, privacy concerns and years of neglect of public-health surveillance systems” as some of the sources for unreliable data on the pandemic range and evolution. Hardly any contact tracking (as opposed to South Korea or Vietnam), a wealth of local, state and federal structures, data diverted and hence delayed (or worse) to a new system launched by the US Department for Health and Human Services (HHS) for an ill-used $10 million. And data often shared (or lost) by fax! “Lack of leadership,” to state the obvious….