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Sample records for health utility index

  1. Health utility indexes in patients with acute coronary syndromes

    PubMed Central

    Gencer, Baris; Rodondi, Nicolas; Auer, Reto; Nanchen, David; Räber, Lorenz; Klingenberg, Roland; Pletscher, Mark; Jüni, Peter; Windecker, Stephan; Matter, Christian M; Lüscher, Thomas F; Mach, François; Perneger, Thomas V; Girardin, François R

    2016-01-01

    Background Acute coronary syndromes (ACS) have been associated with lower health utilities (HUs) compared with the general population. Given the prognostic improvements after ACS with the implementation of coronary angiography (eg, percutaneous coronary intervention (PCI)), contemporary HU values derived from patient-reported outcomes are needed. Methods We analysed data of 1882 patients with ACS 1 year after coronary angiography in a Swiss prospective cohort. We used the EuroQol five-dimensional questionnaire (EQ-5D) and visual analogue scale (VAS) to derive HU indexes. We estimated the effects of clinical factors on HU using a linear regression model and compared the observed HU with the average values of individuals of the same sex and age in the general population. Results Mean EQ-5D HU 1-year after coronary angiography for ACS was 0.82 (±0.16) and mean VAS was 0.77 (±0.18); 40.9% of participants exhibited the highest utility values. Compared with population controls, the mean EQ-5D HU was similar (expected mean 0.82, p=0.58) in patients with ACS, but the mean VAS was slightly lower (expected mean 0.79, p<0.001). Patients with ACS who are younger than 60 years had lower HU than the general population (<0.001). In patients with ACS, significant differences were found according to the gender, education and employment status, diabetes, obesity, heart failure, recurrent ischaemic or incident bleeding event and participation in cardiac rehabilitation (p<0.01). Conclusions At 1 year, patients with ACS with coronary angiography had HU indexes similar to a control population. Subgroup analyses based on patients' characteristics and further disease-specific instruments could provide better sensitivity for detecting smaller variations in health-related quality of life. PMID:27252878

  2. The SF-6D health utility index in carpal tunnel syndrome.

    PubMed

    Atroshi, I; Gummesson, C; McCabe, S J; Ornstein, E

    2007-04-01

    Cost effectiveness is an important factor to consider when choosing between various hand surgical interventions. Health utility measures can be used to determine cost effectiveness. The SF-6D is a health utility index derived from 11 items of the SF-36 quality of life questionnaire; values range from 0.296 to 1.0 ("perfect" health). We evaluated the validity of the SF-6D in patients with carpal tunnel syndrome (CTS) who completed the SF-36 and the CTS symptom severity and functional status questionnaire before and 3 months after carpal tunnel release. Complete responses to the SF-6D items were available for 100 patients at baseline and 95 patients at baseline and follow-up. The mean SF-6D health utility index was 0.69 (SD 0.13) before surgery and 0.77 (SD 0.13) after surgery (moderate effect size). The SF-6D could discriminate between patient groups differing in self-rated global health and in whether, or not, they had a minimal clinically important improvement in CTS symptom severity after surgery. The SF-6D appears to be a valid measure of health utilities in patients with CTS and can be used in cost effectiveness studies. PMID:17223234

  3. Utilizing the School Health Index to Build Collaboration between a University and an Urban School District

    ERIC Educational Resources Information Center

    Butler, James; Fryer, Craig S.; Reed, Ernestine A.; Thomas, Stephen B.

    2011-01-01

    Background: Insufficient attention has been paid to the process of conducting the Centers for Disease Control and Prevention's School Health Index (SHI) to promote collaboration between universities and urban school districts when developing adolescent health promotion initiatives. This article provides an overview of the real-world contextual…

  4. Mapping between Visual Analogue Scale and Standard Gamble data; results from the UK Health Utilities Index 2 valuation survey.

    PubMed

    Stevens, Katherine J; McCabe, Christopher J; Brazier, John E

    2006-05-01

    We examine the relationship between Visual Analogue Scale (VAS) and Standard Gamble (SG) assumed in the development of the multiplicative multi-attribute utility functions (M-MAUFs) for the Health Utilities Index (HUI) Mark 2 and Mark 3, using data from a UK valuation study of the HUI2. A range of functional forms are considered, and are compared on the basis of their explanatory power and predictive ability.A restricted cubic function fits the data better than a power curve with a mean absolute error (MAE) of 0.025 and root mean square error (RMSE) of 0.029 compared to a MAE of 0.135 and RMSE of 0.135 for the power curve. The use of a cubic mapping function instead of a power function leads to different predicted health state values. We question the reliance on the assumption of a power curve relationship between VAS and SG data, in the Health Utilities Index valuation framework. Our results demonstrate that further work is required to examine the appropriateness of the published M-MAUFs for the Health Utilities Indices. PMID:16389651

  5. Utilizing the School Health Index to Foster University and Community Engagement

    ERIC Educational Resources Information Center

    King, Kristi McClary

    2010-01-01

    A Coordinated School Health Program maximizes a school's positive interaction among health education, physical education, health services, nutrition services, counseling/psychological/social services, health school environment, health promotion for staff, and family and community involvement. The purpose of this semester project is for…

  6. Using Health Utility Index (HUI) for measuring the impact on health-related quality of Life (HRQL) among individuals with chronic diseases.

    PubMed

    Mo, Frank; Choi, Bernard C K; Li, Felix C K; Merrick, Joav

    2004-08-27

    Quality of life is an important indicator in assessing the burden of disease, especially for chronic conditions. The Health Utilities Index (HUI) is a recently developed system for measuring the overall health status and health-related quality of life (HRQL) of individuals, clinical groups, and general populations. Using the HUI (constructed based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort) to measure the HRQL for chronic disease patients and to detect possible associations between HUI system and various chronic conditions, this study provides information to improve the management of chronic diseases. This study is of interest to data analysts, policy makers, and public health practitioners involved in descriptive clinical studies, clinical trials, program evaluation, population health planning, and assessments. Based on the Canadian Community Health Survey (CCHS) for 2000-01, the HUI was used to measure the quality of life for individuals living with various chronic conditions (Alzheimer/other dementia, effects of stroke, urinary incontinence, arthritis/rheumatism, bowel disorder, cataracts, back problems, stomach/intestinal ulcers, emphysema/COPD, chronic bronchitis, epilepsy, heart disease, diabetes, migraine headaches, glaucoma, asthma, fibromyalgia, cancers, high blood pressure, multiple sclerosis, thyroid condition, and other remaining chronic diseases). Logistic Regression Model was employed to estimate the associations between the overall HUI scores and various chronic conditions. The HUI scores ranged from 0.00 (corresponding to a state close to death) to 1.00 (corresponding to perfect health); negative scores reflect health states considered worse than death. The mean HUI score by sex and age group indicated the typical quality of life for persons with various chronic conditions. Logistic Regression results showed a strong relationship between low HUI scores (< or = 0.5 and 0.06-1.0) and

  7. Competency Index. [Health Technology Cluster.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This competency index lists the competencies included in the 62 units of the Tech Prep Competency Profiles within the Health Technologies Cluster. The unit topics are as follows: employability skills; professionalism; teamwork; computer literacy; documentation; infection control and risk management; medical terminology; anatomy, physiology, and…

  8. Health Behavior, Health Education, Health Service Utilization and Compliance with Health Regimes: An Annotated Bibliography.

    ERIC Educational Resources Information Center

    Toledo, J. R.; Hughes, Howard

    This bibliography includes references from major articles, Index Medicus (1972- 1977), and Psychological Abstracts (1967-1977). The material is arranged under four major headings--health behavior, health education, health services utilization, and compliance with health regimes. It will be of interest to persons working in medical settings and…

  9. Equity in health care utilization in Chile.

    PubMed

    Núñez, Alicia; Chi, Chunhuei

    2013-01-01

    One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894

  10. Equity in health care utilization in Chile

    PubMed Central

    2013-01-01

    One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894

  11. Indexing: Its Importance in Health Education Research.

    ERIC Educational Resources Information Center

    Horowitz, Stephen M.; Laflin, Molly T.; Nims, Julia K.

    1999-01-01

    Investigated how health educators could improve literature searches and increase the accessibility of their research to others. A frequency count of databases indexed 84 health education journals and analyzed the 16 top indexes for journal coverage. Results indicated that selecting the appropriate indexes can help health educators more effectively…

  12. Sex differences in the relative contribution of social and clinical factors to the Health Utilities Index Mark 2 measure of health-related quality of life in older home care clients

    PubMed Central

    Maxwell, Colleen J; Kang, Jian; Walker, Jennifer D; Zhang, Jenny X; Hogan, David B; Feeny, David H; Wodchis, Walter P

    2009-01-01

    Background The heterogeneity evident among home care clients highlights the need for greater understanding of the clinical and social determinants of multi-dimensional health-related quality of life (HRQL) indices and of potential sex-differences in these determinants. We examined the relative contribution of social and clinical factors to HRQL among older home care clients and explored whether any of the observed associations varied by sex. Methods The Canadian-US sample included 514 clients. Self-reported HRQL was measured during in-home interviews (2002-04) using the Health Utilities Index Mark 2 (HUI2). Data on clients' sociodemographic, health and clinical characteristics were obtained with the Minimum Data Set for Home Care. The relative associations between clients' characteristics and HUI2 scores were examined using multivariable linear regression models. Results Women had a significantly lower mean HUI2 score than men (0.48, 95%CI 0.46-0.50 vs. 0.52, 0.49-0.55). Clients with distressed caregivers and poor self-rated health exhibited significantly lower HRQL scores after adjustment for a comprehensive list of clinical conditions. Several other factors remained statistically significant (arthritis, psychiatric illness, bladder incontinence, urinary tract infection) or clinically important (reported loneliness, congestive heart failure, pressure ulcers) correlates of lower HUI2 scores in adjusted analyses. These associations generally did not vary significantly by sex. Conclusion For females and males, HRQL scores were negatively associated with conditions predictive or indicative of disability and with markers of psychosocial stress. Despite sex differences in the prevalence of social and clinical factors likely to affect HRQL, few varied significantly by sex in their relative impact on HUI2 scores. Further exploration of differences in the relative importance of clinical and psychosocial well-being (e.g., loneliness) to HRQL among female and male clients

  13. A Canadian Indian Health Status Index.

    PubMed

    Connop, P J

    1983-01-01

    Health care services for registered "band" Indians in Ontario are provided primarily by the Canadian Federal Government. Complex management methods preclude the direct involvement of Indian people in the decisions for their health resource allocation. Health indicators, need, and health status indexes are reviewed. The biostatistics of mortality and demography of the Indian and reference populations are aggregated with hospitalization/morbidity experience as the Chen G'1 Index, as an indicator of normative and comparative need. This is weighted by linear measurements of perceived need for preventive medicine programs, as ranked and scaled values of priorities, Zj. These were determined by community survey on 11 Indian reserves using a non-probabilistic psychometric method of "pair comparisons," based upon "Thurstone's Law of Comparative Judgement.," The calculation of the aggregate single unit Indian Health Status Index [Log.G'1].Zj and its potential application in a "zero-base" budget is described. PMID:6601223

  14. Shape matching utilizing indexed hypotheses generation and testing

    NASA Technical Reports Server (NTRS)

    Mehrotra, Rajiv; Grosky, William I.

    1989-01-01

    An indexing mechanism is developed as part of an overall scheme called SMITH (shape matching utilizing indexed hypothesis generation and testing) for two-dimensional model-based object recognition. The approach is based on a dynamic programming implementation of attributed string matching, is computationally efficient, and works effectively for both nonoccluded and occluded shapes. Another advantage of this technique is that models may be inserted or deleted with relatively little cost.

  15. The Construction and Utility of Three Indexes of Intellectual Achievement: An Intellectual-Development (ID) Index; A Socio-Intellectual-Status (SIS) Index; A Differential-Intellectual-Development (DID) Index. U.S. Children and Youths, 6-17 Years. Vital and Health Statistics. Data Evaluation and Methods Research. Series 2-Number 74.

    ERIC Educational Resources Information Center

    Dupuy, Harold J.; Gruvaeus, Gunnar

    Although the Intellectual Development (ID) index was constructed using standard psychometric procedures, the derivation of the other two indexes, Socio Intellectual Status (SIS) and Differential Intellectual Development (DID), by criterion scaling should have applications in diverse areas of scale or index construction. The ID is basically…

  16. 2009 America's Civic Health Index: Civic Health in Hard Times

    ERIC Educational Resources Information Center

    Center for Information and Research on Civic Learning and Engagement (CIRCLE), 2009

    2009-01-01

    Since 2006, the National Conference on Citizenship (NCoC), in partnership with the Civic Indicators Working Group, has published annual reports called "America's Civic Health Index." These reports have informed Americans about leading indicators of the nation's civic health and motivated citizens, leaders and policymakers to strengthen the…

  17. Predictors of Adolescent Health Care Utilization

    ERIC Educational Resources Information Center

    Vingilis, Evelyn; Wade, Terrance; Seeley, Jane

    2007-01-01

    This study, using Andersen's health care utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence health care utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process…

  18. Factors Affecting Health Care Utilization in Tehran

    PubMed Central

    Motlagh, Soraya Nouraei; Sabermahani, Asma; Hadian, Mohammad; Lari, Mohsen Asadi; Mahdavi, Mohamad Reza Vaez; Gorji, Hassan Abolghasem

    2015-01-01

    Introduction: Successful health system planning and management is dependent on well informed decisions, so having complete knowledge about medical services’ utilization is essential for resource allocation and health plans. The main goal of this study is identification of factors effecting inpatient and outpatient services utilization in public and private sectors. Methods: This study encompasses all regions of Tehran in 2011 and uses Urban HEART questionnaires. This population-based survey included 34700 households with 118000 individuals in Tehran. For determining the most important factors affected on health services consumption, logit model was applied. Results: Regarding to the finding, the most important factors affected on utilization were age, income level and deciles, job status, household dimension and insurance coverage. The main point was the negative relationship between health care utilization and education but it had a positive relationship with private health care utilization. Moreover suffering from chronic disease was the most important variable in health care utilization. Conclusions: According to the mentioned results and the fact that access has effect on health services utilization, policy makers should try to eliminate financial access barriers of households and individuals. This may be done with identification of households with more than 65 or smaller than 5 years old, people in low income deciles or with chronic illness. According to age effect on health services usage and aging population of Iran, results of this study show more importance of attention to aged population needs in future years. PMID:26153189

  19. Preventive Health Services Utilization Among Korean Americans.

    PubMed

    Kim, Kyeongmo; Casado, Banghwa Lee

    2016-01-01

    This study examined the use of preventive health services among Korean American adults. Data were drawn from a cross-sectional survey of 212 Korean Americans in the Chicago, Illinois, metropolitan area. Guided by the Andersen's behavioral model, the authors examined whether predisposing (age, gender, marital status, household size, education), enabling (income, health insurance, English proficiency, citizenship, social network), and need (health status) factors are predictive of Korean Americans' preventive health services utilization. A binomial logistic regression showed that younger age, male, noncitizen, low income, no insurance, a larger family network, and better perceived health were associated with decreased odds of using preventive health services. PMID:27171558

  20. Technology Readiness of Early Career Nurse Trainees: Utilization of the Technology Readiness Index (TRI).

    PubMed

    Odlum, Michelle

    2016-01-01

    Health Information Technology (HIT) adoption by clinicians, including nurses, will lead to reduction in healthcare costs and clinical errors and improve health outcomes. Understanding the importance of technology adoption, the current study utilized the Technology Readiness Index to explore technology perceptions of nursing students. Our analysis identifies factors that may influence perceptions of technology, including decreased optimism for students with clinical experience and increased discomfort of US born students. Our study provides insight to inform training programs to further meet the increasing demands of skilled nursing staff. PMID:27332213

  1. COMPARISON OF FIVE HEALTH-RELATED QUALITY-OF-LIFE INDEXES USING ITEM RESPONSE THEORY ANALYSIS

    PubMed Central

    Fryback, Dennis G.; Palta, Mari; Cherepanov, Dasha; Bolt, Daniel; Kim, Jee-Seon

    2009-01-01

    Background Five health-related quality-of-life (HRQoL) indexes—EQ-5D, HUI2, HUI3, QWB-SA, and SF-6D—are each used to assign community-based utility scores to health states, although these scores differ. Objective The authors transform these indexes to a common scale to understand their interrelationships. Methods Data were from the National Health Measurement Study, a telephone survey of 3844 US adults. The 5 indexes were analyzed using item response theory analysis to estimate scores on an underlying construct of summary health, θ. Unidimensionality was evaluated using nonlinear principal components analysis. Index scores were plotted against the estimated scores on the common underlying construct. In addition, scores on the Health and Activities Limitation Index (HALex), the Centers for Disease Control and Prevention Healthy Days questions, and self-rated health on a 5-category scale ranging from excellent to poor were plotted. Results SF-6D and QWB-SA are nearly linear across the range of θ, but with a shallow slope; EQ-5D, HUI2, and HUI3 are linear with steep slope from low θ (poor health) into mid-range of θ, then approximately linear with a less steep slope for higher θ (health just below to well above average) although the inflection points differ by index. Conclusion Simple linear functions may serve as crosswalks among these indexes only for lower health states albeit with low precision. Ceiling effects make crosswalks among most of the indexes ill specified above a certain level of health. Although each index measures generic health on a utility scale, these indexes are not identical but are relatively simply, if imprecisely, related. PMID:19843961

  2. Center for Devices and Radiological Health Publications Index, August 1988

    SciTech Connect

    Not Available

    1988-08-01

    This is the first Publications Index to be published by the Center for Devices and Radiological Health. Previous indexes, titled 'Bureau of Radiological Health Publications Index', were published before the Center was formed in 1982 through the merger of the Bureau of Radiological Health and the Bureau of Medical Devices; the last of these indexes was published in October 1980. The 1988 edition contains records of medical device and radiological health documents authored or published by the Center from 1978 through 1986. It should not be considered all-inclusive since those documents for which bibliographic information was not available have been excluded. The Publications Index is being distributed to Center staff, state radiological health programs, and libraries on the Center's publication mailing list. The Center plans to update and publish the Index every other year to provide a convenient record of published Center documents.

  3. 5 CFR 591.220 - How does OPM calculate energy utility cost indexes?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false How does OPM calculate energy utility... Areas Cost-Of-Living Allowances § 591.220 How does OPM calculate energy utility cost indexes? (a) OPM calculates energy utility cost indexes based on the relative cost of maintaining a standard size dwelling...

  4. 5 CFR 591.220 - How does OPM calculate energy utility cost indexes?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false How does OPM calculate energy utility... Areas Cost-Of-Living Allowances § 591.220 How does OPM calculate energy utility cost indexes? (a) OPM calculates energy utility cost indexes based on the relative cost of maintaining a standard size dwelling...

  5. 5 CFR 591.220 - How does OPM calculate energy utility cost indexes?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false How does OPM calculate energy utility... Areas Cost-Of-Living Allowances § 591.220 How does OPM calculate energy utility cost indexes? (a) OPM calculates energy utility cost indexes based on the relative cost of maintaining a standard size dwelling...

  6. 5 CFR 591.220 - How does OPM calculate energy utility cost indexes?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false How does OPM calculate energy utility... Areas Cost-Of-Living Allowances § 591.220 How does OPM calculate energy utility cost indexes? (a) OPM calculates energy utility cost indexes based on the relative cost of maintaining a standard size dwelling...

  7. 5 CFR 591.220 - How does OPM calculate energy utility cost indexes?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false How does OPM calculate energy utility... Areas Cost-Of-Living Allowances § 591.220 How does OPM calculate energy utility cost indexes? (a) OPM calculates energy utility cost indexes based on the relative cost of maintaining a standard size dwelling...

  8. Body Adiposity Index Utilization in a Spanish Mediterranean Population: Comparison with the Body Mass Index

    PubMed Central

    López, Angel A.; Cespedes, Mey L.; Vicente, Teofila; Tomas, Matias; Bennasar-Veny, Miguel; Tauler, Pedro; Aguilo, Antoni

    2012-01-01

    Background Body fat content and fat distribution or adiposity are indicators of health risk. Several techniques have been developed and used for assessing and/or determining body fat or adiposity. Recently, the Body Adiposity Index (BAI), which is based on the measurements of hip circumference and height, has been suggested as a new index of adiposity. The aim of the study was to compare BAI and BMI measurements in a Caucasian population from a European Mediterranean area and to assess the usefulness of the BAI in men and women separately. Research Methodology/Principal Findings A descriptive cross-sectional study was conducted in a Caucasian population. All participants in the study (1,726 women and 1,474 men, mean age 39.2 years, SD 10.8) were from Mallorca (Spain). Anthropometric data, including percentage of body fat mass obtained by Bioelectrical Impedance Analysis, were determined. Body Mass Index (BMI) and BAI were calculated. BAI and BMI showed a good correlation (r = 0.64, p<0.001). A strong correlation was also found between BAI and the % fat determined using BIA (r = 0.74, p<0.001), which is even stronger than the one between BMI and % fat (r = 0.54, p<0.001). However, the ROC curve analysis showed a higher accuracy for BMI than for the BAI regarding the discriminatory capacity. Conclusion The BAI could be a good tool to measure adiposity due, at least in part, to the advantages over other more complex mechanical or electrical systems. Probably, the most important advantage of BAI over BMI is that weight is not needed. However, in general it seems that the BAI does not overcome the limitations of BMI. PMID:22496915

  9. The Global Health Impact Index: Promoting Global Health

    PubMed Central

    Hassoun, Nicole

    2015-01-01

    Millions of people cannot access essential medicines they need for deadly diseases like malaria, tuberculosis (TB) and HIV/AIDS. There is good information on the need for drugs for these diseases but until now, no global estimate of the impact drugs are having on this burden. This paper presents a model measuring companies’ key malaria, TB and HIV/AIDS drugs’ consequences for global health (global-health-impact.org). It aggregates drugs’ impacts in several ways–by disease, country and originator-company. The methodology can be extended across diseases as well as drugs to provide a more extensive picture of the impact companies’ drugs are having on the global burden of disease. The study suggests that key malaria, TB and HIV/AIDS drugs are, together, ameliorating about 37% of the global burden of these diseases and Sanofi, Novartis, and Pfizer’s drugs are having the largest effect on this burden. Moreover, drug impacts vary widely across countries. This index provides important information for policy makers, pharmaceutical companies, countries, and other stake-holders that can help increase access to essential medicines. PMID:26657064

  10. Health Service Utilization and Poor Health Reporting in Asthma Patients

    PubMed Central

    Behr, Joshua G.; Diaz, Rafael; Akpinar-Elci, Muge

    2016-01-01

    The management and treatment of adult asthma has been associated with utilization of health services. Objectives: First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. Data Source: Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). Study Design: Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. Findings: Those with asthma are found more likely (OR 1.50, 95% CI 1.05–2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56–11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32–2.65) and hospitalization (OR 2.21, 95% CI 1.39–3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. Conclusion: Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are

  11. Health State Utility Values in Patients Undergoing Endoscopic Sinus Surgery

    PubMed Central

    Soler, Zachary M.; Wittenberg, Eve; Schlosser, Rodney J.; Mace, Jess C.; Smith, Timothy L.

    2011-01-01

    OBJECTIVES/HYPOTHESIS The primary study goal was to measure health state utility values in patients with chronic rhinosinusitis (CRS) before and after undergoing endoscopic sinus surgery (ESS). A secondary goal was to assess the meaning of these values by comparing them with other chronic disease processes and currently available medical or surgical treatments. STUDY DESIGN Prospective, observational cohort study METHODS Adults with CRS were enrolled after electing ESS and observed over a 5-year period. Baseline demographic and medical comorbidities were recorded for each patient, as well as computed tomography (CT), endoscopy, olfaction, and disease-specific quality of life scores. Utility values were derived using the Short-Form 6D (SF-6D) at baseline and again after surgery. RESULTS The mean SF-6D utility value for the baseline health state of all patients with CRS (n=232) was 0.65 (95% CI: 0.63–0.66). Baseline utility values correlated with disease-specific QOL as measured by the Rhinosinusitis Disability Index (RSDI) (r=−0.660; P<0.001), but not baseline CT, endoscopy, or olfactory scores. Follow-up utility values (≥6 months) after ESS improved by 0.087 (95% CI: 0.06–0.12; P<0.001) in patients with no history of sinus surgery and 0.062 (95% CI: 0.04–0.09; P<0.001) in those undergoing a revision procedure. CONCLUSIONS Patients with CRS who failed medical therapy and elected to undergo ESS report health state utility values which are significantly lower than the United States population norm. Utility values showed improvement after ESS which was statistically and clinically significant. These results provide the initial data necessary for formal cost-effectiveness analyses incorporating ESS. PMID:22034223

  12. Design of the national health security preparedness index.

    PubMed

    Uzun Jacobson, Evin; Inglesby, Tom; Khan, Ali S; Rajotte, James C; Burhans, Robert L; Slemp, Catherine C; Links, Jonathan M

    2014-01-01

    The importance of health security in the United States has been highlighted by recent emergencies such as the H1N1 influenza pandemic, Superstorm Sandy, and the Boston Marathon bombing. The nation's health security remains a high priority today, with federal, state, territorial, tribal, and local governments, as well as nongovernment organizations and the private sector, engaging in activities that prevent, protect, mitigate, respond to, and recover from health threats. The Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (OPHPR), led an effort to create an annual measure of health security preparedness at the national level. The collaborative released the National Health Security Preparedness Index (NHSPI(™)) in December 2013 and provided composite results for the 50 states and for the nation as a whole. The Index results represent current levels of health security preparedness in a consistent format and provide actionable information to drive decision making for continuous improvement of the nation's health security. The overall 2013 National Index result was 7.2 on the reported base-10 scale, with areas of greater strength in the domains of health surveillance, incident and information management, and countermeasure management. The strength of the Index relies on the interdependencies of the many elements in health security preparedness, making the sum greater than its parts. Moving forward, additional health security-related disciplines and measures will be included alongside continued validation efforts. PMID:24896305

  13. Health Literacy Impact on National Healthcare Utilization and Expenditure

    PubMed Central

    Rasu, Rafia S.; Bawa, Walter Agbor; Suminski, Richard; Snella, Kathleen; Warady, Bradley

    2015-01-01

    Background: Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. Methods: Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. Results: The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05). The extrapolated national

  14. Health care utilization by immigrants in Italy.

    PubMed

    De Luca, Giuliana; Ponzo, Michela; Andrés, Antonio Rodríguez

    2013-03-01

    Healthcare utilization studies show how well documented disparities between migrants and non-migrants. Reducing such disparities is a major goal in European countries. However, healthcare utilization among Italian immigrants is under-studied. The objective of this study is to explore differences in healthcare use between immigrant and native Italians. Cross-sectional study using the latest available (2004/2005) Italian Health Conditions Survey. We estimated separate hurdle binomial negative regression models for GP, specialist, and telephone consultations and a logit model for emergency room (ER) use. We used logistic regression and zero-truncated negative binomial regression to model the zero (contact decision) and count processes (frequency decisions) respectively. Adjusting for risk factors, immigrants are significantly less likely to use healthcare services with 2.4 and 2.7 % lower utilization probability for specialist and telephone consultations, respectively. First- and second-generation immigrants' probability for specialist and telephone contact is significantly lower than natives'. Immigrants, ceteris paribus, have a much higher probability of using ERs than natives (0.7 %). First-generation immigrants show a higher probability of visiting ERs (1 %). GP visits show no significant difference. In conclusion Italian immigrants are much less likely to use specialist healthcare and medical telephone consultations than natives but more likely to use ERs. Hence, we report an over-use of ERs and under-utilization of preventive care among immigrants. We recommend improved health policies for immigrants: promotion of better information dissemination among them, simplification of organizational procedures, better communications between providers and immigrants, and an increased supply of health services for the most disadvantaged populations. PMID:23239018

  15. Health Worker mHealth Utilization: A Systematic Review.

    PubMed

    White, Alice; Thomas, Deborah S K; Ezeanochie, Nnamdi; Bull, Sheana

    2016-05-01

    This systematic review describes mHealth interventions directed at healthcare workers in low-resource settings from the PubMed database from March 2009 to May 2015. Thirty-one articles were selected for final review. Four categories emerged from the reviewed articles: data collection during patient visits, communication between health workers and patients, communication between health workers, and public health surveillance. Most studies used a combination of quantitative and qualitative methods to assess acceptability of use, barriers to use, changes in healthcare delivery, and improved health outcomes. Few papers included theory explicitly to guide development and evaluation of their mHealth programs. Overall, evidence indicated that mobile technology tools, such as smartphones and tablets, substantially benefit healthcare workers, their patients, and healthcare delivery. Limitations to mHealth tools included insufficient program use and sustainability, unreliable Internet and electricity, and security issues. Despite these limitations, this systematic review demonstrates the utility of using mHealth in low-resource settings and the potential for widespread health system improvements using technology. PMID:26955009

  16. Environmental Quality Index and Childhood Mental Health

    EPA Science Inventory

    Childhood mental disorders affect between 13%-20% of children in the United States (US) annually and impact the child, family, and community. Literature suggests associations exist between environmental and children’s mental health such as air pollution with autism and ADHD...

  17. Construction of an environmental quality index for public health research

    PubMed Central

    2014-01-01

    Background A more comprehensive estimate of environmental quality would improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) for all counties in the U.S. was developed. Methods The EQI was developed in four parts: domain identification; data source acquisition; variable construction; and data reduction. Five environmental domains (air, water, land, built and sociodemographic) were recognized. Within each domain, data sources were identified; each was temporally (years 2000–2005) and geographically (county) restricted. Variables were constructed for each domain and assessed for missingness, collinearity, and normality. Domain-specific data reduction was accomplished using principal components analysis (PCA), resulting in domain-specific indices. Domain-specific indices were then combined into an overall EQI using PCA. In each PCA procedure, the first principal component was retained. Both domain-specific indices and overall EQI were stratified by four rural–urban continuum codes (RUCC). Higher values for each index were set to correspond to areas with poorer environmental quality. Results Concentrations of included variables differed across rural–urban strata, as did within-domain variable loadings, and domain index loadings for the EQI. In general, higher values of the air and sociodemographic indices were found in the more metropolitan areas and the most thinly populated areas have the lowest values of each of the domain indices. The less-urbanized counties (RUCC 3) demonstrated the greatest heterogeneity and range of EQI scores (−4.76, 3.57) while the thinly populated strata (RUCC 4) contained counties with the most positive scores (EQI score ranges from −5.86, 2.52). Conclusion The EQI holds promise for improving our characterization of the overall environment for public health. The EQI describes the non-residential ambient county-level conditions to which residents are

  18. A critique of ecosystem health concepts and indexes

    SciTech Connect

    Suter, G.W. II . Environmental Sciences Div.)

    1993-09-01

    Because people wish to preserve their health and do something equivalent for ecosystems, the metaphor of ecosystem health springs to mind. This paper presents the argument that it is a mistake for environmental scientists to treat this metaphor as reality. First, the metaphor fails because it misrepresents both ecology and health science. Ecosystems are not organisms, so they do not behave like organisms and do not have properties of organisms such as health. Also, health is not an operational concept for physicians or health risk assessors because they must predict, diagnose, and treat specific states called diseases or injuries; they do not calculate indexes of health. Second, attempts to operationally define ecosystem health result in the creation of indexes of heterogeneous variables. Such indexes have no meaning; they cannot be predicted, so they are not applicable to most regulatory problems; they have no diagnostic power; effects on one component are eclipsed by responses of other components; and the reason for a high or low index value is unknown. Their only virtue is that they reduce the complex array of ecosystem responses to various disturbances to one number with a reassuring name. A better alternative is to assess the real array of ecosystem responses so that causes can be diagnosed, future states can be predicted, and benefits of treatments can be compared.

  19. Association between Electronic Health Records and Health Care Utilization

    PubMed Central

    Edwards, A.; Kern, L.M.

    2015-01-01

    Summary Background The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited. Objective To determine any association between EHRs and health care utilization. Methods We conducted a cohort study (2008–2009) in the Hudson Valley, a multi-payer, multiprovider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics. Results Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions. Conclusions Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs. PMID:25848412

  20. Body Mass Index Trajectories and Healthcare Utilization in Young and Middle-aged Adults.

    PubMed

    Elrashidi, Muhamad Y; Jacobson, Debra J; St Sauver, Jennifer; Fan, Chun; Lynch, Brian A; Rutten, Lila J Finney; Ebbert, Jon O

    2016-01-01

    The obesity epidemic is a significant public health issue with adverse impact on health and costs. Applying a life-course perspective to obesity may advance our understanding of the influence of obesity over time on patterns of healthcare utilization in young and middle-aged United States (US) adults.We identified baseline body mass index (BMI) and BMI trajectories, and assessed their association with outpatient visits, emergency department (ED) visits, and hospitalizations in a well-defined population of young and middle-aged US adults.Using the Rochester Epidemiology Project resources, we conducted a retrospective cohort study of adults (N = 23,254) aged 18 to 44 years, with at least 3 BMI measurements, residing in Olmsted County, MN from January 1, 2005 through December 31, 2012.We observed that 27.5% of the population was obese. Four BMI trajectories were identified. Compared to under/normal weight, obese class III adults had higher risk of outpatient visits (adjusted rate ratio [RR], 1.86; 95% confidence intervals [CIs], 1.67-2,08), ED visits (adjusted RR, 3.02; 95% CI, 2.74-3.34), and hospitalizations (adjusted RR, 1.67; 95% CI, 1.59-1.75). BMI trajectory was positively associated with ED visits after adjustment for age, sex, race, and Charlson Comorbidity Index (P < 0.001 for trend).Among young and middle-aged US adults, baseline BMI is positively associated with outpatient visits, ED visits, and hospitalizations, while BMI trajectory is positively associated with ED visits. These findings extend our understanding of the longitudinal influence of obesity on healthcare utilization in early to mid-adulthood. PMID:26765446

  1. Marital Distress and Mental Health Care Service Utilization

    ERIC Educational Resources Information Center

    Schonbrun, Yael Chatav; Whisman, Mark A.

    2010-01-01

    Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for…

  2. The Effect of Maternal Health Beliefs on Utilization of Childhood Preventive Health Services and Child Health.

    ERIC Educational Resources Information Center

    Tinsley, Barbara J.

    Relationships among mothers' beliefs and values concerning their children's health, utilization of childhood preventive health services, and children's health status were examined. Mothers' health beliefs were measured with Parental Health Belief scales developed to explore three factors: (1) mothers' degree of perceived control or internality…

  3. Optimal vortex formation as an index of cardiac health

    PubMed Central

    Gharib, Morteza; Rambod, Edmond; Kheradvar, Arash; Sahn, David J.; Dabiri, John O.

    2006-01-01

    Heart disease remains a leading cause of death worldwide. Previous research has indicated that the dynamics of the cardiac left ventricle (LV) during diastolic filling may play a critical role in dictating overall cardiac health. Hence, numerous studies have aimed to predict and evaluate global cardiac health based on quantitative parameters describing LV function. However, the inherent complexity of LV diastole, in its electrical, muscular, and hemodynamic processes, has prevented the development of tools to accurately predict and diagnose heart failure at early stages, when corrective measures are most effective. In this work, it is demonstrated that major aspects of cardiac function are reflected uniquely and sensitively in the optimization of vortex formation in the blood flow during early diastole, as measured by a dimensionless numerical index. This index of optimal vortex formation correlates well with existing measures of cardiac health such as the LV ejection fraction. However, unlike existing measures, this previously undescribed index does not require patient-specific information to determine numerical index values corresponding to normal function. A study of normal and pathological cardiac health in human subjects demonstrates the ability of this global index to distinguish disease states by a straightforward analysis of noninvasive LV measurements. PMID:16606852

  4. The predictive validity of prospect theory versus expected utility in health utility measurement.

    PubMed

    Abellan-Perpiñan, Jose Maria; Bleichrodt, Han; Pinto-Prades, Jose Luis

    2009-12-01

    Most health care evaluations today still assume expected utility even though the descriptive deficiencies of expected utility are well known. Prospect theory is the dominant descriptive alternative for expected utility. This paper tests whether prospect theory leads to better health evaluations than expected utility. The approach is purely descriptive: we explore how simple measurements together with prospect theory and expected utility predict choices and rankings between more complex stimuli. For decisions involving risk prospect theory is significantly more consistent with rankings and choices than expected utility. This conclusion no longer holds when we use prospect theory utilities and expected utilities to predict intertemporal decisions. The latter finding cautions against the common assumption in health economics that health state utilities are transferable across decision contexts. Our results suggest that the standard gamble and algorithms based on, should not be used to value health. PMID:19833400

  5. Developing a risk-based air quality health index

    NASA Astrophysics Data System (ADS)

    Wong, Tze Wai; Tam, Wilson Wai San; Yu, Ignatius Tak Sun; Lau, Alexis Kai Hon; Pang, Sik Wing; Wong, Andromeda H. S.

    2013-09-01

    We developed a risk-based, multi-pollutant air quality health index (AQHI) reporting system in Hong Kong, based on the Canadian approach. We performed time series studies to obtain the relative risks of hospital admissions for respiratory and cardiovascular diseases associated with four air pollutants: sulphur dioxide, nitrogen dioxide, ozone, and particulate matter with an aerodynamic diameter less than 10 μm (PM10). We then calculated the sum of excess risks of the hospital admissions associated with these air pollutants. The cut-off points of the summed excess risk, for the issuance of different health warnings, were based on the concentrations of these pollutants recommended as short-term Air Quality Guidelines by the World Health Organization. The excess risks were adjusted downwards for young children and the elderly. Health risk was grouped into five categories and sub-divided into eleven bands, with equal increments in excess risk from band 1 up to band 10 (the 11th band is 'band 10+'). We developed health warning messages for the general public, including at-risk groups: young children, the elderly, and people with pre-existing cardiac or respiratory diseases. The new system addressed two major shortcomings of the current standard-based system; namely, the time lag between a sudden rise in air pollutant concentrations and the issue of a health warning, and the reliance on one dominant pollutant to calculate the index. Hence, the AQHI represents an improvement over Hong Kong's existing air pollution index.

  6. Construction of an environmental quality index for public health research

    EPA Science Inventory

    A more comprehensive estimate of environmental quality would improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) for all counties in the U.S. was developed. The EQI was developed in four parts: doma...

  7. Data Sources for an Environmental Quality Index: Availability, Quality, and Utility

    PubMed Central

    Rappazzo, Kristen; Messer, Lynne C.

    2011-01-01

    Objectives. An environmental quality index (EQI) for all counties in the United States is under development to explore the relationship between environmental insults and human health. The EQI is potentially useful for investigators researching health disparities to account for other concurrent environmental conditions. This article focused on the identification and assessment of data sources used in developing the EQI. Data source strengths, limitations, and utility were addressed. Methods. Five domains were identified that contribute to environmental quality: air, water, land, built, and sociodemographic environments. An inventory of possible data sources was created. Data sources were evaluated for appropriate spatial and temporal coverage and data quality. Results. The overall data inventory identified multiple data sources for each domain. From the inventory (187 sources, 617 records), the air, water, land, built environment, and sociodemographic domains retained 2, 9, 7, 4, and 2 data sources for inclusion in the EQI, respectively. However, differences in data quality, geographic coverage, and data availability existed between the domains. Conclusions. The data sources identified for use in the EQI may be useful to researchers, advocates, and communities to explore specific environmental quality questions. PMID:21836111

  8. Cost Sharing, Health Care Expenditures, and Utilization: An International Comparison.

    PubMed

    Perkowski, Patryk; Rodberg, Leonard

    2016-01-01

    Health systems implement cost sharing to help reduce health care expenditure and utilization by discouraging the use of unnecessary health care services. We examine cost sharing in 28 countries in the Organisation for Economic Co-operation and Development from 1999 through 2009 in the areas of medical care, hospital care, and pharmaceuticals. We investigate associations between cost sharing, health care expenditures, and health care utilization and find no significant association between cost sharing and health care expenditures or utilization in these countries. PMID:26545706

  9. Mapping health assessment questionnaire disability index (HAQ-DI) score, pain visual analog scale (VAS), and disease activity score in 28 joints (DAS28) onto the EuroQol-5D (EQ-5D) utility score with the KORean Observational study Network for Arthritis (KORONA) registry data.

    PubMed

    Kim, Hye-Lin; Kim, Dam; Jang, Eun Jin; Lee, Min-Young; Song, Hyun Jin; Park, Sun-Young; Cho, Soo-Kyung; Sung, Yoon-Kyoung; Choi, Chan-Bum; Won, Soyoung; Bang, So-Young; Cha, Hoon-Suk; Choe, Jung-Yoon; Chung, Won Tae; Hong, Seung-Jae; Jun, Jae-Bum; Kim, Jinseok; Kim, Seong-Kyu; Kim, Tae-Hwan; Kim, Tae-Jong; Koh, Eunmi; Lee, Hwajeong; Lee, Hye-Soon; Lee, Jisoo; Lee, Shin-Seok; Lee, Sung Won; Park, Sung-Hoon; Shim, Seung-Cheol; Yoo, Dae-Hyun; Yoon, Bo Young; Bae, Sang-Cheol; Lee, Eui-Kyung

    2016-04-01

    The aim of this study was to estimate the mapping model for EuroQol-5D (EQ-5D) utility values using the health assessment questionnaire disability index (HAQ-DI), pain visual analog scale (VAS), and disease activity score in 28 joints (DAS28) in a large, nationwide cohort of rheumatoid arthritis (RA) patients in Korea. The KORean Observational study Network for Arthritis (KORONA) registry data on 3557 patients with RA were used. Data were randomly divided into a modeling set (80 % of the data) and a validation set (20 % of the data). The ordinary least squares (OLS), Tobit, and two-part model methods were employed to construct a model to map to the EQ-5D index. Using a combination of HAQ-DI, pain VAS, and DAS28, four model versions were examined. To evaluate the predictive accuracy of the models, the root-mean-square error (RMSE) and mean absolute error (MAE) were calculated using the validation dataset. A model that included HAQ-DI, pain VAS, and DAS28 produced the highest adjusted R (2) as well as the lowest Akaike information criterion, RMSE, and MAE, regardless of the statistical methods used in modeling set. The mapping equation of the OLS method is given as EQ-5D = 0.95-0.21 × HAQ-DI-0.24 × pain VAS/100-0.01 × DAS28 (adjusted R (2) = 57.6 %, RMSE = 0.1654 and MAE = 0.1222). Also in the validation set, the RMSE and MAE were shown to be the smallest. The model with HAQ-DI, pain VAS, and DAS28 showed the best performance, and this mapping model enabled the estimation of an EQ-5D value for RA patients in whom utility values have not been measured. PMID:26849891

  10. Relationships between sitting time and health indicators, costs, and utilization in older adults

    PubMed Central

    Rosenberg, Dori; Cook, Andrea; Gell, Nancy; Lozano, Paula; Grothaus, Lou; Arterburn, David

    2015-01-01

    Objective To examine whether self-reported sitting time is related to various health indicators, health costs, and utilization in adults over age 65. Methods A retrospective cross-sectional cohort study was conducted using the electronic health record (EHR) from an integrated health system in Washington State. Members who completed an online health risk assessment (HRA) between 2009 and 2011 (N = 3538) were eligible. The HRA assessed sitting time, physical activity, and health status. Diagnosis codes for diabetes and cardiovascular disease (CVD), height and weight for body mass index (BMI) calculations, health care utilization and health costs were extracted from the EHR. Linear regression models with robust standard errors tested differences in sitting time by health status, BMI category, diabetes and CVD, health costs, and utilization adjusting for demographic variables, BMI, physical activity, and health conditions. Results People classified as overweight and obese, that had diabetes or CVD, and with poorer self-rated health had significantly higher sitting time (p < .05). Total annual adjusted health care costs were $126 higher for each additional hour of sitting (p < .05; not significant in final models including health conditions). Conclusion Sitting time may be an important independent health indicator among older adults. PMID:26844078

  11. The importance of establishing a national health security preparedness index.

    PubMed

    Lumpkin, John R; Miller, Yoon K; Inglesby, Tom; Links, Jonathan M; Schwartz, Angela T; Slemp, Catherine C; Burhans, Robert L; Blumenstock, James; Khan, Ali S

    2013-03-01

    Natural disasters, infectious disease epidemics, terrorism, and major events like the nuclear incident at Fukushima all pose major potential challenges to public health and security. Events such as the anthrax letters of 2001, Hurricanes Katrina, Irene, and Sandy, severe acute respiratory syndrome (SARS) and West Nile virus outbreaks, and the 2009 H1N1 influenza pandemic have demonstrated that public health, emergency management, and national security efforts are interconnected. These and other events have increased the national resolve and the resources committed to improving the national health security infrastructure. However, as fiscal pressures force federal, state, and local governments to examine spending, there is a growing need to demonstrate both what the investment in public health preparedness has bought and where gaps remain in our nation's health security. To address these needs, the Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (PHPR), is creating an annual measure of health security and preparedness at the national and state levels: the National Health Security Preparedness Index (NHSPI). PMID:23506403

  12. A Regional-Scale Ocean Health Index for Brazil

    PubMed Central

    Elfes, Cristiane T.; Longo, Catherine; Halpern, Benjamin S.; Hardy, Darren; Scarborough, Courtney; Best, Benjamin D.; Pinheiro, Tiago; Dutra, Guilherme F.

    2014-01-01

    Brazil has one of the largest and fastest growing economies and one of the largest coastlines in the world, making human use and enjoyment of coastal and marine resources of fundamental importance to the country. Integrated assessments of ocean health are needed to understand the condition of a range of benefits that humans derive from marine systems and to evaluate where attention should be focused to improve the health of these systems. Here we describe the first such assessment for Brazil at both national and state levels. We applied the Ocean Health Index framework, which evaluates ten public goals for healthy oceans. Despite refinements of input data and model formulations, the national score of 60 (out of 100) was highly congruent with the previous global assessment for Brazil of 62. Variability in scores among coastal states was most striking for goals related to mariculture, protected areas, tourism, and clean waters. Extractive goals, including Food Provision, received low scores relative to habitat-related goals, such as Biodiversity. This study demonstrates the applicability of the Ocean Health Index at a regional scale, and its usefulness in highlighting existing data and knowledge gaps and identifying key policy and management recommendations. To improve Brazil's ocean health, this study suggests that future actions should focus on: enhancing fisheries management, expanding marine protected areas, and monitoring coastal habitats. PMID:24695103

  13. Methods for comparing drug policies--the utility of composite drug harm indexes.

    PubMed

    Ritter, Alison

    2009-11-01

    One of the challenges for drug policy research is being able to compare policy options and outcomes. The development of indexes, such as the UK Drug Harm Index or the UNODC Illicit Drug Index is a way to systematically enable such comparisons. An Index is a single common metric that represents the diverse outcomes or consequences of drug use. An Index may be used for performance monitoring within one country/region over time; to establish societal benefit of drug policies as expressed in social costs saved; to compare countries or regions; or for comparative policy analysis. Clarity of purpose is important in how an Index is used. The consequences or outcomes that can be combined into a single Index include health consequences, crime consequences, public amenity, pain and suffering, labour market outcomes, and drug manufacture and trafficking activity. The choice of outcomes for inclusion is driven by the purpose but also often by practical considerations, such as data availability. The weighting of the consequences is an important consideration in translating the outcomes into a common metric. A monetary unit has a number of advantages: it is a unit that can be measured across diverse impacts; it gives implicit "weighting" of harms; and it is intuitive for policy makers and community. On the other hand, it represents an economic perspective. No one Index will be regarded as suitable and appropriate by every stakeholder and ongoing research effort on Indexes is an important foundational research activity to advance illicit drug policy. PMID:19356915

  14. Developing a composite index of spatial accessibility across different health care sectors: A German example.

    PubMed

    Siegel, Martin; Koller, Daniela; Vogt, Verena; Sundmacher, Leonie

    2016-02-01

    The evolving lack of ambulatory care providers especially in rural areas increasingly challenges the strict separation between ambulatory and inpatient care in Germany. Some consider allowing hospitals to treat ambulatory patients to tackle potential shortages of ambulatory care in underserved areas. In this paper, we develop an integrated index of spatial accessibility covering multiple dimensions of health care. This index may contribute to the empirical evidence concerning potential risks and benefits of integrating the currently separated health care sectors. Accessibility is measured separately for each type of care based on official data at the district level. Applying an Improved Gravity Model allows us to factor in potential cross-border utilization. We combine the accessibilities for each type of care into a univariate index by adapting the concept of regional multiple deprivation measurement to allow for a limited substitutability between health care sectors. The results suggest that better health care accessibility in urban areas persists when taking a holistic view. We believe that this new index may provide an empirical basis for an inter-sectoral capacity planning. PMID:26831039

  15. Fairness of utilizing health care facilities and out-of-pocket payment burden: evidence from Cambodia.

    PubMed

    Dalal, Koustuv; Aremu, Olatunde

    2013-05-01

    Catastrophic spending on health care through out-of-pocket payment is a huge problem in most low- and middle-income countries all over the world. The collapse of health systems and poverty have resulted in the proliferation of the private health sector in Cambodia, but very few studies have examined the fairness in ease of utilization of these services based on mode of payment. This study examined the utilization of health services for sickness or injury and identified its relationship with people's ability to pay for treatment seeking at various instances. Based on cross-sectional data from the Cambodian 2007 Demographic and Health Survey, the economic index estimated through principal component analysis and Lorenz curve was used to quantify the degree of fairness and equality in utilization and payment burden among the respondents. A distinct level of fairness was found in health care utilization and out-of-pocket payments. Specifically, use of private health care facilities and over-the-counter remedies dominate, and out-of-pocket payments cut across all socioeconomic strata. As many countries in low- and middle-income regions, and most importantly those in transition such as Cambodia, are repositioning their health systems, efforts should be made towards maintaining equitable access through adoption of finance mechanisms that make utilization of health care services fair and equitable. PMID:22958391

  16. Household health care facility utilization in the Philippines.

    PubMed

    Russo, G; Herrin, A N; Pons, M C

    This paper presents probit estimates of household utilization of health care facilities in the Philippines. Using household data from the 1987 National Health Survey and supply data from the Department of Health, separate probit equations are estimated for each of the four major types of facilities in the Philippines: Public hospitals, private hospitals, major rural health units and barangay (village) health stations. The probability that a household will utilize services from these facilities is estimated as a function of socioeconomic, demographic and supply variables. The results indicate substantial differences in utilization patterns by income class. Households in the highest income quartile are approximately twice as likely (0.451 versus 0.236) to utilize private hospital services vis-à-vis households in the lowest income quartile, ceteris paribus. The results also indicate substantial substitution between public and private services. An increase in the availability of private hospital beds significantly reduces the probability that a household will utilize government facilities. PMID:10050192

  17. Assimilation and health service utilization of Korean immigrant women.

    PubMed

    Son, Juyeon

    2013-11-01

    In this case study, I present descriptive findings with regard to immigrant incorporation and health service utilization. Using focus groups and survey of Korean immigrant women in Wisconsin, I examine whether the ways in which they adapt to the U.S. society is relevant to their health services utilization and the alternatives they seek when available health services are less than satisfactory. The findings suggest that adherence to Korean identity appears to be associated with health service utilization. This is evident in the immigrants' evaluation of the U.S. health services as compared to those of Korea, and the consideration given by these immigrants to seeking health services in Korea instead of the United States. Such concerns on the part of these immigrants have important implications for health researchers, as they highlight the significance of immigrants' transnational experiences and their sense of personal agency in the use of health care. PMID:24108090

  18. Horizontal Inequity in Elderly Health Care Utilization: Evidence from India

    PubMed Central

    Rudra, Shalini; Subramanian, S V

    2015-01-01

    Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly. PMID:26617450

  19. Horizontal Inequity in Elderly Health Care Utilization: Evidence from India.

    PubMed

    Joe, William; Rudra, Shalini; Subramanian, S V

    2015-11-01

    Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly. PMID:26617450

  20. Improving the Utilization of Health Manpower.

    ERIC Educational Resources Information Center

    Goldstein, Harold M.; And Others

    The general objectives of the study were to determine whether one can motivate users of health personnel, such as hospitals, to modify their hiring-in-requirements to the actual needs of the job, to restructure health occupational skills, and to develop inservice training programs which permit upward job mobility. Five hospitals, representing a…

  1. Monitoring Rangeland Health With MODIS Vegetation Index Data

    NASA Astrophysics Data System (ADS)

    Brown, J. F.

    2004-12-01

    Rangelands cover approximately one third of the land area of the conterminous U.S. These lands supply much of the forage for the U.S. cattle industry. Large area monitoring of these vast expanses of range has proved challenging since most of these lands are in the western U.S., are relatively sparsely populated, and are not well covered by meteorological weather stations. Improvements in the spatial and temporal precision of rangeland health information would be useful both for the cattle industry and for scientific studies of soil erosion, water runoff, ecosystem health, and carbon cycling. Optical multispectral remote sensing data from satellites are an objective source of synoptic, timely information for monitoring rangeland health. The objective of this study is to develop and evaluate a method for measuring and monitoring rangeland health over large areas. In the past, data collected by the Advanced Very High Resolution Radiometer has proved useful for this purpose, however the basic 1 km spatial resolution is not ideal when scaling up from ground observations. This study assesses MODIS 250 meter resolution vegetation index data for this purpose. MODIS data not only have finer spatial resolution and improved geolocation, but they also exhibit enhanced vegetation sensitivity and minimized variations associated with external atmospheric and non-atmospheric effects. Ground data collected over 51 sites in western South Dakota over four years are used as training for regression tree models of range health. Range health maps for the growing season derived from the models are presented and evaluated.

  2. Mental Health Utilization Among Diverse Parenting Young Couples.

    PubMed

    Albritton, Tashuna; Angley, Meghan; Gibson, Crystal; Sipsma, Heather; Kershaw, Trace

    2015-09-01

    Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social-personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor-Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow-up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse's influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples. PMID:26163272

  3. Dementia in Ontario: Prevalence and Health Services Utilization

    ERIC Educational Resources Information Center

    Tranmer, J. E.; Croxford, R.; Coyte, P. C.

    2003-01-01

    To understand the impact of ongoing reform of mental health and dementia care in Ontario, an examination of prevalence and health services utilization rates is needed. However, there exists a gap in current prevalence and health services research specific to dementia care in Ontario. The objective of this study was to address these concerns using…

  4. Separate and Cumulative Effects of Adverse Childhood Experiences in Predicting Adult Health and Health Care Utilization

    ERIC Educational Resources Information Center

    Chartier, Mariette J.; Walker, John R.; Naimark, Barbara

    2010-01-01

    Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization. Methods:…

  5. The military social health index: a partial multicultural validation.

    PubMed

    Van Breda, Adrian D

    2008-05-01

    Routine military deployments place great stress on military families. Before South African soldiers can be deployed, they undergo a comprehensive health assessment, which includes a social work assessment. The assessment focuses on the resilience of the family system to estimate how well the family will cope when exposed to the stress of deployments. This article reports on the development and validation of a new measuring tool, the Military Social Health Index, or MSHI. The MSHI is made up of four scales, each comprising 14 items, viz social support, problem solving, stressor appraisal, and generalized resistance resources. An initial, large-scale, multicultural validation of the MSHI revealed strong levels of reliability (Cronbach a and standard error of measurement) and validity (factorial, construct, convergent, and discriminant). PMID:18543570

  6. Managing water utility financial risks through third-party index insurance contracts

    NASA Astrophysics Data System (ADS)

    Zeff, Harrison B.; Characklis, Gregory W.

    2013-08-01

    As developing new supply capacity has become increasingly expensive and difficult to permit (i.e., regulatory approval), utilities have become more reliant on temporary demand management programs, such as outdoor water use restrictions, for ensuring reliability during drought. However, a significant fraction of water utility income is often derived from the volumetric sale of water, and such restrictions can lead to substantial revenue losses. Given that many utilities set prices at levels commensurate with recovering costs, these revenue losses can leave them financially vulnerable to budgetary shortfalls. This work explores approaches for mitigating drought-related revenue losses through the use of third-party financial insurance contracts based on streamflow indices. Two different types of contracts are developed, and their efficacy is compared against two more traditional forms of financial hedging used by water utilities: Drought surcharges and contingency funds (i.e., self-insurance). Strategies involving each of these approaches, as well as their use in combination, are applied under conditions facing the water utility serving Durham, North Carolina. A multireservoir model provides information on the scale and timing of droughts, and the financial effects of these events are simulated using detailed data derived from utility billing records. Results suggest that third-party index insurance contracts, either independently or in combination with more traditional hedging tools, can provide an effective means of reducing a utility's financial vulnerability to drought.

  7. The impact of health insurance on health services utilization and health outcomes in Vietnam.

    PubMed

    Guindon, G Emmanuel

    2014-10-01

    In recent years, a number of low- and middle-income country governments have introduced health insurance schemes. Yet not a great deal is known about the impact of such policy shifts. Vietnam's recent health insurance experience including a health insurance scheme for the poor in 2003 and a compulsory scheme that provides health insurance to all children under six years of age combined with Vietnam's commitment to universal coverage calls for research that examines the impact of health insurance. Taking advantage of Vietnam's unique policy environment, data from the 2002, 2004 and 2006 waves of the Vietnam Household Living Standard Survey and single-difference and difference-in-differences approaches are used to assess whether access to health insurance--for the poor, for children and for students--impacts on health services utilization and health outcomes in Vietnam. For the poor and for students, results suggest health insurance increased the use of inpatient services but not of outpatient services or health outcomes. For young children, results suggest health insurance increased the use of outpatient services (including the use of preventive health services such as vaccination and check-up) but not of inpatient services. PMID:24661805

  8. Men's Health Index: A Pragmatic Approach to Stratifying and Optimizing Men's Health

    PubMed Central

    Tan, Hui Meng; Tan, Wei Phin; Wong, Jun Hoe; Teo, Chin Hai; Ng, Chirk Jenn

    2014-01-01

    Purpose The proposed Men's Health Index (MHI) aims to provide a practical and systematic framework for comprehensively assessing and stratifying older men with the intention of optimising their health and functional status. Materials and Methods A literature search was conducted using PubMed from 1980 to 2012. We specifically looked for instruments which: assess men's health, frailty and fitness; predict life expectancy, mortality and morbidities. The instruments were assessed by the researchers who then agreed on the tools to be included in the MHI. When there was disagreements, the researchers discussed and reached a consensus guided by the principle that the MHI could be used in the primary care setting targetting men aged 55-65 years. Results The instruments chosen include the Charlson's Combined Comorbidity-Age Index; the International Index of Erectile Function-5; the International Prostate Symptom Score; the Androgen Deficiency in Aging Male; the Survey of Health, Ageing and Retirement in Europe Frailty Instrument; the Sitting-Rising Test; the Senior Fitness Test; the Fitness Assessment Score; and the Depression Anxiety Stress Scale-21. A pilot test on eight men was carried out and showed that the men's health index is viable. Conclusions The concept of assessing, stratifying, and optimizing men's health should be incorporated into routine health care, and this can be implemented by using the MHI. This index is particularly useful to primary care physicians who are in a strategic position to engage men at the peri-retirement age in a conversation about their life goals based on their current and predicted health status. PMID:25405012

  9. ADHD and Health Services Utilization in the National Health Interview Survey

    ERIC Educational Resources Information Center

    Cuffe, Steven P.; Moore, Charity G.; McKeown, Robert

    2009-01-01

    Objective: Describe the general health, comorbidities and health service use among U.S. children with ADHD. Method: The 2001 National Health Interview Survey (NHIS) contained the Strengths and Difficulties Questionnaire (SDQ; used to determine probable ADHD), data on medical problems, overall health, and health care utilization. Results: Asthma…

  10. Heart failure in primary care: co-morbidity and utilization of health care resources

    PubMed Central

    Carmona, Montserrat; García-Olmos, Luis M; García-Sagredo, Pilar; Alberquilla, Ángel; López-Rodríguez, Fernando; Pascual, Mario; Muñoz, Adolfo; Salvador, Carlos H; Monteagudo, José L; Otero-Puime, Ángel

    2013-01-01

    Background. In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization. Objective. To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. Methods. Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated. Results. One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost). Conclusions. Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity. PMID:23776041

  11. Developing a Forest Health Index for public engagement and decision support using local climatic, ecological, and socioeconomic data

    NASA Astrophysics Data System (ADS)

    Arnott, J. C.; Katzenberger, J.; Cundiff, J.

    2013-12-01

    Forest health is an oft-used term without a generally accepted definition. Nonetheless, the concept of forest health continues to permeate scientific, resource management, and public discourse, and it is viewed as a helpful communication device for engagement on issues of concern to forests and their surrounding communities. Notwithstanding the challenges associated with defining the concept of 'forest health,' we present a model for assessing forest health at a watershed scale. Utilizing the Roaring Fork Valley, Colorado--a mountain watershed of 640,000 forested acres--as a case study, we have created a Forest Health Index that integrates a range of climatic, ecological, and socioeconomic data into an assessment organized along a series of public goals including, 1) Ecosystem Services, 2) Public Health & Safety, 3) Sustainable Use & Management, and 4) Ecological Integrity. Methods for this index were adopted from an earlier effort called the Ocean Health Index by Halpern et al, 2012. Indicators that represent drivers of change, such as temperature and precipitation, as well as effects of change, such as primary productivity and phenology, were selected. Each indicator is assessed by comparing a current status of that indicator to a reference scenario obtained through one of the following methods: a) statistical analysis of baseline data from the indicator record, b) commonly accepted normals, thresholds, limits, concentrations, etc., and c) subjective expert judgment. The result of this assessment is a presentation of graphical data and accompanying ratings that combine to form an index of health for the watershed forest ecosystem. We find this product to have potential merit for communities working to assess the range of conditions affecting forest health as well as making sense of the outcomes of those affects. Here, we present a description of the index methodology, data results from engagement with forest watershed stakeholders, example results of data

  12. Community perceptions and utilization of a consumer health center*

    PubMed Central

    Ports, Katie A.; Ayers, Antoinette; Crocker, Wayne; Hart, Alton; Mosavel, Maghboeba; Rafie, Carlin

    2015-01-01

    The purpose of this study was to understand factors that may affect the usage of a consumer health center located in a public library. More specifically, the authors wanted to know what health resources are of interest to the community, what patrons' perceptions of their experience at the center are, and finally, how staff can increase utilization of the center. In general, perceptions of the center were positive. The findings support that participants appreciate efforts to provide health information in the public library setting and that utilization could be improved through marketing and outreach. PMID:25552943

  13. Community perceptions and utilization of a consumer health center.

    PubMed

    Ports, Katie A; Ayers, Antoinette; Crocker, Wayne; Hart, Alton; Mosavel, Maghboeba; Rafie, Carlin

    2015-01-01

    The purpose of this study was to understand factors that may affect the usage of a consumer health center located in a public library. More specifically, the authors wanted to know what health resources are of interest to the community, what patrons' perceptions of their experience at the center are, and finally, how staff can increase utilization of the center. In general, perceptions of the center were positive. The findings support that participants appreciate efforts to provide health information in the public library setting and that utilization could be improved through marketing and outreach. PMID:25552943

  14. Valve Health Monitoring System Utilizing Smart Instrumentation

    NASA Technical Reports Server (NTRS)

    Jensen, Scott L.; Drouant, George J.

    2006-01-01

    The valve monitoring system is a stand alone unit with network capabilities for integration into a higher level health management system. The system is designed for aiding in failure predictions of high-geared ball valves and linearly actuated valves. It performs data tracking and archiving for identifying degraded performance. The data collection types are cryogenic cycles, total cycles, inlet temperature, body temperature torsional strain, linear bonnet strain, preload position, total travel and total directional changes. Events are recorded and time stamped in accordance with the IRIG B True Time. The monitoring system is designed for use in a Class 1 Division II explosive environment. The basic configuration consists of several instrumentation sensor units and a base station. The sensor units are self contained microprocessor controlled and remotely mountable in three by three by two inches. Each unit is potted in a fire retardant substance without any cavities and limited to low operating power for maintaining safe operation in a hydrogen environment. The units are temperature monitored to safeguard against operation outside temperature limitations. Each contains 902-928 MHz band digital transmitters which meet Federal Communication Commission's requirements and are limited to a 35 foot transmission radius for preserving data security. The base-station controller correlates data from the sensor units and generates data event logs on a compact flash memory module for database uploading. The entries are also broadcast over an Ethernet network. Nitrogen purged National Electrical Manufactures Association (NEMA) Class 4 enclosures are used to house the base-station

  15. Predictors of Healthcare Service Utilization for Mental Health Reasons

    PubMed Central

    Fleury, Marie-Josée; Ngamini Ngui, André; Bamvita, Jean-Marie; Grenier, Guy; Caron, Jean

    2014-01-01

    This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care. PMID:25321874

  16. Short-run effects of job loss on health conditions, health insurance, and health care utilization.

    PubMed

    Schaller, Jessamyn; Stevens, Ann Huff

    2015-09-01

    Job loss in the United States is associated with reductions in income and long-term increases in mortality rates. This paper examines the short-run changes in health, health care access, and health care utilization after job loss that lead to these long-term effects. Using a sample with more than 10,000 individual job losses and longitudinal data on a wide variety of health-related outcomes, we show that job loss results in worse self-reported health, activity limitations, and worse mental health, but is not associated with statistically significant increases in a variety of specific chronic conditions. Among the full sample of workers, we see reductions in insurance coverage, but little evidence of reductions in health care utilization after job loss. Among the subset of displaced workers with chronic conditions and those for whom the lost job was their primary source of insurance we do see reductions in doctor's visits and prescription drug usage. PMID:26250651

  17. Development of Welding Fumes Health Index (WFHI) for Welding Workplace’s Safety and Health Assessment

    PubMed Central

    HARIRI, Azian; PAIMAN, Nuur Azreen; LEMAN, Abdul Mutalib; MD. YUSOF, Mohammad Zainal

    2014-01-01

    Abstract Background This study aimed to develop an index that can rank welding workplace that associate well with possible health risk of welders. Methods Welding Fumes Health Index (WFHI) were developed based on data from case studies conducted in Plant 1 and Plant 2. Personal sampling of welding fumes to assess the concentration of metal constituents along with series of lung function tests was conducted. Fifteen metal constituents were investigated in each case study. Index values were derived from aggregation analysis of metal constituent concentration while significant lung functions were recognized through statistical analysis in each plant. Results The results showed none of the metal constituent concentration was exceeding the permissible exposure limit (PEL) for all plants. However, statistical analysis showed significant mean differences of lung functions between welders and non-welders. The index was then applied to one of the welding industry (Plant 3) for verification purpose. The developed index showed its promising ability to rank welding workplace, according to the multiple constituent concentrations of welding fumes that associates well with lung functions of the investigated welders. Conclusion There was possibility that some of the metal constituents were below the detection limit leading to ‘0’ value of sub index, thus the multiplicative form of aggregation model was not suitable for analysis. On the other hand, maximum or minimum operator forms suffer from compensation issues and were not considered in this study. PMID:25927034

  18. Fuzzy Logic Based Rotor Health Index of Induction Motor

    NASA Astrophysics Data System (ADS)

    Misra, Rajul; Pahuja, G. L.

    2015-10-01

    This paper presents an experimental study on detection and diagnosis of broken rotor bars in Squirrel Cage Induction Motor (SQIM). The proposed scheme is based on Motor Current Signature Analysis (MCSA) which uses amplitude difference of supply frequency to upper and lower side bands. Initially traditional MCSA has been used for rotor fault detection. It provides rotor health index on full load conditions. However in real practice if a fault occurs motor can not run at full load. To overcome the issue of reduced load condition a Fuzzy Logic based MCSA has been designed, implemented, tested and compared with traditional MCSA. A simulation result shows that proposed scheme is not only capable of detecting the severity of rotor fault but also provides remarkable performance at reduced load conditions.

  19. Valve health monitoring system utilizing smart instrumentation

    NASA Astrophysics Data System (ADS)

    Jensen, Scott L.; Drouant, George J.

    2006-05-01

    The valve monitoring system is a stand alone unit with network capabilities for integration into a higher level health management system. The system is designed for aiding in failure predictions of high-geared ball valves and linearly actuated valves. It performs data tracking and archiving for identifying degraded performance. The data collection types are: cryogenic cycles, total cycles, inlet temperature, outlet temperature, body temperature, torsional strain, linear bonnet strain, preload position, total travel, and total directional changes. Events are recorded and time stamped in accordance with the IRIG B True Time. The monitoring system is designed for use in a Class 1 Division II explosive environment. The basic configuration consists of several instrumentation sensor units and a base station. The sensor units are self contained microprocessor controlled and remotely mountable in three by three by two inches. Each unit is potted in a fire retardant substance without any cavities and limited to low operating power for maintaining safe operation in a hydrogen environment. The units are temperature monitored to safeguard against operation outside temperature limitations. Each contains 902-928 MHz band digital transmitters which meet Federal Communication Commissions requirements and are limited to a 35 foot transmission radius for preserving data security. The base-station controller correlates related data from the sensor units and generates data event logs on a compact flash memory module for database uploading. The entries are also broadcast over an Ethernet network. Nitrogen purged National Electrical Manufactures Association (NEMA) Class 4 Enclosures are used to house the base-station.

  20. Health Impact Index. Development and Validation of a Method for Classifying Comorbid Disease Measured against Self-Reported Health

    PubMed Central

    2016-01-01

    The objective of this study was to develop a method of classifying comorbid conditions that accounts for both the severity and joint effects of the diseases. The Tromsø Study is a cohort study with a longitudinal design utilizing a survey approach with physical examinations in the Tromsø municipality from 1974 to 2008, where in total 40051 subjects participated. We used Tromsø 4 as reference population and the Norwegian Institute of Public Health (FHI) panel as validation population. Ordinal regression was used to assess the effect of comorbid disease on Self-Reported Health (SRH). The model is controlled for interaction between diseases, mental health, age, and gender. The health impact index estimated levels of SRH. The comparison of predicted and observed SRH showed no significant differences. Spearman’s correlation showed that increasing levels of comorbidity were related to lower levels of SRH (RS = -0.36, p <.001). The Charlson Comorbidity Index(CCI) was also associated with SRH (r = -.25, p <.001). When focusing on only individuals with a comorbid disease, the relation between SRH and the Health Impact Index (HII) was strengthened (r = -.42, p <.001), while the association between SRH and CCI was attenuated (r = -.14, p <.001). CCI was designed to control for comorbid conditions when survival/mortality is the outcome of interest but is inaccurate when the outcome is SRH. We conclude that HII should be used when SRH is not available, and well-being or quality of survival/life is the outcome of interest. PMID:26849044

  1. Body Mass Index, Perceived Health, and Happiness: Their Determinants and Structural Relationships

    ERIC Educational Resources Information Center

    Cornelisse-Vermaat, Judith R.; Antonides, Gerrit; Van Ophem, Johan A. C.; Van Den Brink, Henriette Maassen

    2006-01-01

    The structural relationships between body mass index, perceived health and happiness have been studied in a survey of 700 native Dutch citizens. We found an indirect effect of body mass index on happiness, via perceived health. Age had an inverted U-shaped relationship with body mass index, and both education and smoking had a negative effect on…

  2. Psychosocial working conditions and the utilization of health care services

    PubMed Central

    2011-01-01

    Background While there is considerable theoretical and empirical evidence on how job stress affects physical and mental health, few studies have examined the association between job related stress and health care utilization. Using data from the Canadian National Population Health Survey from 2000 to 2008, this paper examines the association between stressful working conditions, as measured by the job strain model, and the utilization of health care services. Methods A zero inflated negative binomial regression is used to examine the excess health care utilization due to job strain. Separate regressions are estimated for both males and females since studies have shown gender differences in health care utilization. Results Estimates for the whole population show that high or medium job strain has a positive and statistically significant association with the number of visits to both a general practitioner (GP) and a specialist (SP). On average, the number of GP visits is up to 26% more (IRR = 1.26, 95% CI = 1.19-1.31) for individuals with high strain jobs compared to those in the low job strain category. Similarly, SP visits are up to 27% more (IRR = 1.27, 95% CI = 1.14-142) for the high strain category. Results are quantitatively similar for males and females, save for medium strain. In general, findings are robust to the inclusion of workplace social support, health status, provincial and occupational-fixed effects. Conclusion Job strain may be positively associated with the utilization of health care services. This suggests that improving psychosocial working conditions and educating workers on stress-coping mechanisms could be beneficial for the physical and mental health of workers. PMID:21834974

  3. EXAMINING SOCIOECONOMIC HEALTH DISPARITIES USING A RANK-DEPENDENT RÉNYI INDEX

    PubMed Central

    Talih, Makram

    2015-01-01

    The Rényi index (RI) is a one-parameter class of indices that summarize health disparities among population groups by measuring divergence between the distributions of disease burden and population shares of these groups. The rank-dependent RI introduced in this paper is a two-parameter class of health disparity indices that also accounts for the association between socioeconomic rank and health; it may be derived from a rank-dependent social welfare function. Two competing classes are discussed and the rank-dependent RI is shown to be more robust to changes in the distribution of either socioeconomic rank or health. The standard error and sampling distribution of the rank-dependent RI are evaluated using linearization and re-sampling techniques, and the methodology is illustrated using health survey data from the U.S. National Health and Nutrition Examination Survey and registry data from the U.S. Surveillance, Epidemiology and End Results Program. Such data underlie many population-based objectives within the U.S. Healthy People 2020 initiative. The rank-dependent RI provides a unified mathematical framework for eliciting various societal positions with regards to the policies that are tied to such wide-reaching public health initiatives. For example, if population groups with lower socioeconomic position were ascertained to be more likely to utilize costly public programs, then the parameters of the RI could be selected to reflect prioritizing those population groups for intervention or treatment. PMID:26566419

  4. Testing rank-dependent utility theory for health outcomes.

    PubMed

    Oliver, Adam

    2003-10-01

    Systematic violations of expected utility theory (EU) have been reported in the context of both money and health outcomes. Rank-dependent utility theory (RDU) is currently the most popular and influential alternative theory of choice under circumstances of risk. This paper reports a test of the descriptive performance of RDU compared to EU in the context of health. When one of the options is certain, violations of EU that can be explained by RDU are found. When both options are risky, no evidence that RDU is a descriptive improvement over EU is found, though this finding may be due to the low power of the tests. PMID:14508870

  5. Primer on dietary carbohydrates and utility of the glycemic index in equine nutrition.

    PubMed

    Harris, Patricia; Geor, Raymond J

    2009-04-01

    The feeding of "low carbohydrate" or "low glycemic" diets has been recommended for management of horses with metabolic and endocrine disorders in which insulin resistance is a component. A "low carbohydrate" diet is a misnomer, however, because horses require that a significant proportion of their daily ration comprises structural carbohydrates (fiber/forage) to maintain gut health and mental wellbeing. This article provides a detailed description of the different carbohydrates in equine feeds. It also reviews the terminology used to describe glucose and insulin responses to the ingestion of carbohydrates, in particular the concept of the glycemic index. Some of the factors that influence glycemic index in humans and the glycemic response to a meal in horses are also discussed. PMID:19303548

  6. A comparison of four different approaches to measuring health utility in depressed patients

    PubMed Central

    2013-01-01

    Background A variety of instruments are used to measure health related quality of life. Few data exist on the performance and agreement of different instruments in a depressed population. The aim of this study was to investigate agreement between, and suitability of, the EQ-5D-3L, EQ-5D Visual Analogue Scale (EQ-5D VAS), SF-6D and SF-12 new algorithm for measuring health utility in depressed patients. Methods The intraclass correlation coefficient (ICC) and Bland and Altman approaches were used to assess agreement. Instrument sensitivity was analysed by: (1) plotting utility scores for the instruments against one another; (2) correlating utility scores and depressive symptoms (Beck Depression Inventory (BDI)); and (3) using Tukey’s procedure. Receiver Operating Characteristic (ROC) analysis assessed instrument responsiveness to change. Acceptability was assessed by comparing instrument completion rates. Results The overall ICC was 0.57. Bland and Altman plots showed wide limits of agreement for each pair wise comparison, except between the SF-6D and SF-12 new algorithm. Plots of utility scores displayed ’ceiling effects’ in the EQ-5D-3L index and ’floor effects’ in the SF-6D and SF-12 new algorithm. All instruments showed a negative monotonic relationship with BDI, but the EQ-5D-3L index and EQ-5D VAS could not differentiate between depression severity sub-groups. The SF-based instruments were better able to detect changes in health state over time. There was no difference in completion rates of the four instruments. Conclusions There was a lack of agreement between utility scores generated by the different instruments. According to the criteria of sensitivity, responsiveness and acceptability that we applied, the SF-6D and SF-12 may be more suitable for the measurement of health related utility in a depressed population than the EQ-5D-3L, which is the instrument currently recommended by NICE. PMID:23659557

  7. The Prostate Health Index Selectively Identifies Clinically Significant Prostate Cancer

    PubMed Central

    Loeb, Stacy; Sanda, Martin G.; Broyles, Dennis L.; Shin, Sanghyuk S.; Bangma, Chris H.; Wei, John T.; Partin, Alan W.; Klee, George G.; Slawin, Kevin M.; Marks, Leonard S.; van Schaik, Ron H. N.; Chan, Daniel W.; Sokoll, Lori J.; Cruz, Amabelle B.; Mizrahi, Isaac A.; Catalona, William J.

    2015-01-01

    Purpose The Prostate Health Index (phi) is a new test combining total, free and [-2]proPSA into a single score. It was recently approved by the FDA and is now commercially available in the U.S., Europe and Australia. We investigate whether phi improves specificity for detecting clinically significant prostate cancer and can help reduce prostate cancer over diagnosis. Materials and Methods From a multicenter prospective trial we identified 658 men age 50 years or older with prostate specific antigen 4 to 10 ng/ml and normal digital rectal examination who underwent prostate biopsy. In this population we compared the performance of prostate specific antigen, % free prostate specific antigen, [-2]proPSA and phi to predict biopsy results and, specifically, the presence of clinically significant prostate cancer using multiple criteria. Results The Prostate Health Index was significantly higher in men with Gleason 7 or greater and “Epstein significant” cancer. On receiver operating characteristic analysis phi had the highest AUC for overall cancer (AUCs phi 0.708, percent free prostate specific antigen 0.648, [-2]proPSA 0.550 and prostate specific antigen 0.516), Gleason 7 or greater (AUCs phi 0.707, percent free prostate specific antigen 0.661, [-2]proPSA 0.558, prostate specific antigen 0.551) and significant cancer (AUCs phi 0.698, percent free prostate specific antigen 0.654, [-2]proPSA 0.550, prostate specific antigen 0.549). At the 90% sensitivity cut point for phi (a score less than 28.6) 30.1% of patients could have been spared an unnecessary biopsy for benign disease or insignificant prostate cancer compared to 21.7% using percent free prostate specific antigen. Conclusions The new phi test outperforms its individual components of total, free and [-2]proPSA for the identification of clinically significant prostate cancer. Phi may be useful as part of a multivariable approach to reduce prostate biopsies and over diagnosis. PMID:25463993

  8. Utilization review. Health economics and cost-effective resource management.

    PubMed

    Rosenstein, A H

    1991-01-01

    In an effort to reduce their health care burden, health care payors have turned to utilization controls and restructured health care payment systems to control health care costs. While health care payors are interested in economic restraints, health care providers are being placed at increasing levels of financial risk, and they struggle to maintain high quality services. Quality of care must remain our number one priority, but it is essential to achieve this goal in a cost-efficient manner. Cost-efficiencies are gained through the development of a comprehensive physician education program that encourages information exchange, physician input, and the implementation of positive alternatives that lead to efficiencies in resource management. PMID:1824449

  9. Predicting Health Care Utilization After Behavioral Health Referral Using Natural Language Processing and Machine Learning

    PubMed Central

    Roysden, Nathaniel; Wright, Adam

    2015-01-01

    Mental health problems are an independent predictor of increased healthcare utilization. We created random forest classifiers for predicting two outcomes following a patient’s first behavioral health encounter: decreased utilization by any amount (AUROC 0.74) and ultra-high absolute utilization (AUROC 0.88). These models may be used for clinical decision support by referring providers, to automatically detect patients who may benefit from referral, for cost management, or for risk/protection factor analysis. PMID:26958306

  10. Diagnostic Utility of WISC-IV General Abilities Index and Cognitive Proficiency Index Difference Scores among Children with ADHD

    ERIC Educational Resources Information Center

    Devena, Sarah E.; Watkins, Marley W.

    2012-01-01

    The Wechsler Intelligence Scale for Children-Fourth Edition General Abilities Index and Cognitive Proficiency Index have been advanced as possible diagnostic markers of attention deficit hyperactivity disorder. This hypothesis was tested with a hospital sample with attention deficit hyperactivity disorder (n = 78), a referred but nondiagnosed…

  11. Utility of the Shock Index and Other Risk-Scoring Tools in Patients with Gastrointestinal Bleeding.

    PubMed

    Ratra, Atul; Rassameehiran, Supannee; Parupudi, Sreeram; Nugent, Kenneth

    2016-03-01

    Patients with upper gastrointestinal (GI) bleeding frequently require hospitalization and have a mortality rate that ranges from 6% to 14%. These patients need rapid clinical assessment to determine the urgency of endoscopy and the need for endoscopic treatment. Risk-scoring tools, such as the Rockall score and the Glasgow-Blatchford score, are commonly used in this assessment. These tools clearly help identify high-risk patients but do not necessarily have good predictive value in identifying important outcomes. Their diagnostic accuracy in identifying rebleeding and mortality ranges from poor to fair. The shock index (heart rate divided by systolic blood pressure) provides an integrated assessment of the cardiovascular status. It can be easily calculated during the initial evaluation of patients and monitoring after treatment. The shock index has been used in a few studies in patients with acute GI bleeding, including studies to determine which patients need emergency endoscopy, to predict complications after corrosive ingestions, to identify delayed hemorrhage following pancreatic surgery, and to evaluate the utility of angiograms to identify sites of GI bleeding. Not all studies have found the shock index to be useful in patients with GI bleeding, however. This may reflect the unpredictable natural history of various etiologies of GI bleeding, comorbidity that may influence blood pressure and/or heart rate, and inadequate data acquisition. The shock index needs more formal study in patients with GI bleeding admitted to medical intensive care units. Important considerations include the initial response to resuscitation, persistent bleeding following initial treatment, and rebleeding following a period of stabilization. In addition, it needs correlation with other risk-scoring tools. PMID:26954657

  12. The Utilization of Dental Health Services by Chicanos and Anglos.

    ERIC Educational Resources Information Center

    Garcia, John A.; Juarez, Rumaldo Z.

    The dental utilization patterns of Chicanos and Anglos were compared using several socio-demographic variables to explain any differences or similarities existing between the two groups. Data for this study were part of an extensive household survey conducted in Pima County, Arizona, to obtain information on various health indicators concerning…

  13. Adjusting capitation rates using objective health measures and prior utilization

    PubMed Central

    Newhouse, Joseph P.; Manning, Willard G.; Keeler, Emmett B.; Sloss, Elizabeth M.

    1989-01-01

    Several analysts have proposed adding adjusters based on health status and prior utilization to the adjusted average per capita cost formula. The authors estimate how well such adjusters predict annual medical expenditures among non-elderly adults. Both measures substantially improve on the variables currently used. If only health measures are added, 20-30 percent of the predictable variance is explained; if only prior use is added, more than 40 percent is explained; if both are added, about 60 percent is explained. The results support including some measure of use in the formula until better health measures are developed. PMID:10313096

  14. Quality of Life, Health Status, and Health Service Utilization Related to a New Measure of Health Literacy FLIGHT/VIDAS

    PubMed Central

    Ownby, Raymond L; Acevedo, Amarilis; Jacobs, Robin J.; Caballero, Joshua; Waldrop-Valverde, Drenna

    2014-01-01

    Objective Researchers have identified significant limitations in some currently-used measures of health literacy. The purpose of this paper is to present data on the relation of health-related quality of life, health status, and health service utilization to performance on a new measure of health literacy in a nonpatient population. Methods The new measure was administered to 475 English- and Spanish-speaking community-dwelling volunteers along with existing measures of health literacy and assessments of health-related quality of life, health status, and healthcare service utilization. Relations among measures were assessed via correlations and health status and utilization was tested across levels of health literacy using ANCOVA models. Results The new health literacy measure is significantly related to existing measures of health literacy as well as to participants’ health-related quality of life. Persons with lower levels of health literacy reported more health conditions, more frequent physical symptoms, and greater healthcare service utilization. Conclusion The new measure of health literacy is valid and shows relations to measures of conceptually-related constructs such as quality of life and health behaviors. Practice Implications: FLIGHT/VIDAS may be useful to researchers and clinicians interested in a computer administered and scored measure of health literacy. PMID:24856447

  15. Health State Utilities for Patients with Brain Metastases

    PubMed Central

    Dosoretz, Arie P; Hayman, James A; Yu, James B

    2016-01-01

    Purpose: Estimating the cost-effectiveness of whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS), including Gamma Knife radiosurgery (GKRS), requires the quantitative measurement of patients’ health states after treatment. We sought to quantify individuals’ preferences for the relevant health states after WBRT or GKRS for brain metastases on a 0 to 1 scale, where 1 is perfect health and 0 is death. Methods: We prospectively measured utilities in patients with brain metastases evaluated at Yale for consideration of WBRT and/or GKRS, as well as oncology nurses who had cared for patients with brain metastases before and after WBRT or GKRS, using the Standard Gamble (SG) technique. Demographic information was also collected. Nonparametric tests were used to compare potential differences in utility values and for subgroups based on demographic characteristics. Results: There were 24 patients and 31 nurses who completed the study between December 2013 and May 2015. Median utilities ranged from 0.85 for the status-post (S/P) GKRS state to 0.25 (for neurologic dying). The median utility of being S/P WBRT was 0.70 compared to 0.85 S/P GKRS (p < 0.001). The cognitive decline from WBRT was associated with a notably low utility score of 0.30. There were no statistically significant differences between patients’ and nurses’ median utility scores. Conclusions: These SG utilities provide unique insights into brain metastases-related health states from the patient and provider perspective. As perceived by individuals with direct knowledge of the health states in question, WBRT has a significantly lower utility compared to GKRS. Cognitive decline following WBRT is associated with significant perceived reduction in quality of life. Differences in the relative importance of overall survival and quality of life with treatment existed between patients with different stages of disease. These utilities can be used to calculate quality-adjusted life

  16. The index of multiple deprivation 2000 access domain: a useful indicator for public health?

    PubMed

    Niggebrugge, Aphrodite; Haynes, Robin; Jones, Andrew; Lovett, Andrew; Harvey, Ian

    2005-06-01

    The access domain of the UK index of multiple deprivation (IMD) 2000 was designed to identify populations in small areas with poor geographical access to certain local key services. The measure is a composite of straight line distances to post offices, large food shops, primary schools and general practice surgeries for population sub-groups. Using the region of East Anglia as a case study area, this research evaluated the utility of the IMD2000 as an indicator of access to primary care. IMD2000 access scores for electoral wards were compared with a range of more detailed indicators of travel times and bus availability for visiting a general practitioner generated in a geographical information system (GIS). A range of easy-to-calculate surrogate variables was developed and tested as possible candidates to improve the explanatory power of the IMD2000 access score. The access domain was negatively correlated with the other five deprivation domains that comprise the overall index, suggesting that access should not be combined with the other measures of deprivation into a composite single score. The access domain was also found to predict access to primary care only with moderate accuracy. Two additional indicators of accessibility calculated in a GIS (road kilometres per thousand population and the presence of a major road in each ward) were found to add slightly to the power of the index. The predictive power of the index was best in urban areas, although it is in rural areas that access to primary care is a more important public health issue. The IMD2000 should be therefore used with caution as a measure of health service accessibility in rural areas. PMID:15820584

  17. Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam

    PubMed Central

    Duc, Nguyen Huu Chau; Nakamura, Keiko; Kizuki, Masashi; Seino, Kaoruko; Rahman, Mosiur

    2015-01-01

    Objective: This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. Methods: Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household’s ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. Results: Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. Conclusions: More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery

  18. Mental health care utilization and costs in a corporate setting.

    PubMed

    Tsai, S P; Bernacki, E J; Reedy, S M

    1987-10-01

    This article presents the mental health care utilization and costs among 14,162 employees and their families, covered under a major medical policy of a large multinational corporation for the 1984 policy year. Mental health care costs comprise a substantial portion of the total health care dollars expended (8.1%) for a relatively small fraction of the total number of claims (2.8%). The average hospital stay for mental disorders (20 days for employees; 15 days for spouses; 43 days for dependents) was significantly longer than for other illnesses (6.1 days for employees; 6.2 days for spouses; 4.4 days for dependents). Although the average daily hospital cost for mental disorders was less than that for non-mental conditions, total expenditures per admission were approximately three times higher due to the long lengths of stay. Case management, peer utilization review, and day treatment are recommended to reduce these costs. PMID:3681492

  19. Relationship between Revised Graduated Index (R-GINDEX) of Prenatal Care Utilization & Preterm Labor and Low Birth Weight

    PubMed Central

    Tayebi, Tahereh; Hamzehgardeshi, Zeinab; Shirvani, Marjan Ahmad; Dayhimi, Marjaneh; Danesh, Mahmonir

    2014-01-01

    Prenatal care refers to accurate and consistent performance of the principles important to maintain healthy pregnancy outcomes and also for mother and child health. One of the new indices to assess the adequacy of care is Revised Graduated Index of Prenatal Care Utilization (R-GINDEX). The study aims to assess the relationship between quantitative prenatal care factors and preterm labor and low birth weight using R-GINDEX. This historical cohort study has been conducted on 420 mothers during the first two years after delivery in 2010. The adequacy of care was calculated by R-GINDEX. Based on this index, participants have been divided into three care groups including inadequate, adequate and intensive care groups. A significant relationship has been found between R-GINDEX and preterm birth and low birth weight (P<0.05). Thus the probability of premature labor in inadequate care group (RR=3.93) and low birth weight (RR= 2.53) was higher than that of the adequate and intensive care group. The results showed that the quantity of prenatal care is effective in reducing preterm birth and low birth weight. PMID:24762355

  20. Predicting SF-6D utility scores from the Neck Disability Index and Numeric Rating Scales for Neck and Arm Pain

    PubMed Central

    Carreon, Leah Y.; Anderson, Paul A.; McDonough, Christine M.; Djurasovic, Mladen; Glassman, Steven D.

    2010-01-01

    Study Design Cross-sectional cohort Objective This study aims to provide an algorithm estimate SF-6D utilities using data from the NDI, neck pain and arm pain scores. Summary of Background Data Although cost-utility analysis is increasingly used to provide information about the relative value of alternative interventions, health state values or utilities are rarely available from clinical trial data. The Neck Disability Index (NDI) and numeric rating scales for neck and arm pain, are widely used disease-specific measures of symptoms, function and disability in patients with cervical degenerative disorders. The purpose of this study is to provide an algorithm to allow estimation of SF-6D utilities using data from the NDI, and numeric rating scales for neck and arm pain. Methods SF-36, NDI, neck and arm pain rating scale scores were prospectively collected pre-operatively, at 12 and 24 months post-operatively in 2080 patients undergoing cervical fusion for degenerative disorders. SF-6D utilities were computed and Spearman correlation coefficients were calculated for paired observations from multiple time points between NDI, neck and arm pain scores and SF-6D utility scores. SF-6D scores were estimated from the NDI, neck and arm pain scores using a linear regression model. Using a separate, independent dataset of 396 patients in which and NDI scores were available SF-6D was estimated for each subject and compared to their actual SF-6D. Results The mean age for those in the development sample, was 50.4 ± 11.0 years and 33% were male. In the validation sample the mean age was 53.1 ± 9.9 years and 35% were male. Correlations between the SF-6D and the NDI, neck and arm pain scores were statistically significant (p<0.0001) with correlation coefficients of 0.82, 0.62, and 0.50 respectively. The regression equation using NDI alone to predict SF-6D had an R2 of 0.66 and a root mean square error (RMSE) of 0.056. In the validation analysis, there was no statistically

  1. Utility and limitations of measures of health inequities: a theoretical perspective

    PubMed Central

    Alonge, Olakunle; Peters, David H.

    2015-01-01

    Summary box What is already known on this subject? Various measures have been used in quantifying health inequities among populations in recent times; most of these measures were derived to capture the socioeconomic inequalities in health. These different measures do not always lend themselves to common interpretation by policy makers and health managers because they each reflect limited aspects of the concept of health inequities. What does this study add? To inform a more appropriate application of the different measures currently used in quantifying health inequities, this article explicates common theories underlying the definition of health inequities and uses this understanding to show the utility and limitations of these different measures. It also suggests some key features of an ideal indicator based on the conceptual understanding, with the hope of influencing future efforts in developing more robust measures of health inequities. The article also provides a conceptual ‘product label’ for the common measures of health inequities to guide users and ‘consumers’ in making more robust inferences and conclusions. This paper examines common approaches for quantifying health inequities and assesses the extent to which they incorporate key theories necessary for explicating the definition of health inequity. The first theoretical analysis examined the distinction between inter-individual and inter-group health inequalities as measures of health inequities. The second analysis considered the notion of fairness in health inequalities from different philosophical perspectives. To understand the extent to which different measures of health inequities incorporate these theoretical explanations, four criteria were used to assess each measure: 1) Does the indicator demonstrate inter-group or inter-individual health inequalities or both; 2) Does it reflect health inequalities in relation to socioeconomic position; 3) Is it sensitive to the absolute transfer of

  2. Utilization of health insurance data in an environmental epidemiology

    PubMed Central

    Ha, Jongsik; Cho, Seongkyung

    2015-01-01

    Objectives In South Korea, health insurance data are used as material for the health insurance of national whole subject. In general, health insurance data could be useful for estimating prevalence or incidence rate that is representative of the actual value in a population. The purpose of this study was to apply the concept of episode of care (EoC) in the utilization of health insurance data in the field of environmental epidemiology and to propose an improved methodology through an uncertainty assessment of disease course and outcome. Methods In this study, we introduced the concept of EoC as a methodology to utilize health insurance data in the field of environmental epidemiology. The characterization analysis of the course and outcome of applying the EoC concept to health insurance data was performed through an uncertainty assessment. Results The EoC concept in this study was applied to heat stroke (International Classification of Disease, 10th revision, code T67). In the comparison of results between before and after applying the EoC concept, we observed a reduction in the deviation of daily claims after applying the EoC concept. After that, we categorized context, model, and input uncertainty and characterized these uncertainties in three dimensions by using uncertainty typology. Conclusions This study is the first to show the process of constructing episode data for environmental epidemiological studies by using health insurance data. Our results will help in obtaining representative results for the processing of health insurance data in environmental epidemiological research. Furthermore, these results could be used in the processing of health insurance data in the future. PMID:26796891

  3. Surrogate analysis and index developer (SAID) tool and real-time data dissemination utilities

    USGS Publications Warehouse

    Domanski, Marian M.; Straub, Timothy D.; Wood, Molly S.; Landers, Mark N.; Wall, Gary R.; Brady, Steven J.

    2015-01-01

    The use of acoustic and other parameters as surrogates for suspended-sediment concentrations (SSC) in rivers has been successful in multiple applications across the Nation. Critical to advancing the operational use of surrogates are tools to process and evaluate the data along with the subsequent development of regression models from which real-time sediment concentrations can be made available to the public. Recent developments in both areas are having an immediate impact on surrogate research, and on surrogate monitoring sites currently in operation. The Surrogate Analysis and Index Developer (SAID) standalone tool, under development by the U.S. Geological Survey (USGS), assists in the creation of regression models that relate response and explanatory variables by providing visual and quantitative diagnostics to the user. SAID also processes acoustic parameters to be used as explanatory variables for suspended-sediment concentrations. The sediment acoustic method utilizes acoustic parameters from fixed-mount stationary equipment. The background theory and method used by the tool have been described in recent publications, and the tool also serves to support sediment-acoustic-index methods being drafted by the multi-agency Sediment Acoustic Leadership Team (SALT), and other surrogate guidelines like USGS Techniques and Methods 3-C4 for turbidity and SSC. The regression models in SAID can be used in utilities that have been developed to work with the USGS National Water Information System (NWIS) and for the USGS National Real-Time Water Quality (NRTWQ) Web site. The real-time dissemination of predicted SSC and prediction intervals for each time step has substantial potential to improve understanding of sediment-related water-quality and associated engineering and ecological management decisions.

  4. Alcohol Dependence and Health Care Utilization in African Americans

    PubMed Central

    Marshall, Vanessa J.; Kalu, Nnenna; Kwagyan, John; Scott, Denise M.; Cain, Gloria E.; Hill, Karen; Hesselbrock, Victor; Ferguson, Clifford L.; Taylor, Robert E.

    2013-01-01

    Objective Ethnic and cultural differences in patterns of alcohol use disorders must be understood in order to address improvement in prevention of such disorders and accessibility to health care services. The purpose of this study was to evaluate factors that influence the utilization of medical and mental health services among alcohol-dependent and non alcohol–dependent African Americans. Method A cohort of 454 African Americans was evaluated. Alcohol-dependent participants were recruited from various inpatient treatment facilities in the Washington, DC, metropolitan area and through advertisement and word of mouth. Non–alcohol-dependent participants were recruited by advertisements. Each participant was administered the Semi-Structured Assessment for the Genetics of Alcoholism to assess alcohol dependency and the Family History Assessment module to access family history of alcoholism. χ2 Test and analysis of variance were used to analyze the data. Results Alcohol dependence was more prevalent among men, those with lower income, those with less education, and they utilized mental health counseling as opposed to medical-based therapy. Increased reports of medical conditions such as migraine (p < .001), loss of consciousness (p = .001), and sexually transmitted diseases (p < .001) were also associated with alcohol dependency. Other factors, including visits to inpatient treatment programs, were directly related to incidence of alcohol dependency regardless of gender status (p < .001). Conclusions This study suggests an association exists among alcohol dependence, medical conditions, health care, and mental care utilization among African Americans. Future research may benefit from investigating if an association exists between alcohol use disorders and health care utilization for other ethnic groups. PMID:23862295

  5. Variation in child health care utilization by medical complexity.

    PubMed

    Kuo, Dennis Z; Melguizo-Castro, Maria; Goudie, Anthony; Nick, Todd G; Robbins, James M; Casey, Patrick H

    2015-01-01

    Children with medical complexity (CMC) have multiple specialty need, technology dependence, and high health care utilization. The objective of this study is to profile types of pediatric health care utilization and costs by increasing levels of medical complexity. This is a cross-sectional study of the 2007, 2008 and 2009 Full-Year Data Sets from the Medical Expenditure Panel Survey. Medical complexity was defined by a higher number of positive items from the five question children with special health care needs (CSHCN) Screener. CMC were defined by ≥ 4 positive screener items. Outcomes included the number of inpatient, outpatient, and emergency department visits, associated costs and diagnoses, and reported satisfaction. ICD-9 codes were grouped by Clinical Classifications Software. Of 27,755 total study subjects ≤ 17 years, 4,851 had special needs and 541 were CMC. Older age, male gender, white/non-Hispanic race/ethnicity, and public insurance were all associated with medical complexity (all p < 0.001). CMC had an annual mean of 19 annual outpatient visits ($616) and 0.26 inpatient visits ($3,308), with other significant cost drivers including home health ($2,957) and prescriptions ($2,182). The most common reasons for non-CSHCN and less-complex CSHCN outpatient visits were viral illnesses, while the main reasons for CMC visits were for mental health. Compared to families without CSHCN, those with CMC have, on average, lower satisfaction with health care (8.4 vs. 8.9 out of 10, p < 0.001). Health care models for CMC should account for mental health conditions that may be driving high numbers of outpatient encounters. PMID:24740726

  6. Index of Graduate Theses and Projects in Allied Health.

    ERIC Educational Resources Information Center

    Journal of Allied Health, 1991

    1991-01-01

    Contains 1,073 entries from 91 institutions, giving author, institution, year, degree, emphasis, discipline, and title, arranged by topic: allied health, biocommunication arts, child development/care, clinical psychology, dentistry, environmental health, exercise science, food service, health education, health services, medical laboratories, nurse…

  7. Occupational safety and health implications of increased coal utilization.

    PubMed Central

    Bridbord, K; Costello, J; Gamble, J; Groce, D; Hutchison, M; Jones, W; Merchant, J; Ortmeyer, C; Reger, R; Wagner, W L

    1979-01-01

    An area of major concern in considering increased coal production and utilization is the health and safety of increased numbers of workers who mine, process, or utilize coal. Hazards related to mining activities in the past have been especially serious, resulting in many mine related accidental deaths, disabling injuries, and disability and death from chronic lung disease. Underground coal mines are clearly less safe than surface mines. Over one-third of currently employed underground miners experience chronic lung disease. Other stresses include noise and extremes of heat and cold. Newly emphasized technologies of the use of diesel powered mining equipment and the use of longwall mining techniques may be associated with serious health effects. Workers at coal-fired power plants are also potentially at risk of occupational diseases. Occupational safety and health aspects of coal mining are understood well enough today to justify implementing necessary and technically feasible and available control measures to minimize potential problems associated with increased coal production and use in the future. Increased emphasis on safety and health training for inexperienced coal miners expected to enter the work force is clearly needed. The recently enacted Federal Mine Safety and Health Act of 1977 will provide impetus for increased control over hazards in coal mining. PMID:540621

  8. Report on health and environmental effects of increased coal utilization*

    PubMed Central

    1980-01-01

    The National Energy Plan announced by President Carter on April 29, 1977 proposed a significant increase in the utilization of the vast domestic deposits of coal to replace the dwindling supplies of oil and natural gas, and increasingly expensive oil from foreign sources, to meet national energy needs. At the same time, in recognition of possible adverse health and ecological consequences of increased coal production and use, the President announced that a special committee would be formed to study this aspect of the National Energy Plan. The Committee held a series of public meetings during November and December 1977 to review a number of special papers on particular problems associated with increased coal utilization. These papers, which were prepared by scientists of the US Environmental Protection Agency; the Department of Energy; the HEW National Institute for Occupational Safety and Health, and the National Institute of Environmental Health Sciences; New York University; and Vanderbilt University; provided essential background information for the deliberations of the Committee and were published in EHP Vol. 33, pp. 127–314, 1979. One paper by A. P. Altschuler et al. is published in this volume of EHP. The Committee's basic finding was that it is safe to proceed with plans to increase the utilization of coal if the following environmental and safety policies are adhered to: • Compliance with Federal and State air, water, and solid waste regulations • Universal adoption and successful operation of best available control technology on new facilities • Compliance with reclamation standards • Compliance with mine health and safety standards • Judicious siting of coal-fired facilities The Committee concluded that, even with the best mitigation policies, there will be some adverse health and environmental effects from the dramatic increase in coal use. However, these will not impact all regions and individuals uniformly. The Committee identified six

  9. The Stigma of Reproductive Health Services Utilization by Unmarried Women

    PubMed Central

    Mohammadi, Fatemeh; Kohan, Shahnaz; Mostafavi, Firoozeh; Gholami, Ali

    2016-01-01

    Background: Fear of the stigma associated with reproductive health services has always been one of the reasons why youth and unmarried individuals avoid making use of such services. This stigma imposes a great deal of mental stress, fear, and depression on patients and causes delays in the diagnosis and treatment of their conditions. Objectives: This paper explores the concept of stigma in the context of the utilization of reproductive health services by unmarried women. Patients and Methods: This study is qualitative in nature. Purposive sampling was employed, and semi-structured interviews were conducted with 16 unmarried women, five midwives, and two physicians. The data were analyzed using the conventional content analysis method. Results: Four main categories constituted the general concept concerning the stigma suffered by unmarried women for using reproductive health services, i.e., prevalent stereotypical thinking patterns in society, the fear of being judged and labeled by others, discrimination, and feeling ashamed of seeking reproductive health services. Conclusions: The findings indicated that society associates reproductive health issues with sexual relations, which in turn shapes the stigma and places limitations on unmarried women for using reproductive health services. Thus, while reproductive health services are planned and provided to unmarried women, strategies are demanded for overcoming this stigma. PMID:27247794

  10. Is Dental Utilization Associated with Oral Health Literacy?

    PubMed

    Burgette, J M; Lee, J Y; Baker, A D; Vann, W F

    2016-02-01

    The objectives of this study were to examine the pattern of association between dental utilization and oral health literacy (OHL). As part of the Carolina Oral Health Literacy Project, clients in the Women, Infants, and Children's Special Supplemental Nutrition Program completed a structured 30-min in-person interview conducted by 2 trained interviewers at 9 sites in 7 counties in North Carolina. Data were collected on clients' OHL, sociodemographics, dental utilization, self-efficacy, and dental knowledge. The outcome, OHL, was measured with a dental word recognition test (30-item Rapid Estimate of Adult Literacy in Dentistry). Descriptive and multiple linear regression methods were used to examine the distribution of OHL and its association with covariates. After adjusting for age, education, race, marital status, self-efficacy, and dental knowledge, multiple linear regression showed that dental utilization was not a significant predictor of OHL (P > 0.05). Under the conditions of this study, dental utilization was not a significant predictor of OHL. PMID:26567035

  11. Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

    ERIC Educational Resources Information Center

    Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.

    2008-01-01

    Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…

  12. Health service utilization patterns of primary care patients with osteoarthritis

    PubMed Central

    Rosemann, Thomas; Joos, Stefanie; Szecsenyi, Joachim; Laux, Gunter; Wensing, Michel

    2007-01-01

    Background To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA). Methods Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF) to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9) to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. Results 1021 of 1250 (81.6%) questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU) varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the “symptom” scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. Conclusion Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done successfully. PMID:17956605

  13. Self‐Rated Health Predicts Healthcare Utilization in Heart Failure

    PubMed Central

    Chamberlain, Alanna M.; Manemann, Sheila M.; Dunlay, Shannon M.; Spertus, John A.; Moser, Debra K.; Berardi, Cecilia; Kane, Robert L.; Weston, Susan A.; Redfield, Margaret M.; Roger, Véronique L.

    2014-01-01

    Background Heart failure (HF) patients experience impaired functional status, diminished quality of life, high utilization of healthcare resources, and poor survival. Yet, the identification of patient‐centered factors that influence prognosis is lacking. Methods and Results We determined the association of 2 measures of self‐rated health with healthcare utilization and skilled nursing facility (SNF) admission in a community cohort of 417 HF patients prospectively enrolled between October 2007 and December 2010 from Olmsted County, MN. Patients completed a 12‐item Short Form Health Survey (SF‐12). Low self‐reported physical functioning was defined as a score ≤25 on the SF‐12 physical component. The first question of the SF‐12 was used as a measure of self‐rated general health. After 2 years, 1033 hospitalizations, 1407 emergency department (ED) visits, and 19,780 outpatient office visits were observed; 87 patients were admitted to a SNF. After adjustment for confounding factors, an increased risk of hospitalizations (1.52 [1.17 to 1.99]) and ED visits (1.48 [1.04 to 2.11]) was observed for those with low versus moderate‐high self‐reported physical functioning. Patients with poor and fair self‐rated general health also experienced an increased risk of hospitalizations (poor: 1.73 [1.29 to 2.32]; fair: 1.46 [1.14 to 1.87]) and ED visits (poor: 1.73 [1.16 to 2.56]; fair: 1.48 [1.13 to 1.93]) compared with good‐excellent self‐rated general health. No association between self‐reported physical functioning or self‐rated general health with outpatient visits and SNF admission was observed. Conclusion In community HF patients, self‐reported measures of physical functioning predict hospitalizations and ED visits, indicating that these patient‐reported measures may be useful in risk stratification and management in HF. PMID:24870937

  14. Urban Sprawl, Physical Activity, and Body Mass Index: Nurses’ Health Study and Nurses’ Health Study II

    PubMed Central

    Troped, Philip J.; Hart, Jaime E.; Joshu, Corinne E.; Colditz, Graham A.; Brownson, Ross C.; Ewing, Reid; Laden, Francine

    2013-01-01

    Objectives. We evaluated the association between the county sprawl index, a measure of residential density and street accessibility, and physical activity and body mass index (BMI). Methods. We conducted a multilevel cross-sectional analysis in a sample of Nurses’ Health Study participants living throughout the United States in 2000 to 2001 (n = 136 592). Results. In analyses adjusted for age, smoking status, race, and husband’s education, a 1-SD (25.7) increase in the county sprawl index (indicating a denser, more compact county) was associated with a 0.13 kilograms per meters squared (95% confidence interval [CI] = −0.18, −0.07) lower BMI and 0.41 (95% CI = 0.17, 0.65) more metabolic equivalent (MET) hours per week of total physical activity, 0.26 (95% CI = 0.19, 0.33) more MET hours per week of walking, and 0.47 (95% CI = 0.34, 0.59) more MET hours per week of walking, bicycling, jogging, and running. We detected potential effect modification for age, previous disease status, husband’s education level (a proxy for socioeconomic status), and race. Conclusions. Our results suggest that living in a dense, compact county may be conducive to higher levels of physical activity and lower BMI in women. PMID:22698015

  15. Eliciting health state utilities for Dupuytren’s contracture using a discrete choice experiment

    PubMed Central

    2013-01-01

    Background and purpose An internet-based discrete choice experiment (DCE) was conducted to elicit preferences for a wide range of Dupuytren’s contracture (DC)-related health states. An algorithm was subsequently developed to convert these preferences into health state utilities that can be used to assess DC’s impact on quality of life and the value of its treatments. Methods Health state preferences for varying levels of DC hand severity were elicited via an internet survey from a sample of the UK adult population. Severity levels were defined using a combination of contractures (0, 45, or 90 degrees) in 8 proximal interphalangeal and metacarpophalangeal joints of the index, middle, ring, and little fingers. Right-handed, left-handed, and ambidextrous respondents indicated which hand was preferable in each of the 10 randomly-selected hand-pairings comparing different DC severity levels. For consistency across comparisons, anatomically precise digital hand drawings were used. To anchor preferences onto the traditional 0–1 utility scale used in health economic evaluations, unaffected hands were assigned a utility of 1.0 whereas the utility for a maximally affected hand (i.e., all 8 joints set at 90 degrees of contracture) was derived by asking respondents to indicate what combination of attributes and levels of the EQ-5D-5L profile most accurately reflects the impact of living with such hand. Conditional logistic models were used to estimate indirect utilities, then rescaled to the anchor points on the EQ-5D-5L. Results Estimated utilities based on the responses of 1,745 qualified respondents were 0.49, 0.57, and 0.63 for completely affected dominant hands, non-dominant hands, or ambidextrous hands, respectively. Utility for a dominant hand with 90-degree contracture in t h e metacarpophalangeal joints of the ring and little fingers was estimated to be 0.89. Separately, reducing the contracture of metacarpophalangeal joint for a little finger from 50 to 12

  16. Spiral Enteroscopy Utilizing Capsule Location Index for Achieving High Diagnostic and Therapeutic Yield

    PubMed Central

    Korenblit, Jason; O'Hare, Brendan; Shnitser, Anastasia; Kedika, Ramalinga; Matro, Rebecca; Halegoua-De Marzio, Dina; Infantolino, Anthony; Conn, Mitchell

    2015-01-01

    Background and Aim. Spiral enteroscopy (SE) is a new small bowel endoscopic technique. Our aim is to review the diagnostic and therapeutic yield, safety of SE, and the predictive role of prior capsule endoscopy (CE) at an academic center. Methods. A retrospective review of patients undergoing SE after prior CE between 2008 and 2013 was performed. Capsule location index (CLI) was defined as the fraction of total small bowel transit time when the lesion was seen on CE. Results. A total of 174 SEs were performed: antegrade (147) and retrograde (27). Abnormalities on SE were detected in 65% patients. The procedure was safe in patients with surgically altered bowel anatomy (n = 12). The diagnostic yield of antegrade SE decreased with increasing CLI range. The diagnostic yield of retrograde SE decreased on decreasing CLI range. A CLI cutoff of 0.6 was derived that determined the initial route of SE. Vascular ectasias seen on CE were detected in 83% cases on SE; p < 0.01. Conclusions. SE is safe with a high diagnostic and therapeutic yield. CLI is predictive of the success of SE and determines the best route of SE. The type of small bowel pathology targeted by SE may affect its utility and yield. PMID:26681910

  17. Explanation of inequality in utilization of ambulatory care before and after universal health insurance in Thailand.

    PubMed

    Yiengprugsawan, V; Carmichael, Ga; Lim, Ll-Y; Seubsman, S; Sleigh, Ac

    2011-03-01

    Thailand implemented a Universal Coverage Scheme (UCS) of national health insurance in April 2001 to finance equitable access to health care. This paper compares inequalities in health service use before and after the UCS, and analyses the trend and determinants of inequality. The national Health and Welfare Surveys of 2001 and 2005 are used for this study. The concentration index for use of ambulatory care among the population reporting a recent illness is used as a measure of health inequality, decomposed into contributing demographic, socio-economic, geographic and health insurance determinants. As a result of the UCS, the uninsured group fell from 24% in 2001 to 3% in 2005 and health service patterns changed. Use of public primary health care facilities such as health centres became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off. Decomposition analysis shows that the increasingly common use of health centres among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the UCS. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes. Although the UCS scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required. PMID:20736414

  18. Equity of access to and utilization of reproductive health services in Thailand: national Reproductive Health Survey data, 2006 and 2009.

    PubMed

    Kongsri, Suratchada; Limwattananon, Supon; Sirilak, Supakit; Prakongsai, Phusit; Tangcharoensathien, Viroj

    2011-05-01

    This study assessed trends in equity of access to reproductive health services and service utilization in terms of coverage of family planning, antenatal care and skilled birth attendance in Thailand. Two health indicators were measured: the prevalence of low birthweight and exclusive breastfeeding. Equity was measured against the combined urban-rural areas and geographic regions, women's education level and quintiles of household assets index. The study used data from two nationally representative household surveys, the 2006 and 2009 Reproductive Health Surveys. Very high coverage of family planning (79.6%), universal antenatal care (98.9%) and skilled birth attendance (99.7%), with very small socioeconomic and geographic disparities, were observed. The public sector played a dominant role in maternity care (90.9% of all deliveries in 2009). The private sector also had a role among the higher educated, wealthier women living in urban areas. Public sector facilities, followed by drug stores, were a major supplier of contraception, which had a high use rate. High coverage and low inequity were the result of extensive investment in the health system by successive governments, in particular primary health care at district and sub-district levels, reaching universality by 2002. While maintaining these achievements, methodological improvements in measuring low birthweight and exclusive breastfeeding for future reproductive health surveys are recommended. PMID:21555089

  19. The Sensitivity of the Geriatric Oral Health Assessment Index to Dental Care.

    ERIC Educational Resources Information Center

    Dolan, Teresa A.

    1997-01-01

    A 24-month study of 96 patients in a community-based oral health promotion project found the Geriatric Oral Health Assessment Index (GOHAI), a self-report measure of oral health, to be sensitive to provision of dental care. Some further development of measures is needed. Potential applications of this and similar self-report measures in dental…

  20. School Health Index: A Self-Assessment and Planning Guide. Middle School/High School.

    ERIC Educational Resources Information Center

    Barrios, Lisa C.; Burgeson, Charlene R.; Crossett, Linda; Harrykissoon, Samantha D.; Pritzl, Jane; Wechsler, Howell; Kuester, Sarah A.; Pederson, Linda; Graffunder, Corinne; Rainford, Neil; Sleet, David

    2004-01-01

    The "School Health Index" is a self-assessment and planning guide that will enable schools to: (1) identify the strengths and weaknesses of school policies and programs for promoting health and safety; (2) develop an action plan for improving student health and safety, and (3) involve teachers, parents, students, and the community in improving…

  1. [Job insecurity versus unemployment: unequal in socioeconomic status but comparable detrimental effects on mental health and health care utilization].

    PubMed

    Mewes, Ricarda; Rief, Winfried; Martin, Alexandra; Glaesmer, Heide; Brähler, Elmar

    2013-03-01

    Knowledge about differential effects of unemployment and job insecurity on mental health and health care utilization are of high relevance. There are no studies which compare unemployed persons and persons with an insecure job in terms of different mental health indicators, and which investigate the mediating effect of mental health on health care utilization. Somatoform symptoms, anxiety, depression, physical health, and health care utilization were assessed in 161 unemployed persons, 218 persons with an insecure job, and 957 securely employed persons. Unemployed persons and persons with an insecure job showed equally worse mental health than securely employed persons on average. They also had significantly higher health care utilization. Mental health was a full mediator between job insecurity and unemployment on the one hand and health care utilization on the other hand. An adequate mental health care is necessary for unemployed persons as well as for persons with an insecure job. PMID:23526088

  2. Public health infrastructure and equity in the utilization of outpatient health care services in Peru.

    PubMed

    Valdivia, Martín

    2002-12-01

    This article analyzes the magnitude and nature of socioeconomic differences in the utilization of outpatient health care services in Peru. In particular, it explores the potential equity-enhancing effect of the expansion and improvements in the network of health centres during the 1990s. The Peruvian health reform made relatively little progress in terms of the reform agenda promoted internationally during the 1990s. Nevertheless, the expansion of the public network of health centres and the improvements in their equipment has been noteworthy during the same period. Using the 1997 survey of the Peruvian Living Standards Measurement Study (PLSMS), we find large differences in the utilization of outpatient health care services. The richest to poorest quintile ratio is 1.9, and even larger in rural areas. Estimating a probit model with random effects at the district level to control for the systematic geographic bias associated with the optimal public allocation of such infrastructure, we find the income effect to be very large, even after controlling for other socioeconomic characteristics. Finally, we also find that the expansion of the public network of health centres has indeed an equity-enhancing effect, but this is rather small. These results indicate that although the expansion of the public network of health facilities may be necessary, it is not sufficient to promote equity in the utilization of health care services by Peruvian adults, especially in rural areas. It is important to look deeper into the costs of consultations and drugs as economic barriers to the utilization of health services by the poor. In particular, the expansion of health insurance mechanisms for the poor should be carefully monitored and evaluated. PMID:12477737

  3. Expected utility theory and risky choices with health outcomes.

    PubMed

    Hellinger, F J

    1989-03-01

    Studies of people's attitude towards risk in the health sector often involve a comparison of the desirability of alternative medical treatments. Since the outcome of a medical treatment cannot be known with certainty, patients and physicians must make a choice that involves risk. Each medical treatment may be characterized as a gamble (or risky option) with a set of outcomes and associated probabilities. Expected utility theory (EUT) is the standard method to predict people's choices under uncertainty. The author presents the results of a survey that suggests people are very risk averse towards gambles involving health-related outcomes. The survey also indicates that there is significant variability in the risk attitudes across individuals for any given gamble and that there is significant variability in the risk attitudes of a given individual across gambles. The variability of risk attitudes of a given individual suggests that risk attitudes are not absolute but are functions of the parameters in the gamble. PMID:2927183

  4. An Index of Child Health in the Least Developed Countries (LDCs) of Africa

    ERIC Educational Resources Information Center

    Martin, Jose Antonio Rodriguez

    2012-01-01

    In this article we present a new composite index of child health, applied to the Least Developed Countries (LDCs) of Africa, one of the areas of the planet most castigated by poverty. Our index has been constructed attending to the variables defined in the Goals of the Millennium Declaration. For this purpose we will use the P2 distance method for…

  5. Creating an Overall Environmental Quality Index to Examine Health Outcomes

    EPA Science Inventory

    The interaction between environmental conditions and human health transpire from complex processes. Environmental exposures tend to cluster and disamenities such as landfills or industrial plants are often located in areas with high a percentage of minority and poor residents. Wh...

  6. The Utility of the MMPI-2 Malingering Discriminant Function Index in the Detection of Malingering: A Study of Criminal Defendants

    ERIC Educational Resources Information Center

    Toomey, Joseph A.; Kucharski, L. Thomas; Duncan, Scott

    2009-01-01

    This study examined the utility of the Minnesota Multiphasic Personality Inventory-2's (MMPI-2) malingering discriminant function index (M-DFI), recently developed by Bacchiochi and Bagby, in the detection of malingering in a forensic sample. Criminal defendants were divided into "malingering" and "not malingering" groups using the structured…

  7. Rich-poor gap in utilization of reproductive and child health services in India, 1992-2005.

    PubMed

    Mohanty, S K; Pathak, P K

    2009-05-01

    This paper examines the trends in utilization of five indicators of reproductive and child health services, namely, childhood immunization, medical assistance at delivery, antenatal care, contraceptive use and unmet need for contraception, by wealth index of the household in India and two disparate states, Uttar Pradesh and Maharashtra. The data from three rounds of the National Family and Health Survey conducted during 1992-2005 are analysed. The wealth index is computed using principal component derived weights from a set of consumer durables, land size, housing quality and water and sanitation facilities of the household, and classified into quintiles for all three rounds. Bivariate analyses, rich-poor ratio and concentration index are used to understand the trends in utilization of, and inequality in, reproductive and child health services. The results indicate huge disparities in utilization of these services, largely to the disadvantage of the poor. Utilization of basic childhood immunization among the poorest and the poor stagnated in India, as well as in both states, during 1998-2005 compared with 1992-1998. The use of maternal care services such as medical assistance at delivery and antenatal care remained at a low level among the poor over this period. However, contraceptive use increased relatively faster among the poor, even with higher unmet need. Of all these services, the inequality in medical assistance at delivery is consistently large, while that of contraceptive use is small. The state-level differences in service coverage by wealth quintiles over time are large. PMID:18845026

  8. 78 FR 74173 - Notice of Proposed Information Collection Requests: Heritage Health Index II on the State of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-10

    ... ARTS AND THE HUMANITIES Notice of Proposed Information Collection Requests: Heritage Health Index II on... of the Heritage Health Index II on the State of America's Collections (HHI II) is to assess the state.... Title: Heritage Health Index II on the State of America's Collections (HHI II). OMB Number: To...

  9. Patterns of health care utilization for low back pain

    PubMed Central

    Stewart, Walter F; Yan, Xiaowei; Boscarino, Joseph A; Maeng, Daniel D; Mardekian, Jack; Sanchez, Robert J; Von Korff, Michael R

    2015-01-01

    Background The purpose of this study was to determine if primary care patients with low back pain (LBP) cluster into definable care utilization subgroups that can be explained by patient and provider characteristics. Materials and methods Adult primary care patients with an incident LBP encounter were identified from Geisinger Clinic electronic health records over 5 years. Two-thirds of the cohort had only one to two encounters. Principal component analysis was applied to the data from the remaining one-third on use of ambulatory, inpatient, emergency department, and surgery care and use of magnetic resonance imaging, injections, and opioids in 12 months following the incident encounter. Groups were compared on demographics, health behaviors, chronic and symptomatic disease burden, and a measure of physician efficiency. Results Six factors with eigenvalues >1.5 explained 71% of the utilization variance. Patient subgroups were defined as: 1–2 LBP encounters; 2+ surgeries; one surgery; specialty care without primary care; 3+ opioid prescriptions; laboratory dominant care; and others. The surgery and 3+ opioid subgroups, while accounting for only 10.4% of the cohort, had used disproportionately more magnetic resonance imaging, emergency department, inpatient, and injectable resources. The specialty care subgroup was characterized by heavy use of inpatient care and the lowest use of injectables. Anxiety disorder and depression were not more prevalent among the surgery patients than in the others. Surgery patients had features in common with specialty care patients, but were older, had higher prevalence of Fibromyalgia, and were associated primary care physicians with worse efficiency scores. Conclusion LBP care utilization is highly variable and concentrated in small subgroups using disproportionate amounts of potentially avoidable care that reflect both patient and provider characteristics. PMID:26316803

  10. The associations between diet quality, body mass index (BMI) and health and activity limitation index (HALEX) in the Geisinger Rural Aging Study (GRAS)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Objectives To determine the associations between diet quality, body mass index (BMI), and health-related quality of life (HRQOL) as assessed by the health and activity limitation index (HALex) in older adults. Design Multivariate linear regression models were used to analyze associations between Di...

  11. Periodontal Health, Perceived Oral Health and Dental Care Utilization of Breast Cancer Survivors

    PubMed Central

    Taichman, L. Susan; Griggs, Jennifer J.; Inglehart, Marita R.

    2015-01-01

    OBJECTIVES This population-based analysis examined the prevalence of periodontal diseases along with the self-perceived oral health and patterns of dental care utilization of breast cancer survivors in the U.S. METHODS Data from the 1999–2004 NHANES were utilized, examining information from 3,354 women between 50–85 years of age. Primary outcomes were gingivitis and periodontitis, self-perceived oral health and dental care utilization. Logistic regression analyses were used to estimate relationships of breast cancer diagnosis and primary outcomes, while controlling for confounding factors. RESULTS Breast cancer survivors were more likely to be older than 55 years, white, non-smokers, have higher levels of education and income and a higher prevalence of osteoporosis. Breast cancer survivors were significantly less likely to have dental insurance (p=0.04). Utilization of dental services and reason for last dental visit did not significantly differ between groups. A history of a breast cancer diagnosis did not increase the odds of gingivitis (OR=1.32; 95% CI: 0.53–3.63), periodontitis (OR=1.82; 95% CI = 0.89–4.01) or poor self-perceived oral health (OR=0.89; 95% CI: 0.61–1.33) after adjusting for age, race, education, dental care utilization, and smoking status. CONCLUSIONS In this sample, a history of breast cancer does not significantly impact periodontal health, self-perceived oral health and dental care utilization. However, efforts should be made to assure that breast cancer survivors have dental insurance. PMID:25648337

  12. Anonymous indexing of health conditions for a similarity measure.

    PubMed

    Song, Insu; Marsh, Nigel V

    2012-07-01

    A health social network is an online information service which facilitates information sharing between closely related members of a community with the same or a similar health condition. Over the years, many automated recommender systems have been developed for social networking in order to help users find their communities of interest. For health social networking, the ideal source of information for measuring similarities of patients is the medical information of the patients. However, it is not desirable that such sensitive and private information be shared over the Internet. This is also true for many other security sensitive domains. A new information-sharing scheme is developed where each patient is represented as a small number of (possibly disjoint) d-words (discriminant words) and the d-words are used to measure similarities between patients without revealing sensitive personal information. The d-words are simple words like "food,'' and thus do not contain identifiable personal information. This makes our method an effective one-way hashing of patient assessments for a similarity measure. The d-words can be easily shared on the Internet to find peers who might have similar health conditions. PMID:22531815

  13. Index of Opportunity in Nursing and Allied Health Professions, 1972.

    ERIC Educational Resources Information Center

    Resource Publications, Inc., Princeton, NJ.

    This publication contains descriptions of 59 hospitals and other medical agencies which offer job opportunities to nurses and those trained in the allied health professions. Included in the descriptions are a brief introduction, salaries and/or benefits, employment opportunities, location, and source of further information. A geographical index…

  14. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey

    PubMed Central

    2014-01-01

    Background Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Methods Data were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis. Results Thirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women’s autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by

  15. Health Literacy INDEX: development, reliability, and validity of a new tool for evaluating the health literacy demands of health information materials.

    PubMed

    Kaphingst, Kimberly A; Kreuter, Matthew W; Casey, Chris; Leme, Luisa; Thompson, Tess; Cheng, Meng-Ru; Jacobsen, Heather; Sterling, Ryan; Oguntimein, Joy; Filler, Carl; Culbert, Arthur; Rooney, Megan; Lapka, Christy

    2012-01-01

    There is no consensus on how best to assess the health literacy demands of health information materials. Comprehensive, reliable, and valid assessment tools are needed. The authors report on the development, refinement, and testing of Health Literacy INDEX, a new tool reflecting empirical evidence and best practices. INDEX is comprised of 63 indicators organized into 10 criteria: plain language, clear purpose, supporting graphics, user involvement, skill-based learning, audience appropriateness, user instruction, development details, evaluation methods, and strength of evidence. In a sample of 100 materials, intercoder agreement was high: 90% or better for 52% of indicators, and above 80% for nearly all others. Overall scores generated by INDEX were highly correlated with average ratings from 12 health literacy experts (r = 0.89, p < .0001). Additional research is warranted to examine the association between evaluation ratings generated by INDEX and individual understanding, behaviors, and improved health. Health Literacy INDEX is a comprehensive tool with evidence for reliability and validity that can be used to evaluate the health literacy demands of health information materials. Although improvement in health information materials is just one aspect of mitigating the effects of limited health literacy on health outcomes, it is an essential step toward a more health literate public. PMID:23030571

  16. Applying the School Health Index to a Nationally Representative Sample of Schools: Update for 2006

    ERIC Educational Resources Information Center

    Brener, Nancy D.; Pejavara, Anu; McManus, Tim

    2011-01-01

    Background: The School Health Index (SHI) is a tool designed to help schools assess the extent to which they are implementing practices included in the research-based guidelines and strategies for school health and safety programs developed by the Centers for Disease Control and Prevention (CDC). CDC previously analyzed data from the 2000 School…

  17. A quantitative health assessment index for rapid evaluation of fish condition in the field

    SciTech Connect

    Adams, S.M. ); Brown, A.M. ); Goede, R.W. )

    1993-01-01

    The health assessment index (HAI) is an extension and refinement of a previously published field necropsy system. The HAI is a quantitative index that allows statistical comparisons of fish health among data sets. Index variables are assigned numerical values based on the degree of severity or damage incurred by an organ or tissue from environmental stressors. This approach has been used to evaluate the general health status of fish populations in a wide range of reservoir types in the Tennessee River basin (North Carolina, Tennessee, Alabama, Kentucky), in Hartwell Reservoir (Georgia, South Carolina) that is contaminated by polychlorinated biphenyls, and in the Pigeon River (Tennessee, North Carolina) that receives effluents from a bleaches kraft mill. The ability of the HAI to accurately characterize the health of fish in these systems was evaluated by comparing this index to other types of fish health measures (contaminant, bioindicator, and reproductive analysis) made at the same time as the HAI. In all cases, the HAI demonstrated the same pattern of fish health status between sites as did each of the other more sophisticated health assessment methods. The HAI has proven to be a simple and inexpensive means of rapidly assessing general fish health in field situations. 29 refs., 5 tabs.

  18. Body Mass Index and the Use of the Internet for Health Information

    ERIC Educational Resources Information Center

    Faith, Jennifer; Thorburn, Sheryl; Smit, Ellen

    2016-01-01

    Objective: Individuals who experience or anticipate negative interactions from medical providers related to conditions such as obesity may preferentially use the Internet for health information. Our objectives in this study were to (1) examine the association between body mass index (BMI) and Internet health information-seeking and (2) examine…

  19. Body Mass Index, Nutrient Intakes, Health Behaviours and Nutrition Knowledge: A Quantile Regression Application in Taiwan

    ERIC Educational Resources Information Center

    Chen, Shih-Neng; Tseng, Jauling

    2010-01-01

    Objective: To assess various marginal effects of nutrient intakes, health behaviours and nutrition knowledge on the entire distribution of body mass index (BMI) across individuals. Design: Quantitative and distributional study. Setting: Taiwan. Methods: This study applies Becker's (1965) model of health production to construct an individual's BMI…

  20. School Social Capital and Body Mass Index in the National Longitudinal Study of Adolescent Health

    ERIC Educational Resources Information Center

    Richmond, Tracy K.; Milliren, Carly; Walls, Courtney E.; Kawachi, Ichiro

    2014-01-01

    Background: Social capital in neighborhoods and workplaces positively affects health. Less is known about the influence of school social capital on student health outcomes, in particular weight status. We sought to examine the association between individual- and school-level social capital and student body mass index (BMI). Methods: Analyzing data…

  1. Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

    ERIC Educational Resources Information Center

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

    Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…

  2. Health status: types of validity and the index of well-being.

    PubMed Central

    Kaplan, R M; Bush, J W; Berry, C C

    1976-01-01

    The concept of validity as it applies to measures of health and health status is examined in the context of a set of standard, widely accepted definitions of validity. Criterion validity is shown to be irrelevant to health status measures because of the lack of a single specific, directly observable measure of health for use as a criterion. To overcome this problem, the Index of Well-being has been constructed to fulfill the definition of content validity by including all levels of function and symptom/problem complexes, a clearly defined relation to the death state, and consumer ratings of the relative desirability of the function levels. Data from a two-wave household interview survey provide convergent evidence of construct validity by demonstrating an expected positive correlation of the Index of Well-being with self-rated well-being and expected negative correlations with age, number of chronic medical conditions, number of reported symptoms or problems, number of physician contacts, and dysfunctional status. Discriminant evidence of construct validity is demonstrated by predicted differences in correlation between concurrent Index of Well-being scores and self-assessed overall health status, and between the Index of Well-being scores and self-rated well-being on different days. A simple method of estimating a currently usable comprehensive population index of health status, the Weighted Life Expectancy, is described. PMID:1030700

  3. Utilization of village health workers within a primary health care programme in The Gambia.

    PubMed

    Menon, A

    1991-08-01

    The utilization of Village Health Workers (VHWs) was studied in a rural area of The Gambia 3 years after the introduction of a village-based Primary Health Care (PHC) programme. Of 23 children who died from conditions treatable at village level, only five were first seen by the VHW. Fourteen were seen elsewhere in the region by staff more qualified than the first tier workers. The implications of this pattern of utilization on the lack of impact of VHWs on mortality are discussed. Only half of the non-fatal illnesses were attended to by VHWs. Reasons for this included such factors as lack of knowledge of services available, shortages of money, absence of the VHW at critical periods and social or political disputes with VHWs. Attempts must be made to tackle these fundamental problems if VHWs are to be successfully incorporated into the health services. PMID:1880830

  4. "Back to Basics" Approach for Improving Maternal Health Care Services Utilization in Lao PDR.

    PubMed

    Ngan, Do Kim; Kang, Minah; Lee, Chaeun; Vanphanom, Sychareun

    2016-04-01

    Earlier studies claim inadequate knowledge and understanding of maternal health care service among women and families account for low demand and utilization of these services. This study explores maternal service utilization in Lao PDR by interviewing women, families, health service providers, and community members in Xiengkhuang province. In general, women's attitude and acceptance of maternal health care were positive, with many expressing appreciation and need for maternal health services. Nevertheless, utilization of maternal health services remained poor largely due to dissatisfaction with services: inaccessibility, irregular services, fund shortage, poor facilities, and problems dealing with male health service providers. It appears that utilization of maternal health care services in Lao PDR is as much a health system concern as it is a user preference issue. This article advocates a "back to basics" approach for reviewing maternal health care infrastructure systems in developing countries to improve community health services and utilization. PMID:26969638

  5. Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening

    PubMed Central

    2014-01-01

    Background Peripheral arterial disease (PAD) is a marker of systemic atherosclerosis and associated with a three to six fold increased risk of death from cardiovascular causes. Furthermore, it is typically asymptomatic and under-diagnosed; this has resulted in escalating calls for the instigation of Primary Care PAD screening via Ankle Brachial Index (ABI) measurement. However, there is limited evidence regarding the feasibility of this and if the requisite core skills and knowledge for such a task already exist within primary care. This study aimed to determine the current utility of ABI measurement in general practices across Wales, with consideration of the implications for its use as a cardiovascular risk screening tool. Method A self-reporting questionnaire was distributed to all 478 General Practices within Wales, sent via their responsible Health Boards. Results The survey response rate was 20%. ABI measurement is primarily performed by nurses (93%) for the purpose of wound management (90%). It is infrequently (73% < 4 times per month) and often incorrectly used (42% out of compliance with current ABI guidance). Only 52% of general practitioners and 16% of nurses reported that patients with an ABI of ≤ 0.9 require aggressive cardiovascular disease risk factor modification (as recommended by current national and international guidelines). Conclusion ABI measurement is an under-utilised and often incorrectly performed procedure in the surveyed general practices. Prior to its potential adoption as a formalised screening tool for cardiovascular disease, there is a need for a robust training programme with standardised methodology in order to optimise accuracy and consistency of results. The significance of a diagnosis of PAD, in terms of associated increased cardiovascular risk and the necessary risk factor modification, needs to be highlighted. PMID:24742018

  6. The Aggregate Risk Index: An intuitive tool providing the health risks of air pollution to health care community and public

    NASA Astrophysics Data System (ADS)

    Sicard, Pierre; Talbot, Charles; Lesne, Olivia; Mangin, Antoine; Alexandre, Nicolas; Collomp, Rémy

    2012-01-01

    In the framework of the European project PASODOBLE (FP7), we set up downstream information services by combining environmental and health data with a view to support the health care community and to improve vulnerable people welfare. Indeed there is a profound relationship between human health, well-being and air pollution levels. The main objectives are to establish correlations between air quality, exposure of populations and their reactivity, to develop and validate air quality indexes and to construct a prediction model of this sanitary index. This index will be implemented on 3 European sites: Greece (Athens and Thessaloniki), the Netherlands and "Provence Alpes Côte d'Azur" (South East of France). The selected region and cities are among the most affected by the atmospheric pollution in Europe and leads to serious sanitary concerns. The service aims to provide up-to-date, detailed information on air quality discomfort. The Aggregate Risk Index is based on the Cairncross's concept, obtained from the Relative Risk associated with short-term exposure to common air pollutants and takes into account the possible effects of a mixture of pollutants. This communication tool, easy to use and intuitive, about the levels of air pollution and the associated health risks, will be used to communicate information to the general population, authorities and to the health care community and will provide advanced warning of potentially health-damaging air pollution events.

  7. Under-nutrition at baseline and health services utilization and mortality over a one-year period in older adults receiving Medicare home health services

    PubMed Central

    Yang, Yongbin; Brown, Cynthia J.; Burgio, Kathryn L.; Kilgore, Meredith L.; Ritchie, Christine S.; Roth, David L.; West, Delia Smith; Locher, Julie L.

    2010-01-01

    Objective Older adults receiving Medicare home health services who experience under-nutrition may be at increased risk of experiencing adverse outcomes. We sought to identify the association between baseline nutritional status and subsequent health service utilization and mortality over a one-year period in older adults receiving Medicare home health services. Design This was a longitudinal study using questionnaires and anthropometric measures designed to assess nutritional status (Mini-Nutritional Assessment [MNA]) at baseline and health services utilization and mortality status at six-month and one-year follow-ups. Setting Participants were evaluated in their homes. Participants 198 older adults who were receiving Medicare home health services. Results Based upon MNA, 12.0% of patients were Malnourished, 51.0% were At Risk for Malnourishment, and 36.9% had Normal Nutrition Status. Based upon body mass index (BMI), 8.1% of participants were underweight, 37.9% were normal weight, 25.3% were overweight, and 28.8% were obese. Using multivariate binary logistic regression analyses, participants who were Malnourished or At Risk for Malnourishment were more likely to experience subsequent hospitalization, emergency room visit, home health aide use, and mortality for the entire sample and hospitalization and nursing home stay for overweight and obese participants. Conclusions Experiencing under-nutrition at the time of receipt of Medicare home health services was associated with increased health services utilization and mortality for the entire sample, and with increased health services utilization only for the overweight and obese subsample. Opportunities exist to address risk of under-nutrition in patients receiving home health services, including those who are overweight or obese, to prevent subsequent adverse health outcomes. PMID:21527170

  8. Performance verification of bivariate regressive adaptive index for structural health monitoring

    NASA Astrophysics Data System (ADS)

    Su, Su; Kijewski-Correa, Tracy

    2007-04-01

    This study focuses on data-driven methods for structural health monitoring and introduces a Bivariate Regressive Adaptive INdex (BRAIN) for damage detection in a decentralized, wireless sensor network. BRAIN utilizes a dynamic damage sensitive feature (DSF) that automatically adapts to the data set, extracting the most damage sensitive model features, which vary with location, damage severity, loading condition and model type. This data-driven feature is key to providing the most flexible damage sensitive feature incorporating all available data for a given application to enhance reliability by including heterogeneous sensor arrays. This study will first evaluate several regressive-type models used for time-series damage detection, including common homogeneous formats and newly proposed heterogeneous descriptors and then demonstrate the performance of the newly proposed dynamic DSF against a comparable static DSF. Performance will be validated by documenting their damage success rates on repeated simulations of randomly-excited thin beams with minor levels of damage. It will be shown that BRAIN dramatically increases the detection capabilities over static, homogeneous damage detection frameworks.

  9. A REFERENCE-INVARIANT HEALTH DISPARITY INDEX BASED ON RÉNYI DIVERGENCE

    PubMed Central

    Talih, Makram

    2015-01-01

    One of four overarching goals of Healthy People 2020 (HP2020) is to achieve health equity, eliminate disparities, and improve the health of all groups. In health disparity indices (HDIs) such as the mean log deviation (MLD) and Theil index (TI), disparities are relative to the population average, whereas in the index of disparity (IDisp) the reference is the group with the least adverse health outcome. Although the latter may be preferable, identification of a reference group can be affected by statistical reliability. To address this issue, we propose a new HDI, the Rényi index (RI), which is reference-invariant. When standardized, the RI extends the Atkinson index, where a disparity aversion parameter can incorporate societal values associated with health equity. In addition, both the MLD and TI are limiting cases of the RI. Also, a symmetrized Rényi index (SRI) can be constructed, resulting in a symmetric measure in the two distributions whose relative entropy is being evaluated. We discuss alternative symmetric and reference-invariant HDIs derived from the generalized entropy (GE) class and the Bregman divergence, and argue that the SRI is more robust than its GE-based counterpart to small changes in the distribution of the adverse health outcome. We evaluate the design-based standard errors and bootstrapped sampling distributions for the SRI, and illustrate the proposed methodology using data from the National Health and Nutrition Examination Survey (NHANES) on the 2001–04 prevalence of moderate or severe periodontitis among adults aged 45–74, which tracks Oral Health objective OH-5 in HP2020. Such data, which uses a binary individual-level outcome variable, are typical of HP2020 data. PMID:26568778

  10. "Remnants of feudalism"? Women's health and their utilization of health services in rural China.

    PubMed

    Anson, O; Haanappel, F W

    1999-01-01

    Almost five decades ago, the Chinese Communist Party wished to abolish all "remnants of feudalism," including the patriarchal social order. Just one year after the revolution, the Marriage Law endorsed women's rights within the family, but no operative measures were taken to enforce it. Some of the economic reforms since independence even strengthened patrilocality and, possibly, patriarchal values. The purpose of this study was to explore the degree to which patrilocality served to maintain the traditional patriarchal stratification among women in the household by exploring women's health patterns and utilization of health services. Data were collected from 3859 women residing in rural Hebei, and variation in health and help seeking of six categories of relation to household head--mothers, wives, daughters, daughters-in-law, family heads, and other relatives--were explored. Utilization of health services is not dependent on women's position in the household, but primarily on per-capita income. Health patterns seem to indicate that mothers of the head of the household still have a considerable power to define their roles and share of household work. Women head of family, most of whom are married, appear to be under strain, which could be a result of their culturally "deviant" position. We conclude that old patriarchal values are intertwined with values of equality in current rural China. PMID:10813270

  11. Pesticide Exposures and Body Mass Index (BMI) of Pesticide Applicators From the Agricultural Health Study.

    PubMed

    LaVerda, Nancy L; Goldsmith, David F; Alavanja, Michael C R; Hunting, Katherine L

    2015-01-01

    Endocrine-disrupting chemicals, including pesticides, may be associated with weight gain. This is the first longitudinal study to examine a potential association between weight gain and pesticides using data on 8,365 male pesticide applicators from the Agricultural Health Study (AHS) cohort established in 1993. The relationship between total cumulative days of exposure to pesticide functional/chemical classes and to the four most frequently used individual pesticides was studied in relation to body mass index (BMI) at the time of 5-yr follow-up (beginning in 1998) with the length of the exposure period dating back to age 20 yr. Multiple regression, Spearman correlation, ordinal logistic regression, and logistic regression models all utilized a Bonferroni-adjusted p value, were adjusted for relevant covariates, and were stratified by state of residence (Iowa/North Carolina) and presence/absence of weight-related health conditions. Adjusted multiple regression yielded statistically significant positive parameter estimates for the study sample and Iowa subgroups with consistent findings for triazine herbicides and atrazine: Change in BMI per 100 cumulative pesticide exposure days ranged from 0.07 to 0.11 for triazine herbicides and from 0.10 to 0.19 for atrazine. Ordinal logistic regression compared normal weight with overweight and with obese using the zero exposure category as referent. Statistically significant adjusted odds ratios identified for the study sample and both state subgroups for the highest level of atrazine exposure ranged from 1.4 to 1.7. Further investigation is warranted to evaluate the associations identified here. PMID:26479458

  12. Predicting Health Care Utilization in Marginalized Populations: Black, Female, Street-based Sex Workers

    PubMed Central

    Varga, Leah M.; Surratt, Hilary L.

    2014-01-01

    Background Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. Methods The outcome variable was utilization of health care services in the previous 12 months. Using Andersen’s Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. Findings The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Conclusions Any type of resource, link, or connection to or with an institution, or any consistent point of care contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. PMID:24657047

  13. Utility of the MMPI Pain Assessment Index in Predicting Outcome After Lumbar Surgery.

    ERIC Educational Resources Information Center

    Turner, Judith; And Others

    1986-01-01

    Examined the ability of the Pain Assesment Index, determined from presurgery Minnesota Multiphasic Personality Inventory scores, to predict outcome subsequent to lumbar laminectomy and discectomy. The PAI was found to have good ability to identify patients who were doing well after surgery, but low power in predicting which patients would have…

  14. Outpatient Health Care Utilization of Suicide Decedents in Their Last Year of Life

    ERIC Educational Resources Information Center

    Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming

    2012-01-01

    The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901…

  15. Access to Transportation and Health Care Utilization in a Rural Region

    ERIC Educational Resources Information Center

    Arcury, Thomas A.; Preisser, John S.; Gesler, Wilbert M.; Powers, James M.

    2005-01-01

    Access to transportation to transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access to transportation in analyses of rural health care utilization. This analysis addresses the association of transportation and health care utilization in a rural…

  16. Correlates of Suicide among Home Health Care Utilizers Who Died by Suicide and Community Controls

    ERIC Educational Resources Information Center

    Rowe, Jennifer L.; Bruce, Martha L.; Conwell, Yeates

    2006-01-01

    Home health care patients often have several late-life risk factors for suicide and constitute a high risk group for suicidal behaviors. In this study, we examined the characteristics of 14 older adult home health care utilizers who died by suicide and four community controls who used similar services. Both groups of home health care utilizers had…

  17. Impact of roflumilast on exacerbations of COPD, health care utilization, and costs in a predominantly elderly Medicare Advantage population

    PubMed Central

    Moll, Keran; Sun, Shawn X; Ellis, Jeffrey J; Howe, Andrew; Amin, Alpesh

    2015-01-01

    Background Chronic obstructive pulmonary disease (COPD) exacerbations are associated with declining lung function and health-related quality of life, and increased hospitalization and mortality. Clinical trials often poorly represent the elderly and thus have only partial applicability to their clinical care. Objective To compare exacerbations, COPD-related health care utilization (HCU), and costs in a predominantly elderly Medicare COPD population initiated on roflumilast versus those not initiated on roflumilast. Methods Deidentified administrative claims data from a large, national payer were utilized. Medicare patients aged 40–89 years with at least one COPD diagnosis from May 1, 2010 to December 31, 2012 were included. Members with at least one roflumilast pharmacy claim (index) were assigned to the roflumilast group and those without were assigned to the non-roflumilast group. Proxy index dates for the non-roflumilast group were randomly assigned for similar distribution of all patients’ time at risk. Subjects with at least one pre-index COPD exacerbation had to be continuously enrolled for ≥365 days pre-index and post-index. Unadjusted and adjusted difference-in-difference (DID) analyses contrasted pre-index with post-index changes in exacerbations, HCU, and costs of roflumilast treatment compared with non-roflumilast treatment. Results A total of 500 roflumilast and 60,145 non-roflumilast patients were included (mean age 69.7 and 72.3 years, respectively; P<0.0001). Unadjusted DID favored roflumilast for all exacerbations, with greater pre-index to post-index reductions in mean per 30-day COPD-related hospitalizations (−0.0182 versus −0.0013, P=0.009), outpatient visits (−0.2500 versus −0.0606, P<0.0001), and COPD-related inpatient costs (−US$141 versus −US$11, P=0.0346) and outpatient costs (−US$31 versus −US$4, P<0.0001). Multivariate analyses identified significantly improved pre-index to post-index COPD-related total costs (P=0

  18. Hurricane exposure and county fetal death rates, utilization of a county environmental quality index for confounding control.

    EPA Science Inventory

    The effects of natural disasters on public health are a rising concern, with increasing severity of disaster events. Many disaster studies utilize county-level analysis, however most do not control for county level environmental factors. Hurricane exposure during pregnancy could ...

  19. Health Literacy Association With Health Behaviors and Health Care Utilization in Multiple Sclerosis: A Cross-Sectional Study

    PubMed Central

    Salter, Amber; Tyry, Tuula; Fox, Robert J; Cutter, Gary R

    2014-01-01

    Background Low health literacy is generally associated with poor health outcomes; however, health literacy has received little attention in multiple sclerosis (MS). Objective The aim of this study was to investigate the health literacy of persons with MS using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Methods In 2012, we conducted a cross-sectional study of health literacy among NARCOMS participants. Respondents completed the Medical Term Recognition Test (METER) which assesses the ability to distinguish medical and nonmedical words, and the Newest Vital Sign (NVS) instrument which evaluates reading, interpretation, and numeracy skills. Respondents reported their sociodemographic characteristics, health behaviors, comorbidities, visits to the emergency room (ER), and hospitalizations in the last 6 months. We used logistic regression to evaluate the characteristics associated with functional literacy, and the association between functional literacy and health care utilization. Results Of 13,020 eligible participants, 8934 (68.6%) completed the questionnaire and were US residents. Most of them performed well on the instruments with 81.04% (7066/8719) having functional literacy on the METER and 74.62% (6666/8933) having adequate literacy on the NVS. Low literacy on the METER or the NVS was associated with smoking, being overweight or obese (all P<.001). After adjustment, low literacy on the METER was associated with ER visits (OR 1.28, 95% CI 1.10-1.48) and hospitalizations (OR 1.19, 95% CI 0.98-1.44). Findings were similar for the NVS. Conclusions In the NARCOMS cohort, functional health literacy is high. However, lower levels of health literacy are associated with adverse health behaviors and greater health care utilization. PMID:24513479

  20. Predisposing, Enabling and Need Correlates of Mental Health Treatment Utilization Among Homeless Men

    PubMed Central

    Wenzel, Suzanne L.; Golinelli, Daniela; Tucker, Joan S.; Kennedy, David P.; Ewing, Brett

    2016-01-01

    There is significant unmet need for mental health treatment among homeless men, but little is known about the correlates of treatment utilization in this population. Within the framework of the Behavioral Model for Vulnerable Populations, this study examines predisposing, enabling and need factors that may be associated with mental health care utilization. Participants were a representative sample of 305 heterosexually active homeless men utilizing meal programs in the Skid Row region of LA. Logistic regression examined the association between predisposing, enabling and need factors and past 30 day mental health service utilization on Skid Row. Results indicated that while need, operationalized as positive screens for posttraumatic stress disorder or depression, was associated with recent mental health care utilization, predisposing and enabling factors were also related to utilization. African-American homeless men, and those men who also reported substance abuse treatment and drop-in center use, had increased odds of reporting mental health care utilization. PMID:24595594

  1. Predisposing, enabling and need correlates of mental health treatment utilization among homeless men.

    PubMed

    Rhoades, Harmony; Wenzel, Suzanne L; Golinelli, Daniela; Tucker, Joan S; Kennedy, David P; Ewing, Brett

    2014-11-01

    There is significant unmet need for mental health treatment among homeless men, but little is known about the correlates of treatment utilization in this population. Within the framework of the Behavioral Model for Vulnerable Populations, this study examines predisposing, enabling and need factors that may be associated with mental health care utilization. Participants were a representative sample of 305 heterosexually active homeless men utilizing meal programs in the Skid Row region of LA. Logistic regression examined the association between predisposing, enabling and need factors and past 30 day mental health service utilization on Skid Row. Results indicated that while need, operationalized as positive screens for posttraumatic stress disorder or depression, was associated with recent mental health care utilization, predisposing and enabling factors were also related to utilization. African-American homeless men, and those men who also reported substance abuse treatment and drop-in center use, had increased odds of reporting mental health care utilization. PMID:24595594

  2. Veterans Affairs Health System Enrollment and Health Care Utilization After the Affordable Care Act: Initial Insights.

    PubMed

    Silva, Abigail; Tarlov, Elizabeth; French, Dustin D; Huo, Zhiping; Martinez, Rachael N; Stroupe, Kevin T

    2016-05-01

    The Affordable Care Act (ACA) was signed into law in 2010 and its individual mandate and expanded health care coverage options were implemented in 2014. These provisions may affect Veterans Affairs (VA) enrollment and health care utilization. Using data from two VA regional networks, we examined recent patterns in the number of new VA enrollees and their primary care use. Trends were assessed by enrollment priority group (based on the veteran's severity of service-connected disabilities, exposures, and income level) and a state's Medicaid expansion status. Compared to the same time period in the previous year, the number of new enrollees from low-income priority groups was higher during the open enrollment period and the increase was sharper in Medicaid non-expansion states (25-42%) than in expansion states (20-32%). In addition, low-income patients with a copay requirement who enrolled in the VA during the ACA open enrollment had a lower average number of primary care visits than counterparts who had enrolled in prior time periods (1.73 versus 1.87, p < 0.0001). Although this study is an initial step, more research is required to better understand veterans' decision making and behavior in regard to health care coverage through the ACA and related impacts on VA and non-VA health care utilization and care coordination. PMID:27136655

  3. Wealth Index association with gender issues and the reproductive health of Egyptian women.

    PubMed

    Afifi, Mustafa

    2009-03-01

    This study investigated the association of the Wealth Index of married women in Egypt with a number of gender and reproductive health issues found in the 2005 Egypt Demographic Health Survey. The data from a subsample of 5249 currently married women from a total of 19,474 was examined using logistic regression analysis. The women's lowest wealth quintile predicted the intention to continue female genital cutting for their daughters, exposure to physical and sexual marital violence, not being empowered in household decisions, having a higher number of children, having an unintended last child, mothers' maltreatment of their children, the perception of a lack of health-care providers or drugs as an obstacle to receiving care, and not being covered by health insurance. The association of poverty with the aforementioned adverse health outcomes are discussed. Physicians should understand the effect of poverty on health and endeavour to influence policy-makers to reduce the poverty burden on health. PMID:19298306

  4. Rating health and stability of engineering structures via classification indexes of InSAR Persistent Scatterers

    NASA Astrophysics Data System (ADS)

    Pratesi, Fabio; Tapete, Deodato; Terenzi, Gloria; Del Ventisette, Chiara; Moretti, Sandro

    2015-08-01

    We propose a novel set of indexes to classify the information content of Persistent Scatterers (PS) and rate the health of engineering structures at urban to local scale. PS are automatically sampled and grouped via 'control areas' coinciding with the building and its surrounding environment. Density over the 'control areas' and velocity of PS are converted respectively into: Completeness of Information Index (Ici) that reflects the PS coverage grade; and Conservation Criticality Indexes (Icc) which rate the health condition of the monument separately for the object and surrounding control areas. The deformation pattern over the structure is classified as isolated (i) or diffused (d) based on the Velocity Distribution Index (Ivd). Both Ici and Icc are rated from A to E classes using a colour-coded system that intentionally emulates an energy-efficiency scale, to encourage the exploitation of PS by stakeholders and end-users in the practise of engineering surveying. Workability and reliability of the classification indexes are demonstrated over the urban heritage of Florence, Italy, using well established ERS-1/2 (1992-2000) descending, ENVISAT (2003-2010) ascending and descending PS datasets. The indexes are designed in perspective of handling outputs from InSAR processing of higher-resolution time series.

  5. Forecasting drug utilization and expenditure in a metropolitan health region

    PubMed Central

    2010-01-01

    Background New pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning), forecasting of drug utilization and expenditure, critical drug evaluation as well as structured programs for the introduction and follow-up of new drugs. The aim of this paper is to present the forecasting model and the predicted growth in all therapeutic areas in 2010 and 2011. Methods Linear regression analysis was applied to aggregate sales data on hospital sales and dispensed drugs in ambulatory care, including both reimbursed expenditure and patient co-payment. The linear regression was applied on each pharmacological group based on four observations 2006-2009, and the crude predictions estimated for the coming two years 2010-2011. The crude predictions were then adjusted for factors likely to increase or decrease future utilization and expenditure, such as patent expiries, new drugs to be launched or new guidelines from national bodies or the regional Drug and Therapeutics Committee. The assessment included a close collaboration with clinical, clinical pharmacological and pharmaceutical experts from the regional Drug and Therapeutics Committee. Results The annual increase in total expenditure for prescription and hospital drugs was predicted to be 2.0% in 2010 and 4.0% in 2011. Expenditures will increase in most therapeutic areas, but most predominantly for antineoplastic and immune modulating agents as well as drugs for the nervous system, infectious diseases, and blood and blood-forming organs. Conclusions The utilisation and expenditure of drugs is difficult to forecast due to uncertainties about the rate of adoption of new

  6. One of many lessons from the European Mental Health Integration Index.

    PubMed

    Murawiec, Sławomir; Krysta, Krzysztof

    2015-09-01

    The Mental Health Integration Index developed by the Economist Intelligence Unit describes and explores the challenges of European countries of integrating people with mental illness into society and employment, within the European Union's 28 Member States, plus Norway and Switzerland. Countries have been ranked according to estimation based on indicators of their degree of commitment to support those living with mental illness into society and employment. The Index is based on a list of indicators including the environment for those with mental illness, their access to medical help and services, their opportunities--specifically job-related--and the governance of the system, including human rights issues and efforts to combat stigma. The indicators were developed in consultation with a panel of independent experts on mental health. Key findings of the research are that Germany's strong healthcare system and generous social provision put it at the top of the Index, with the UK and Scandinavian states not far behind. However, examples of best practice "islands of excellence" in integration are not limited to the leading countries and exists in all European Countries. The Index reveals also the discrepancy between perfect legislation and poor implementation of it in practice in many European countries. It proposes that the investment figure is a proxy for seriousness in establishing good policy and practice. According to the Index some reform plans including entire national mental health programmes are largely aspirational and are grossly under-funded. Moreover various levels of government responsible for the implementation of its component parts are largely ignoring its implementation. When we consider the legislation as an promise to professionals and people with mental health problems, this promise is largely unfulfilled. The is a need for strong leadership in mental health changes process, policy capacity and real financial investments in the way of The European

  7. Informing food choices and health outcomes by use of the dietary glycemic index

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Considerable epidemiologic evidence links consuming lower glycemic index (GI) diets with good health, particularly upon aging. The GI is a kinetic parameter that reflects the ability of carbohydrate (CHO) contained in consumed foods to raise blood glucose in vivo. Newer nutritional, clinical, and ex...

  8. Utilization and Limitations of the American College Health Association's National College Health Assessment Instrument: A Systematic Review

    ERIC Educational Resources Information Center

    Rahn, Rhonda N.; Pruitt, Buster; Goodson, Patricia

    2016-01-01

    Objective: To analyze the literature in which researchers have utilized the National College Health Assessment (NCHA) I or the NCHA II. Participants and Methods: The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument…

  9. [Evaluating the utility of MODIS vegetation index for monitoring agricultural drought].

    PubMed

    Li, Hua-Peng; Zhang, Shu-Qing; Gao, Zi-Qiang; Sun, Yan

    2013-03-01

    The exclusive shortwave bands provided by MODIS sensors offer new opportunities for agricultural drought monitoring, since they are very sensitive to vegetation moisture. In the present work, we selected Songnen Plain in Northeast China as study area aiming at monitoring agricultural drought of dry farmland here. Four types of vegetation water indices and vegetation greenness indices were calculated from the 8-day composite MODIS product (MODO9A1) in vegetation growing season between 2001 and 2010, respectively. Multi-scale standardized precipitation index (SPI) derived from precipitation data of weather stations was used as reference data to estimate drought sensitivity of various vegetation indices, and a pixel-to-weather station paired correlation approach was used to calculate the Pearson correlation coefficient between vegetation index and SPIs. The result indicated that vegetation water indices established by near infrared and shortwave infrared bands outperformed vegetation greenness indices based on visible and near infrared bands. Of these indices, NDII7 performs the best with highest correlation coefficients across all SPIs. The authors' results demonstrated the potential of MODIS shortwave spectral bands in monitoring agricultural drought, and this provides new insights to future research. PMID:23705448

  10. Association between ideal cardiovascular health and the atherogenic index of plasma.

    PubMed

    Shen, Shiwei; Lu, Yun; Qi, Huajin; Li, Feng; Shen, Zhenhai; Wu, Liuxin; Yang, Chengjian; Wang, Ling; Shui, Kedong; Wang, Yaping; Qiang, Dongchang; Yun, Jingting; Weng, Xiaofeng

    2016-06-01

    The American Heart Association aims to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health behaviors and factors. The atherogenic index of plasma (AIP) is an important index. Our aim is to evaluate the relationship between ideal cardiovascular health and the atherogenic index of plasma (AIP) in middle-aged Chinese men.A cross-sectional study was performed. A total of 27,824 middle-aged Chinese men were enrolled. The association between ideal cardiovascular health behaviors and factors and AIP was determined. The 7 cardiovascular health metrics were scored as follows: 0, poor; 1, general; and 2, ideal. The cardiovascular health status was classified according to the total score, as follows: 0 to 4, inadequate; 5 to 9, average; and 10 to 14, optimum. Analyses assessed the prevalence of 7 cardiovascular health metrics, its association with AIP. Logistic regression models were used to calculate odds ratios (ORs), adjusting for age.All 7 cardiovascular health metrics were shown to correlate with AIP (all P values < 0.05), and the strongest correlation existed between body mass and AIP, followed by total cholesterol and AIP. The mean AIP level increased with the decrease in the score of each of the 7 cardiovascular health metrics (all P values < 0.05). The subjects with poor cardiovascular health status had a 4.982-fold increase in the high risk of developing atherosclerosis, whereas a 1-point increase in the cardiovascular health score resulted a 0.046 reduction in AIP and a 22.3% reduction in the high-risk of developing atherosclerosis (OR = 0.777, 95% CI: 0.768-0.787).The ideal cardiovascular health score correlated significantly with AIP, and a 1-point increase in the cardiovascular health score led to a 0.046 reduction in AIP and a 22.3% reduction in the high risk of developing atherosclerosis. These validated the value of ideal cardiovascular health behaviors and factors in the prediction of high risk of

  11. Association between ideal cardiovascular health and the atherogenic index of plasma

    PubMed Central

    Shen, Shiwei; Lu, Yun; Qi, Huajin; Li, Feng; Shen, Zhenhai; Wu, Liuxin; Yang, Chengjian; Wang, Ling; Shui, Kedong; Wang, Yaping; Qiang, Dongchang; Yun, Jingting; Weng, Xiaofeng

    2016-01-01

    Abstract The American Heart Association aims to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health behaviors and factors. The atherogenic index of plasma (AIP) is an important index. Our aim is to evaluate the relationship between ideal cardiovascular health and the atherogenic index of plasma (AIP) in middle-aged Chinese men. A cross-sectional study was performed. A total of 27,824 middle-aged Chinese men were enrolled. The association between ideal cardiovascular health behaviors and factors and AIP was determined. The 7 cardiovascular health metrics were scored as follows: 0, poor; 1, general; and 2, ideal. The cardiovascular health status was classified according to the total score, as follows: 0 to 4, inadequate; 5 to 9, average; and 10 to 14, optimum. Analyses assessed the prevalence of 7 cardiovascular health metrics, its association with AIP. Logistic regression models were used to calculate odds ratios (ORs), adjusting for age. All 7 cardiovascular health metrics were shown to correlate with AIP (all P values < 0.05), and the strongest correlation existed between body mass and AIP, followed by total cholesterol and AIP. The mean AIP level increased with the decrease in the score of each of the 7 cardiovascular health metrics (all P values < 0.05). The subjects with poor cardiovascular health status had a 4.982-fold increase in the high risk of developing atherosclerosis, whereas a 1-point increase in the cardiovascular health score resulted a 0.046 reduction in AIP and a 22.3% reduction in the high-risk of developing atherosclerosis (OR = 0.777, 95% CI: 0.768–0.787). The ideal cardiovascular health score correlated significantly with AIP, and a 1-point increase in the cardiovascular health score led to a 0.046 reduction in AIP and a 22.3% reduction in the high risk of developing atherosclerosis. These validated the value of ideal cardiovascular health behaviors and factors in the prediction of high

  12. Modeling Key Malaria Drugs' Impact on Global Health: A Reason to Invest in the Global Health Impact Index.

    PubMed

    Hassoun, Nicole

    2016-05-01

    Millions of people cannot access good quality essential medicines they need for some of the world's worst diseases like malaria. The World Health Organization estimates that, in 2013, 198 million people became sick with malaria and 584,000 people died of the disease, while the Institute for Health Metrics Evaluation estimates that there were 164,929,872 cases of malaria in 2013 and 854,568 deaths in 2013. There are many attempts to model different aspects of the global burden of tropical diseases like malaria, but it is also important to measure success in averting malaria-related death and disability. This perspective proposes investing in a systematic effort to measure the benefits of health interventions for malaria along the lines of a model embodied in the Global Health Impact Index (global-health-impact.org). PMID:26856915

  13. A note on the nature of utility in time and health and implications for cost utility analysis.

    PubMed

    Buckingham, Ken J; Devlin, Nancy Joy

    2009-01-01

    Time Trade-Off (TTO) valuations of health are widely used in economic evaluation of health care. Current approaches to eliciting TTO values, and their use in economic evaluation, rest on specific assumptions about the way utility relates to time and health. Both the assumptions themselves and evidence of violations of them are discussed in the literature - yet the issues appear not to be widely appreciated by those using and applying TTO in economic evaluation. This paper adds to that literature by demonstrating both the requirements of TTO and violations of these assumptions in terms of the underlying indifference curve maps and utility functions. The advantage of this approach is that it demonstrates very clearly a number of fundamental problems for the way TTO values are currently elicited and used in cost utility analysis. In essence, it is extremely unwise to assume that the current 'tariffs' of TTO values, such as those widely used in cost utility analysis to inform health sector decisions in many countries can be applied irrespective of the duration of the health states to which they are assigned. The estimates of QALYs that result will, quite often, simply be wrong. We conclude by pointing to a number of possible solutions. PMID:19019518

  14. Predicting the EQ-5D-3L Preference Index from the SF-12 Health Survey in a National US Sample

    PubMed Central

    Coca Perraillon, Marcelo; Shih, Ya-Chen Tina; Thisted, Ronald A.

    2015-01-01

    Background. When data on preferences are not available, analysts rely on condition-specific or generic measures of health status like the SF-12 for predicting or mapping preferences. Such prediction is challenging because of the characteristics of preference data, which are bounded, have multiple modes, and have a large proportion of observations clustered at values of 1. Methods. We developed a finite mixture model for cross-sectional data that maps the SF-12 to the EQ-5D-3L preference index. Our model characterizes the observed EQ-5D-3L index as a mixture of 3 distributions: a degenerate distribution with mass at values indicating perfect health and 2 censored (Tobit) normal distributions. Using estimation and validation samples derived from the Medical Expenditure Panel Survey 2000 dataset, we compared the prediction performance of these mixture models to that of 2 previously proposed methods: ordinary least squares regression (OLS) and two-part models. Results. Finite mixture models in which predictions are based on classification outperform two-part models and OLS regression based on mean absolute error, with substantial improvement for samples with fewer respondents in good health. The potential for misclassification is reflected on larger root mean square errors. Moreover, mixture models underperform around the center of the observed distribution. Conclusions. Finite mixtures offer a flexible modeling approach that can take into account idiosyncratic characteristics of the distribution of preferences. The use of mixture models allows researchers to obtain estimates of health utilities when only summary scores from the SF-12 and a limited number of demographic characteristics are available. Mixture models are particularly useful when the target sample does not have a large proportion of individuals in good health. PMID:25840902

  15. User charges in health care: Evidence of effect on service utilization & equity from north India

    PubMed Central

    Prinja, Shankar; Aggarwal, Arun Kumar; Kumar, Rajesh; Kanavos, Panos

    2012-01-01

    Background & objectives: User charges have been advocated on efficiency grounds despite the widespread criticism about their adverse effect on equity. We assessed the effect of user charges on inpatient hospitalizations rate and equity in Haryana State. Methods: The inpatient department (IPD) statistics of the public sector facilities in Yamuna Nagar district where user charges had been introduced were analysed and compared with Rohtak district which did not have user charge between 2000 and 2006. National Sample Survey data of Haryana for the 2004-2005 period were analyzed to compare utilization of public sector facilities for hospitalization, cost of hospitalization, and prevalence of catastrophic out-of-pocket (OOP) expenditure by income quintiles in three districts which had user charges and 17 districts of Haryana which did not levy user charges. Results: During 2000 and 2006, hospital admissions declined by 23.8 per cent in Yamuna Nagar district where user charges had been introduced compared to an almost static hospitalization rate in Rohtak district which did not have user charges (P<0.01). Public sector hospital utilization for inpatient services had a pro-rich (concentration index 0.144) distribution in the three districts with user charges and pro-poor (concentration index -0.047) in the 17 districts without user charges. Significantly higher prevalence of catastrophic health expenditure was observed in public sector institutions with user charges (48%) compared to those without user charges (35.4%) (P<0.001). Interpretation & conclusions: The findings of our study showed that user charges had a negative influence on hospitalizations in Haryana especially among the poor. Public policies for revenue generation should avoid user charges. PMID:23287137

  16. A statistical procedure to create a neighborhood socioeconomic index for health inequalities analysis

    PubMed Central

    2013-01-01

    Introduction In order to study social health inequalities, contextual (or ecologic) data may constitute an appropriate alternative to individual socioeconomic characteristics. Indices can be used to summarize the multiple dimensions of the neighborhood socioeconomic status. This work proposes a statistical procedure to create a neighborhood socioeconomic index. Methods The study setting is composed of three French urban areas. Socioeconomic data at the census block scale come from the 1999 census. Successive principal components analyses are used to select variables and create the index. Both metropolitan area-specific and global indices are tested and compared. Socioeconomic categories are drawn with hierarchical clustering as a reference to determine “optimal” thresholds able to create categories along a one-dimensional index. Results Among the twenty variables finally selected in the index, 15 are common to the three metropolitan areas. The index explains at least 57% of the variance of these variables in each metropolitan area, with a contribution of more than 80% of the 15 common variables. Conclusions The proposed procedure is statistically justified and robust. It can be applied to multiple geographical areas or socioeconomic variables and provides meaningful information to public health bodies. We highlight the importance of the classification method. We propose an R package in order to use this procedure. PMID:23537275

  17. Comparison and Relative Utility of Inequality Measurements: As Applied to Scotland’s Child Dental Health

    PubMed Central

    Blair, Yvonne I.; McMahon, Alex D.; Macpherson, Lorna M. D.

    2013-01-01

    This study compared and assessed the utility of tests of inequality on a series of very large population caries datasets. National cross-sectional caries datasets for Scotland’s 5-year-olds in 1993/94 (n = 5,078); 1995/96 (n = 6,240); 1997/98 (n = 6,584); 1999/00 (n = 6,781); 2002/03 (n = 9,747); 2003/04 (n = 10,956); 2005/06 (n = 10,945) and 2007/08 (n = 12,067) were obtained. Outcomes were based on the d3mft metric (i.e. the number of decayed, missing and filled teeth). An area-based deprivation category (DepCat) measured the subjects’ socioeconomic status (SES). Simple absolute and relative inequality, Odds Ratios and the Significant Caries Index (SIC) as advocated by the World Health Organization were calculated. The measures of complex inequality applied to data were: the Slope Index of Inequality (absolute) and a variety of relative inequality tests i.e. Gini coefficient; Relative Index of Inequality; concentration curve; Koolman & Doorslaer’s transformed Concentration Index; Receiver Operator Curve and Population Attributable Risk (PAR). Additional tests used were plots of SIC deciles (SIC10) and a Scottish Caries Inequality Metric (SCIM10). Over the period, mean d3mft improved from 3.1(95%CI 3.0–3.2) to 1.9(95%CI 1.8–1.9) and d3mft = 0% from 41.1(95%CI 39.8–42.3) to 58.3(95%CI 57.8–59.7). Absolute simple and complex inequality decreased. Relative simple and complex inequality remained comparatively stable. Our results support the use of the SII and RII to measure complex absolute and relative SES inequalities alongside additional tests of complex relative inequality such as PAR and Koolman and Doorslaer’s transformed CI. The latter two have clear interpretations which may influence policy makers. Specialised dental metrics (i.e. SIC, SIC10 and SCIM10) permit the exploration of other important inequalities not determined by SES, and could be applied to many other types of disease where ranking of morbidity

  18. The Meaningful Use of Electronic Health Records and Health Care Utilization.

    PubMed

    Kern, Lisa M; Edwards, Alison; Kaushal, Rainu

    2016-07-01

    This study sought to determine the effects on health care utilization of meaningful use (MU) of electronic health records (EHRs) compared to typical use of EHRs without MU. This was a cohort study of primary care physicians in New York State (2010-2011). A total of 7 outcomes (primary care visits, specialist visits, laboratory tests, radiology tests, emergency department visits, admissions and readmissions) and 11 potential confounders were considered. The study sample included 213 physicians (50% of whom had achieved MU) and 127 353 patients. There were 17 fewer primary care visits and 61 fewer laboratory tests for every 100 patients whose physicians achieved MU, compared with patients whose physicians did not achieve MU (P < .05 for each). There were no differences for other outcomes. Achieving stage 1 MU was associated with fewer primary care visits and laboratory tests, suggesting that effects of MU are distinct from effects of typical EHR use. PMID:25712134

  19. Utilization of health services in Western Canada: basic Canadian data from the World Health Organization/International Collaborative Study of Medical Care Utilization.

    PubMed Central

    Matthews, V. L.; Feather, J.

    1976-01-01

    In a household health survey more than 15 000 individuals in four areas of Canada were interviewed as part of the World Health Organization/International Collaborative Study of Medical Care Utilization. Data were collected to describe the health services system in each area and to measure the population's utilization of health professionals, hospitals, medicines and selected preventive services, perceived acute and chronic morbidity, attitudes and beliefs about health and health care, and sociodemographic characteristics. The proportion of persons with perceived morbidity was twice that of persons reporting visits with a physician in the same 2-week period. Prescribed and nonprescribed medications had been used by more than 50% of respondents in each area in the 2 days before the interview, nonprescribed medicines accounting for more than half of this use. Respondents were found to be more sceptical of medical doctors than of medical science. PMID:1253067

  20. Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan

    PubMed Central

    Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Oweis, Arwa; Al Ward, Nada; Burton, Ann

    2016-01-01

    Introduction The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings. Methods A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Results Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications. Discussion Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs. PMID:27073930

  1. Focus on vulnerable populations and promoting equity in health service utilization ––an analysis of visitor characteristics and service utilization of the Chinese community health service

    PubMed Central

    2014-01-01

    Background Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents. Methods Multistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors. Results The proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs. Conclusions The CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened. PMID:24884542

  2. Utility of Psychosocial Screening at a School-based Health Center.

    ERIC Educational Resources Information Center

    Gall, Gail; Pagano, Maria E.; Desmond, M. Sheila; Perrin, James M.; Murphy, J. Michael

    2000-01-01

    Evaluated the utility of the Pediatric Symptom Checklist for youth when completed by adolescents at a school-based health center (SBHC), noting how identification of psychosocial dysfunction and referral to mental health services improved academic functioning. Results support the utility of psychosocial screening and referral in SBHCs in…

  3. Health Service Utilization among Older Adults in British Columbia: Making Sense of Geography

    ERIC Educational Resources Information Center

    Allan, Diane; Cloutier-Fisher, Denise

    2006-01-01

    The utilization of health services by older adults has received increased attention over the past decade, but little is known about how service utilization varies between rural and urban areas. In an era of restructuring and downsizing within the Canadian health care system, there are concerns that rural older adults may be increasingly…

  4. Health Services Utilization between Older and Younger Homeless Adults.(author Abstract)

    ERIC Educational Resources Information Center

    Nakonezny, Paul A.; Ojeda, Michael

    2005-01-01

    Purpose: Our purpose in the current study was to examine the relationship between health services utilization delivered by means of the Homeless Outreach Medical Services (HOMES) program and health services utilization delivered by means of the Parkland emergency room and inpatient units among a sample of older and younger homeless adults being…

  5. Disability, Health Insurance Coverage, and Utilization of Acute Health Services in the United States. Disability Statistics Report 4.

    ERIC Educational Resources Information Center

    LaPlante, Mitchell P.

    This report uses data from the 1989 National Health Interview Survey to estimate health insurance coverage of children and nonelderly adults with disabilities and their utilization of physician and hospital care as a function of health insurance status. In part 1, national statistics on disability and insurance status are provided for different…

  6. Horizontal equity in health care utilization evidence from three high-income Asian economies.

    PubMed

    Lu, Jui-fen R; Leung, Gabriel M; Kwon, Soonman; Tin, Keith Y K; Van Doorslaer, Eddy; O'Donnell, Owen

    2007-01-01

    This paper compares the extent to which the principle of "equal treatment for equal need"(ETEN) is maintained in the health care delivery systems of Hong Kong, South Korea and Taiwan. Deviations in the degree to which health care is distributed according to need are measured by an index of horizontal inequity. Income-related inequality in utilization is split into four major sources: (i) direct effect of income; (ii) need indicators (self-assessed health status, activity limitation, and age and gender interaction terms); (iii) non-need variables (education, work status, private health insurance coverage, employer-provided medical benefits, Medicaid status (low-income medical assistance), geographic region and urban/rural residency and (iv) a residual term. Service types studied include western doctor, licensed traditional medicine practitioner (LTMP), dental and emergency room (ER) visits, as well as inpatient admissions. Violations of the ETEN principle are observed for physician and dental services in Hong Kong . There is pro-rich inequity in western doctor visits. Unusually, this inequity exists for general practitioner but not specialist care. In contrast, South Korea appears to have almost comprehensively maintained ETEN although the better-off have preferential access to higher levels of outpatient care. Taiwan shows intermediate results in that the rich are marginally more likely to use outpatient services, but quantities of western doctor and dental visits are evenly distributed while there is modest pro-rich bias in the number of LTMP episodes. ER visits and inpatient admissions in Taiwan are either proportional or slightly pro-poor. Future work should focus on the evaluation of policy interventions aimed at reducing the observed unequal distributions. PMID:17014944

  7. Development of the Facial Skin Care Index: A Health-Related Outcomes Index for Skin Cancer Patients

    PubMed Central

    Matthews, B. Alex; Rhee, John S.; Neuburg, Marcy; Burzynski, Mary L.; Nattinger, Ann B.

    2006-01-01

    BACKGROUND Existing health-related quality-of-life (HRQOL) tools do not appear to capture patients' specific skin cancer concerns. OBJECTIVE To describe the conceptual foundation, item generation, reduction process, and reliability testing for the Facial Skin Cancer Index (FSCI), a HRQOL outcomes tool for skin cancer researchers and clinicians. METHODS Participants in Phases I to III consisted of adult patients (N = 134) diagnosed with biopsy-proven nonmelanoma cervicofacial skin cancer. Data were collected via self-report surveys and clinical records. RESULTS Seventy-one distinct items were generated in Phase I and rated for their importance by an independent sample during Phase II; 36 items representing six theoretical HRQOL domains were retained. Test–retest I results indicated that four subscales showed adequate reliability coefficients (α = 0.60 to 0.91). Twenty-six items remained for test–retest II. Results indicated excellent internal consistency for emotional, social, appearance, and modified financial/work subscales (range 0.79 to 0.95); test–retest correlation coefficients were consistent across time (range 0.81 to 0.97; lifestyle omitted). CONCLUSION Pretesting afforded the opportunity to select items that optimally met our a priori conceptual and psychometric criteria for high data quality. Phase IV testing (validity and sensitivity before surgery and 4 months after Mohs micrographic surgery) for the 20-item FSCI is under way. PMID:16875475

  8. Utilizing the AAVSO's Variable Star Index (VSX) In Undergraduate Research Projects

    NASA Astrophysics Data System (ADS)

    Larsen, Kristine

    2016-01-01

    Among the many important services that the American Association of Variable Star Observers (AAVSO) provides to the astronomical community is the Variable Star Index (VSX - https://www.aavso.org/vsx/). This online catalog of variable stars is the repository of data on over 334,000 variable stars, including information on spectral type, range of magnitude, period, and type of variable, among other properties. A number of these stars were identified as being variable through automated telescope surveys, such as ASAS (All Sky Automated Survey). The computer code of this survey classified newly discovered variables as best it could, but a significant number of false classifications have been noted. The reclassification of ASAS variables in the VSX data, as well as a closer look at variables identified as miscellaneous type in VSX, are two of many projects that can be undertaken by interested undergraduates. In doing so, students learn about the physical properties of various types of variable stars as well as statistical analysis and computer software, especially the VStar variable star data visualization and analysis tool that is available to the astronomical community free of charge on the AAVSO website (https://www.aavso.org/vstar-overview). Two such projects are described in this presentation, the first to identify BY Draconis variables erroneously classified as Cepheids in ASAS data, and the second to identify SRD semiregular variables misidentified as "miscellaneous" in VSX.

  9. A prospective study evaluating utility of Mannheim peritonitis index in predicting prognosis of perforation peritonitis

    PubMed Central

    Sharma, Rajesh; Ranjan, Vikrant; Jain, Suraj; Joshi, Tulika; Tyagi, Anurag; Chaphekar, Rohan

    2015-01-01

    Aims: We aimed to validate Mannheim peritonitis index (MPI) for prediction of outcome in patients with perforation peritonitis. Materials and Methods: A prospective study involving 100 subjects operated for perforation peritonitis over the period of 2 years was designed. Postevaluation of predesigned performa, MPI score was calculated and analyzed for each patient with death being the main outcome measure. The MPI scores were divided into three categories; scores <15 (category 1), 16-25 (category 2), and >25 (category 3). Results: Our study consisted of 82 males and 18 females (male:female ratio 4.56:1), with the mean patients age of 37.96 ± 17.49 years. 47, 26, and 27 cases belonged to MPI score categories 1, 2, and 3, respectively. The most common origin of sepsis was ileal with small intestine dominating the source of perforation. When the individual parameters of MPI score were assessed against the mortality only, age >50 years (P = 0.015), organ failure (P = 0.0001), noncolonic origin of sepsis (P = 0.002), and generalized peritonitis (P = 0.0001) significantly associated with mortality. The sensitivity of MPI was 92% with a specificity of 78% in receiver operating characteristic curves. Conclusion: MPI is an effective tool for prediction of mortality in cases of perforation peritonitis. PMID:26604619

  10. Utilization of mental health services among adolescents in community-based substance abuse outpatient clinics.

    PubMed

    Chan, Ya-Fen; Godley, Mark D; Godley, Susan H; Dennis, Michael L

    2009-01-01

    This study examined the rates and correlates of self-reported receipt for mental health services among 1,190 adolescents, aged 12-19, who were admitted to community-based substance abuse outpatient clinics and had a co-occurring mental health problem. Utilization of mental health service was ascertained 3 months post-intake. About one third (35%) of adolescents with a co-occurring mental health problem identified at intake received mental health service in the 3 months after treatment entry. After holding other correlates constant, history of mental health treatment, suicidal behavior, family history of mental disorder and insurance coverage at intake were associated with mental health service utilization at the 3-month follow up. Predictors of service utilization varied by gender and racial/ethnic status. Implications for integrated substance use and mental health services are discussed. PMID:18157641

  11. Analysis of development levels in the cities of Tehran province regarding health infrastructural index: the strategy of standardized score and Morris’ inequality index

    PubMed Central

    Javani, Ali; Abolhallaje, Masoud; Raadabadi, Mehdi; Rezaee Dehaghi, Hanieh; Nazari, Aslan; Nazari, Hamed; Chatrouz, Azadeh

    2015-01-01

    Background: One of the main indexes of development is health index or the degree to which a society enjoys health and therapeutic services. The present study was done with the aim to analyze development levels in cities in Tehran regarding health infrastructural index using the standardized score and Morris’ model. Methods: This is a descriptive and pragmatic study which ranks 14 cities in Tehran province using the standardized score and Morris’ models based on 10 selected health indexes. The required data were gathered using a researcher-made information list and the information gathered from the Statistics Center and Tehran University of Medical Sciences. The data were analyzed using Excel software. Results: The development coefficient in the studied cities varies from 0.595 to -0.379 so that Rey city has the highest level of development and Pishva city has the lowest level of development among the studied cities. The more number of the cities (43%) was among the rather undeveloped group and none of the cities (0%) was in the rather developed group. Conclusion: Regarding the findings, there is a big gap and difference regarding enjoying health and therapeutic infrastructural indexes among the cities in Tehran province. Therefore, it is suggested that development-oriented plans consistentent with development levels should be implemented in these cities. PMID:26913267

  12. African Americans: Disparities in Health Care Access and Utilization

    ERIC Educational Resources Information Center

    Copeland, Valire Carr

    2005-01-01

    Despite remarkable improvements in the overall health of the nation during the past two decades, compelling evidence suggests that the nation's racial and ethnic minority Americans suffer increasing disparities in the incidence, prevalence, mortality, and burden of diseases and adverse health outcomes compared with white Americans. The 1998…

  13. Update: Health Insurance and Utilization of Care among Rural Adolescents

    ERIC Educational Resources Information Center

    Probst, Janice C.; Moore, Charity G.; Baxley, Elizabeth G.

    2005-01-01

    Context: Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. Purpose: To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. Methods:…

  14. The Index of Vulnerability: An anthropological method linking social-ecological systems to mental and physical health outcomes.

    PubMed

    Tallman, Paula Skye

    2016-08-01

    Researchers need measures of vulnerability that are grounded in explicit theoretical and conceptual frameworks, that are sensitive to local contexts, and that are easy to collect. This paper presents the Index of Vulnerability (IoV), a quantitative yet anthropologically-informed method connecting social-ecological systems to mental and physical health outcomes. The IoV combines measures of five life domains; food insecurity, water insecurity, access to healthcare, social support, and social status. Scores on this index increase for each life domain where the individual falls into a "high risk" category. Thus, individuals with the highest IoV scores are those who are at risk across multiple life domains. This approach makes the IoV malleable to local contexts, as scholars can choose which measure of each life domain is most appropriate for their study population. An anthropological study conducted among 225 Awajún adults living in the Peruvian Amazon from March to November of 2013 showed that men with higher IoV scores had significantly lower summary fat skinfolds, lower triglyceride levels, and a greater probability of reporting moderate to severe somatic symptoms and poor perceived health. Awajún women with higher IoV scores had significantly elevated perceived stress levels and a greater probability of reporting poor perceived health and moderate to severe somatic and depressive symptoms. Importantly, comparing the IoV to its constituent parts shows that it predicts a wider range of mental and physical health outcomes than any of the life domains alone. The IoV is presented here in relation to the broader political-economic and cultural context of the Awajún, forwarding a critical biocultural approach within anthropology, and demonstrating the IoV's utility for other scholars and practitioners. PMID:27340916

  15. Measuring the Safety of Excreta Disposal Behavior in India with the New Safe San Index: Reliability, Validity and Utility

    PubMed Central

    Jenkins, Marion W.; Freeman, Matthew C.; Routray, Parimita

    2014-01-01

    Methods to assess household excreta disposal practices are critical for informing public health outcomes of efforts to improve sanitation in developing countries. We present a new metric, the Safe San Index (SSI), to quantify the hygienic safety of a household’s defecation and human feces disposal practices in India, where behavioral outcomes from on-going public expenditures to construct household sanitation facilities and eliminate open defecation are poorly measured. We define hygienic safety of feces disposal as capture in a hygienic sanitation facility. The SSI consists of 15 self-report items and two sub-scales, Latrine Use Frequency and Seven-Day Open Defecation Rate. Households are scored on a standardized scale from 0 (no defecation safely captured) to 100 (all defecation safely captured). We present results of a pilot study in Odisha, India to apply the Index to assess excreta disposal behaviors among rural households and evaluate the reliability and validity of the Index for estimating the rate of correct and consistent sanitation facility usage of household with an improved latrine. PMID:25153464

  16. PSA, PSA derivatives, proPSA and prostate health index in the diagnosis of prostate cancer

    PubMed Central

    Ayyıldız, Sema Nur; Ayyıldız, Ali

    2014-01-01

    Currently, prostate- specific antigen (PSA) is the most common oncological marker used for prostate cancer screening. However, high levels of PSA in benign prostatic hyperplasia and prostatitis decrease the specificity of PSA as a cancer marker. To increase the specificity of PSA, PSA derivatives and PSA kinetics have been used. However, these new techniques were not able to increase the diagnostic specificity for prostate cancer. Therefore, the search for new molecules and derivatives of PSA continues. With the aim of increasing the specificity of prostate cancer diagnosis, proPSA and the Prostate Health Index have been introduced. In this review, the roles of PSA, PSA derivatives, proPSA and the Prostate Health Index in Prostate Cancer diagnosis are examined. PMID:26328156

  17. The child opportunity index: improving collaboration between community development and public health.

    PubMed

    Acevedo-Garcia, Dolores; McArdle, Nancy; Hardy, Erin F; Crisan, Unda Ioana; Romano, Bethany; Norris, David; Baek, Mikyung; Reece, Jason

    2014-11-01

    Improving neighborhood environments for children through community development and other interventions may help improve children's health and reduce inequities in health. A first step is to develop a population-level surveillance system of children's neighborhood environments. This article presents the newly developed Child Opportunity Index for the 100 largest US metropolitan areas. The index examines the extent of racial/ethnic inequity in the distribution of children across levels of neighborhood opportunity. We found that high concentrations of black and Hispanic children in the lowest-opportunity neighborhoods are pervasive across US metropolitan areas. We also found that 40 percent of black and 32 percent of Hispanic children live in very low-opportunity neighborhoods within their metropolitan area, compared to 9 percent of white children. This inequity is greater in some metropolitan areas, especially those with high levels of residential segregation. The Child Opportunity Index provides perspectives on child opportunity at the neighborhood and regional levels and can inform place-based community development interventions and non-place-based interventions that address inequities across a region. The index can also be used to meet new community data reporting requirements under the Affordable Care Act. PMID:25367989

  18. Impact of lung function on exacerbations, health care utilization, and costs among patients with COPD

    PubMed Central

    Ke, Xuehua; Marvel, Jessica; Yu, Tzy-Chyi; Wertz, Debra; Geremakis, Caroline; Wang, Liya; Stephenson, Judith J; Mannino, David M

    2016-01-01

    Objective To evaluate the impact of lung function, measured as forced expiratory volume in 1 second (FEV1) % predicted, on health care resource utilization and costs among patients with COPD in a real-world US managed-care population. Methods This observational retrospective cohort study utilized administrative claim data augmented with medical record data. The study population consisted of patients with one or more medical claims for pre- and postbronchodilator spirometry during the intake period (July 1, 2012 to June 30, 2013). The index date was the date of the earliest medical claim for pre- and postbronchodilator spirometry. Spirometry results were abstracted from patients’ medical records. Patients were divided into two groups (low FEV1% predicted [,50%] and high FEV1% predicted [≥50%]) based on the 2014 Global Initiative for Chronic Obstructive Lung Disease report. Health care resource utilization and costs were based on the prevalence and number of discrete encounters during the 12-month postindex follow-up period. Costs were adjusted to 2014 US dollars. Results A total of 754 patients were included (n=297 low FEV1% predicted group, n=457 high FEV1% predicted group). COPD exacerbations were more prevalent in the low FEV1% predicted group compared with the high group during the 12-month pre- (52.5% vs 39.6%) and postindex periods (49.8% vs 36.8%). Mean (standard deviation) follow-up all-cause and COPD-related costs were $27,380 ($38,199) and $15,873 ($29,609) for patients in the low FEV1% predicted group, and $22,075 ($28,108) and $10,174 ($18,521) for patients in the high group. In the multivariable analyses, patients in the low FEV1% predicted group were more likely to have COPD exacerbations and tended to have higher COPD-related costs when compared with patients in the high group. Conclusion Real-world data demonstrate that patients with COPD who have low FEV1% predicted levels use more COPD medications, have more COPD exacerbations, and incur higher

  19. The health heterogeneity of and health care utilization by the elderly in Taiwan.

    PubMed

    Liu, Li-Fan

    2014-02-01

    A good understanding of the health heterogeneity of elderly people, their characteristics, patterns of health care utilization and subsequent expenditures is necessary to adequately evaluate the policy options and interventions aimed at improving quality and efficiency of care for older people. This article reviews studies that used Latent Class Analysis to identify four health profiles among elderly people in Taiwan: High Comorbidity (HC), Functional Impairment (FI), Frail (FR), and Relatively Healthy (RH). Variables associated with increased likelihood of being in the FR group were older age, female gender, and living with one's family, and these also correlated with ethnicity and level of education. The HC group tended to use more ambulatory care services compared with those in the RH group. The HC group tended to be younger, better educated, and was more likely to live in urban areas than were people in the FI group. The FI group, apart from age and gender, was less likely be of Hakka ethnicity and more likely to live with others than were individuals in the RH group. The FI group had relatively high probabilities of needing assistance, and the FR group had higher healthcare expenditures. A person-centered approach would better satisfy current healthcare needs of elderly people and help forecast future expenditures. PMID:24473113

  20. A small-area index of socioeconomic deprivation to capture health inequalities in France.

    PubMed

    Havard, Sabrina; Deguen, Séverine; Bodin, Julie; Louis, Karine; Laurent, Olivier; Bard, Denis

    2008-12-01

    In the absence of individual data, ecological or contextual measures of socioeconomic level are frequently used to describe social inequalities in health. This work focuses on the methodological aspects of the development and validation of a French small-area index of socioeconomic deprivation and its application to the evaluation of the socioeconomic differentials in health outcomes. This index was derived from a principal component analysis of 1999 national census data from the Strasbourg metropolitan area in eastern France, at the census block level. Composed of 19 variables that reflect the multiple aspects of socioeconomic status (income, employment, housing, family and household, and educational level), it can discriminate disadvantaged urban centres from more privileged rural and suburban areas. Several statistical tests (Cronbach's alpha coefficient, convergent validity tests with other deprivation indices from the literature) provided internal and external validation. Its successful application to another French metropolitan area (Lille, in northern France) confirmed its transposability. Finally, its capacity to capture the social inequalities in health when applied to myocardial infarction data shows its potential value. This study thus provides a new tool in French public health research for characterising neighbourhood deprivation and detecting socioeconomic disparities in the distribution of health outcomes at the small-area level. PMID:18950926

  1. Employment and family conditions are related to health care utilization among foreign-born farmworker men.

    PubMed

    López-Cevallos, Daniel F; Garside, Leda I

    2013-01-01

    Despite their increased vulnerability to disease and injury, farmworkers have limited access to health services. The purpose of this study was to analyze the influence of employment and family conditions on health care utilization among foreign-born farmworker men. Using the Hispanic Farmworker Health model as the theoretical framework, a secondary data analysis was conducted among 397 foreign-born vineyard and winery worker men who attended the ¡Salud! Services mobile health screenings during the summer of 2009. Working full time (odds ratio [OR] = 2.49), being employed directly by the vineyard or winery (OR = 1.96), and having immediate family members (children, spouse) living in Oregon (OR = 2.65) were positively associated with health care utilization. Findings suggest that despite the many barriers farmworker men face, supportive employment and family conditions may increase health care utilization for this population. Implications of these results are discussed in the context of health care reform. PMID:24831072

  2. The Outcome of Breast Cancer Is Associated with National Human Development Index and Health System Attainment

    PubMed Central

    Tian, Wei; Pan, Tao; Ye, Juan; Zhang, Suzhan

    2016-01-01

    Breast cancer is a worldwide threat to female health with patient outcomes varying widely. The exact correlation between global outcomes of breast cancer and the national socioeconomic status is still undetermined. Mortality-to-incidence ratio (MIR) of breast cancer was calculated with the contemporary age standardized incidence and mortality rates for countries with data available at GLOBOCAN 2012 database. The MIR matched national human development indexes (HDIs) and health system attainments were respectively obtained from Human Development Report and World Health Report. Correlation analysis, regression analysis, and Tukey-Kramer post hoc test were used to explore the effects of HDI and health system attainment on breast cancer MIR. Our results demonstrated that breast cancer MIR was inversely correlated with national HDI (r = -.950; P < .001) and health system attainment (r = -.898; P < .001). Countries with very high HDI had significantly lower MIRs than those with high, medium and low HDI (P < .001). Liner regression model by ordinary least squares also indicated negative effects of both HDI (adjusted R2 = .903, standardize β = -.699, P < .001) and health system attainment (adjusted R2 =. 805, standardized β = -.009; P < .001), with greater effects in developing countries identified by quantile regression analysis. It is noteworthy that significant health care disparities exist among countries in accordance with the discrepancy of HDI. Policies should be made in less developed countries, which are more likely to obtain worse outcomes in female breast cancer, that in order to improve their comprehensive economic strength and optimize their health system performance. PMID:27391077

  3. Effect of Personality on the Use and Perceived Utility of Web-Based Health Resources

    ERIC Educational Resources Information Center

    Hruska, Natalie

    2012-01-01

    Studies document numerous threats to human health exacerbated by multiple factors, including inadequate access to health-related information. The Internet has developed as one resource to provide health information; however, there remains a significant gap in understanding how personality differences influence the use and perceived utility of the…

  4. Health Care Utilization among Migrant Latino Farmworkers: The Case of Skin Disease

    ERIC Educational Resources Information Center

    Feldman, Steven R.; Vallejos, Quirina M.; Quandt, Sara A.; Fleischer, Alan B., Jr.; Schulz, Mark R.; Verma, Amit; Arcury, Thomas A.

    2009-01-01

    Context: Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. Purpose: Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods: Three hundred and four migrant…

  5. The Rural-Urban Divide: Health Services Utilization among Older Mexicans in Mexico

    ERIC Educational Resources Information Center

    Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.

    2010-01-01

    Context: Mexico. Purpose: Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods: The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's "model of health…

  6. Income, Language, and Citizenship Status: Factors Affecting the Health Care Access and Utilization of Chinese Americans.

    ERIC Educational Resources Information Center

    Jang, Michael; Lee, Evelyn; Woo, Kent

    1998-01-01

    The effects of income, language, and citizenship on the use of health-care services by Chinese Americans is examined (N=1808). Focus groups, a telephone survey, and key informant interviews were conducted. Data analysis included an acculturation index, demographic profile, and logistical regression. Health insurance and social factors are…

  7. Relationship Between Systems' Mental Health Paradigm and Personpower Utilization.

    ERIC Educational Resources Information Center

    Hurley, Daniel J., Jr.; Tyler, Forrest B.

    Recent proliferation at training and educational programs for paraprofessional and non professionals has occurred without systematic evaluation of systems' utilization of newly trained people. It was the purpose of this study to assess both job functioning and attitudes of paraprofessionals in relation to professionals and the interaction of…

  8. Disaggregating health inequalities within Rio de Janeiro, Brazil, 2002-2010, by applying an urban health inequality index

    PubMed Central

    Bortz, Martin; Kano, Megumi; Ramroth, Heribert; Barcellos, Christovam; Weaver, Scott R.; Rothenberg, Richard; Magalhães, Monica

    2016-01-01

    An urban health index (UHI) was used to quantify health inequalities within Rio de Janeiro, Brazil, for the years 2002-2010. Eight main health indicators were generated at the ward level using mortality data. The indicators were combined to form the index. The distribution of the rank ordered UHI-values provides information on inequality among wards, using the ratio of the extremes and the gradient of the middle values. Over the decade the ratio of extremes in 2010 declined relative to 2002 (1.57 vs. 1.32) as did the slope of the middle values (0.23 vs. 0.16). A spatial division between the affluent south and the deprived north and east is still visible. The UHI correlated on an ecological ward-level with socioeconomic and urban environment indicators like square meter price of apartments (0.54, p < 0.01), low education of mother (-0.61, p < 0.01), low income (-0.62, p < 0.01) and proportion of black ethnicity (-0.55, p < 0.01). The results suggest that population health and equity have improved in Rio de Janeiro in the last decade though some familiar patterns of spatial inequality remain. PMID:26648367

  9. Automated Indexing of Internet Stories for Health Behavior Change: Weight Loss Attitude Pilot Study

    PubMed Central

    Manuvinakurike, Ramesh; Velicer, Wayne F

    2014-01-01

    Background Automated health behavior change interventions show promise, but suffer from high attrition and disuse. The Internet abounds with thousands of personal narrative accounts of health behavior change that could not only provide useful information and motivation for others who are also trying to change, but an endless source of novel, entertaining stories that may keep participants more engaged than messages authored by interventionists. Objective Given a collection of relevant personal health behavior change stories gathered from the Internet, the aim of this study was to develop and evaluate an automated indexing algorithm that could select the best possible story to provide to a user to have the greatest possible impact on their attitudes toward changing a targeted health behavior, in this case weight loss. Methods An indexing algorithm was developed using features informed by theories from behavioral medicine together with text classification and machine learning techniques. The algorithm was trained using a crowdsourced dataset, then evaluated in a 2×2 between-subjects randomized pilot study. One factor compared the effects of participants reading 2 indexed stories vs 2 randomly selected stories, whereas the second factor compared the medium used to tell the stories: text or animated conversational agent. Outcome measures included changes in self-efficacy and decisional balance for weight loss before and after the stories were read. Results Participants were recruited from a crowdsourcing website (N=103; 53.4%, 55/103 female; mean age 35, SD 10.8 years; 65.0%, 67/103 precontemplation; 19.4%, 20/103 contemplation for weight loss). Participants who read indexed stories exhibited a significantly greater increase in self-efficacy for weight loss compared to the control group (F 1,107=5.5, P=.02). There were no significant effects of indexing on change in decisional balance (F 1,97=0.05, P=.83) and no significant effects of medium on change in self

  10. Utilizing health information technology to improve vaccine communication and coverage

    PubMed Central

    Stockwell, Melissa S; Fiks, Alexander G

    2013-01-01

    Vaccination coverage is still below the Healthy People 2010 and 2020 goals. Technology use in the US is widespread by patients and providers including text message, email, internet, social media and electronic health records. Health information technology (IT) interventions can facilitate the rapid or real-time identification of children in need of vaccination and provide the foundation for vaccine-oriented parental communication or clinical alerts in a flexible and tailored manner. There has been a small but burgeoning field of work integrating IT into vaccination interventions including reminder/recall using non-traditional methods, clinical decision support for providers in the electronic health record, use of technology to affect work-flow and the use of social media. The aim of this review is to introduce and present current data regarding the effectiveness of a range of technology tools to promote vaccination, describe gaps in the literature and offer insights into future directions for research and intervention. PMID:23807361

  11. Utilizing health information technology to improve vaccine communication and coverage.

    PubMed

    Stockwell, Melissa S; Fiks, Alexander G

    2013-08-01

    Vaccination coverage is still below the Healthy People 2010 and 2020 goals. Technology use in the US is widespread by patients and providers including text message, email, internet, social media and electronic health records. Health information technology (IT) interventions can facilitate the rapid or real-time identification of children in need of vaccination and provide the foundation for vaccine-oriented parental communication or clinical alerts in a flexible and tailored manner. There has been a small but burgeoning field of work integrating IT into vaccination interventions including reminder/recall using non-traditional methods, clinical decision support for providers in the electronic health record, use of technology to affect work-flow and the use of social media. The aim of this review is to introduce and present current data regarding the effectiveness of a range of technology tools to promote vaccination, describe gaps in the literature and offer insights into future directions for research and intervention. PMID:23807361

  12. Global forecasting of thermal health hazards: the skill of probabilistic predictions of the Universal Thermal Climate Index (UTCI)

    NASA Astrophysics Data System (ADS)

    Pappenberger, F.; Jendritzky, G.; Staiger, H.; Dutra, E.; Di Giuseppe, F.; Richardson, D. S.; Cloke, H. L.

    2015-03-01

    Although over a hundred thermal indices can be used for assessing thermal health hazards, many ignore the human heat budget, physiology and clothing. The Universal Thermal Climate Index (UTCI) addresses these shortcomings by using an advanced thermo-physiological model. This paper assesses the potential of using the UTCI for forecasting thermal health hazards. Traditionally, such hazard forecasting has had two further limitations: it has been narrowly focused on a particular region or nation and has relied on the use of single `deterministic' forecasts. Here, the UTCI is computed on a global scale, which is essential for international health-hazard warnings and disaster preparedness, and it is provided as a probabilistic forecast. It is shown that probabilistic UTCI forecasts are superior in skill to deterministic forecasts and that despite global variations, the UTCI forecast is skilful for lead times up to 10 days. The paper also demonstrates the utility of probabilistic UTCI forecasts on the example of the 2010 heat wave in Russia.

  13. The community need index. A new tool pinpoints health care disparities in communities throughout the nation.

    PubMed

    Roth, Richard; Barsi, Eileen

    2005-01-01

    Catholic Healthcare West, San Francisco (CHW), has developed a national Community Need Index (CNI) in partnership with Solucient, an information products company, to help health care organizations, not-for-profits, and policymakers identify and address barriers to health care access in their communities. The CNI aggregates five socioeconomic indicators long known to contribute to health disparity--income, culture/language, education, housing status, and insurance coverage--and applies them to every zip code in the United States. Each zip code is then given a score ranging from 1.0 (low need) to 5.0 (high need). Residents of communities with the highest CNI scores were shown to be twice as likely to experience preventable hospitalization for manageable conditions--such as ear infections, pneumonia or congestive heart failure--as communities with the lowest CNI scores. The CNI provides compelling evidence for addressing socioeconomic barriers when considering health policy and local health planning. The tool highlights health care disparities between geographic regions and illustrates the acute needs of several notable geographies, including inner city and rural areas.Further, it should enable health care providers, policymakers, and others to allocate resources where they are most needed, using a standardized, quantitative tool. The CNI provides CHW with an important means to strategically allocate resources where it will be most effective in maintaining a healthy community. PMID:16092512

  14. Gender disparities in HIV health care utilization among the severely disadvantaged: can we determine the reasons?

    PubMed

    Sohler, Nancy L; Li, Xuan; Cunningham, Chinazo O

    2009-09-01

    Data repeatedly demonstrate that HIV-infected people who regularly utilize primary health care services are more likely to have access to lifesaving treatments (including antiretroviral medications); have better indicators of health status; survive longer; and use acute care services far less. Women tend to have poorer HIV outcomes than men, which is likely due to gender disparities in optimal utilization of HIV primary care services. To understand the relationship between gender and the HIV health care system, we collected interview and medical record data between August 12, 2004 and June 7, 2005 from 414 severely marginalized, HIV-infected people in New York City and examined whether gender-related disparities in HIV health care utilization existed, and, if so, whether these patterns were explained by patient sociodemographic/behavioral characteristics and/or attitudes toward the health care system and providers. Women were significantly less likely to have optimal HIV health care services utilization, including lower use of HIV primary care services (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.35, 0.90) and greater use of the emergency department (OR = 2.13, 95% CI = 1.31, 3.46). Although we identified several factors associated with suboptimal HIV health care services utilization patterns in addition to female gender (low education, insurance status, mistrust of the health care system, and poor trust in health care providers), we were unable to identify factors that explained the observed gender disparities. We conclude that gender disparities in HIV health care utilization are due to a complex array of factors, which require more qualitative and quantitative research attention. Development of intervention strategies that specifically target severely disadvantaged women's HIV health care utilization is in great need. PMID:19663745

  15. Food Insecurity and Health Care Utilization Among Older Adults in the United States.

    PubMed

    Bhargava, Vibha; Lee, Jung Sun

    2016-01-01

    This study examined the relationships between food insecurity and utilization of four health services among older Americans: office visits, inpatient hospital nights, emergency department visits, and home health care. Nationally representative data from the 2011 and 2012 National Health Interview Survey were used (N = 13,589). Nearly 83.0% of the sample had two or more office visits, 17.0% reported at least one hospital night, 23.0% had at least one emergency room visit, and 8.1% used home health care during the past 12 months. Adjusting for confounders, food-insecure older adults had higher odds of using more office visits, inpatient hospital nights, and emergency department visits than food-secure older adults, but similar odds of home health care utilization. The findings of this study suggest that programs and policies aimed at reducing food insecurity among older adults may have a potential to reduce utilization of health care services. PMID:27559853

  16. Social Factors Related to the Utilization of Health Care Among Prison Inmates.

    PubMed

    Nowotny, Kathryn M

    2016-04-01

    This study examines the demographic and social factors related to health care utilization in prisons using the 2004 Survey of Inmates in State Correctional Facilities. The findings show that education and employment, strong predictors of health care in the community, are not associated with health care in prisons. Although female inmates have a higher disease burden than male inmates, there are no sex differences in health care usage. The factors associated with health care, however, vary for women and men. Notably, Black men are significantly more likely to utilize health care compared to White and Latino men. The findings suggest that, given the constitutionally mandated health care for inmates, prisons can potentially minimize racial disparities in care and that prisons, in general, are an important context for health care delivery in the United States. PMID:26984136

  17. OCLC Utilization in Health Sciences Libraries. CE 35, Revised Edition.

    ERIC Educational Resources Information Center

    Armes, Patti

    This syllabus for a continuing education course describes the OCLC system and considers how it can be used by health science libraries. The general governance and administrative structure of OCLC and its network affiliates are detailed, and the OCLC subsystems--online union catalog, serials, interlibrary loan, and acquisitions--and their major…

  18. Utilizing Codes of Ethics in Health Professions Education

    ERIC Educational Resources Information Center

    Dahnke, Michael D.

    2014-01-01

    Codes of ethics abound in health care, the aims and purposes of which are multiple and varied, from operating as a decision making tool to acting as a standard of practice that can be operational in a legal context to providing a sense of elevated seriousness and professionalism within a field of practice. There is some doubt and controversy,…

  19. Provider Types Utilized and Recency of Mental Health Service Use among African American Emerging Adults

    PubMed Central

    Williams, Sha-Lai

    2014-01-01

    Objective This study examined factors associated with mental health service utilization among African American emerging adults, specifically, when services were used (recency) and the types of providers utilized (mental health/non-mental health). Methods Guided by the Behavioral Model for Vulnerable Populations, secondary analysis of the National Survey of American Life (2001-2003) was conducted. A nationally representative sample of African American emerging adults, ages 18-29 (n=806), were assessed using the Composite International Diagnostic Interview. “Evaluated need” was determined by endorsement for one of four DSM-IV diagnosis types (mood, anxiety, substance use, impulse control). Respondents who reported a need for services for emotional/substance use problems were considered to have a “perceived need”. Those who reported voluntary use of mental health/health services to address these problems were considered to have utilized services. Results 25%of the sample utilized services in their lifetime, while 9% utilized services in the past 12 months. Females were more likely than males to utilize services in three of the four service use categories (lifetime, mental health sector, and non-mental health sector).Respondents with an evaluated need for services were 2-12 times more likely to have utilized services compared to those without a need. Conclusions Little is known about why African American emerging adults underutilize mental health services. These findings indicate that being female and having an evaluated need for services were associated with greater odds of service use among this sample. This suggests the need for additional examination of gender differences in service utilization and greater mental health outreach/education among African American males. PMID:24981778

  20. Air quality trends and potential health effects - Development of an aggregate risk index

    NASA Astrophysics Data System (ADS)

    Sicard, Pierre; Lesne, Olivia; Alexandre, Nicolas; Mangin, Antoine; Collomp, Rémy

    2011-02-01

    The "Provence Alpes Côte d'Azur" (PACA) region, in the South East of France, is one of Europe's regions most influenced by the atmospheric pollution. During the last 15 years, the industrial emissions decrease caused an evolution of the atmospheric pollution nature. Nowadays, atmospheric pollution is more and more influenced by the road traffic, the dominating pollution source in urban zones for the PACA region. Combined with this intense road traffic, the strong hot season of the Mediterranean climate contributes to the region bad air quality; it is known to be one of the worse in Europe. The recognized air pollution effects over public health include increased risk of hospital admissions and mortality by respiratory or cardiovascular diseases. The combination of these serious pollution related health hazards with senior and children vulnerabilities leads to serious sanitary concerns. Over the 1990-2005 period, we obtained, using the non-parametric Mann-Kendall test from annual mortality dataset (CépiDC), decreasing trends for Asthma (-5.00% year -1), Cardiovascular (-0.73% year -1), Ischemic (-0.69% year -1) and cerebrovascular diseases (-3.10% year -1). However, for "Other heart diseases" (+0.10% year -1) and "Respiratory" (+0.10% year -1) an increase was observed. The development of an adequate tool to understand impacts of pollution levels is of utmost importance. Different pollutants have different health endpoints, information may be lost through the use of a single index consequently, in this study we present the modified formula of air quality index, based on Cairncross's concept the Aggregate Risk Index (ARI). ARI is based on the relative risk of the well-established increased daily mortality, or morbidity, enabling an assessment of additive effects of short-term exposure to the main air pollutants: PM 2.5, PM 10, SO 2, O 3 and NO 2 in order to account for the reality of the multiple exposures impacts of chemical agents. The ARI, developed per pathology

  1. Using Simpson’s diversity index to examine multidimensional models of diversity in health professions education

    PubMed Central

    McLaughlin, Gerald W.; McLaughlin, Josetta S.; White, Carla Y.

    2016-01-01

    Objectives This study explored new models of diversity for health professions education that incorporate multiple attributes and examined differences in diversity based on urbanicity, geographic region, and institutional structure. Methods Simpson’s Diversity Index was used to develop race, gender, and interprofessional diversity indices for health professions schools in the United States (N = 318). Sullivan’s extension was used to develop a composite diversity index that incorporated multiple individual attributes for each school. Pearson’s r was used to investigate correlations between continuous variables. ANOVA and independent t-tests were used to compare groups based on urbanicity, geographic region, and Basic Carnegie Classification. Results Mean (SD) for race, gender, and interprofessional  diversity indices were 0.36(0.17), 0.45(0.07), and 0.22(0.27) respectively. All correlations between the three indices were weak. The composite diversity index for this sample was 0.34(0.13). Significant differences in diversity were found between institutions based on urbanicity, Basic Carnegie Classification, and geographic region. Conclusions Multidimensional models provide support for expanding measures of diversity to include multiple characteristics and attributes. The approach demonstrated in this study enables institutions to complement and extend traditional measures of diversity as a means of providing evidence for decision-making and progress towards institutional initiatives. PMID:26724917

  2. Mapping Uncertainty Due to Missing Data in the Global Ocean Health Index.

    PubMed

    Frazier, Melanie; Longo, Catherine; Halpern, Benjamin S

    2016-01-01

    Indicators are increasingly used to measure environmental systems; however, they are often criticized for failing to measure and describe uncertainty. Uncertainty is particularly difficult to evaluate and communicate in the case of composite indicators which aggregate many indicators of ecosystem condition. One of the ongoing goals of the Ocean Health Index (OHI) has been to improve our approach to dealing with missing data, which is a major source of uncertainty. Here we: (1) quantify the potential influence of gapfilled data on index scores from the 2015 global OHI assessment; (2) develop effective methods of tracking, quantifying, and communicating this information; and (3) provide general guidance for implementing gapfilling procedures for existing and emerging indicators, including regional OHI assessments. For the overall OHI global index score, the percent contribution of gapfilled data was relatively small (18.5%); however, it varied substantially among regions and goals. In general, smaller territorial jurisdictions and the food provision and tourism and recreation goals required the most gapfilling. We found the best approach for managing gapfilled data was to mirror the general framework used to organize, calculate, and communicate the Index data and scores. Quantifying gapfilling provides a measure of the reliability of the scores for different regions and components of an indicator. Importantly, this information highlights the importance of the underlying datasets used to calculate composite indicators and can inform and incentivize future data collection. PMID:27483378

  3. Mapping Uncertainty Due to Missing Data in the Global Ocean Health Index

    PubMed Central

    Longo, Catherine; Halpern, Benjamin S.

    2016-01-01

    Indicators are increasingly used to measure environmental systems; however, they are often criticized for failing to measure and describe uncertainty. Uncertainty is particularly difficult to evaluate and communicate in the case of composite indicators which aggregate many indicators of ecosystem condition. One of the ongoing goals of the Ocean Health Index (OHI) has been to improve our approach to dealing with missing data, which is a major source of uncertainty. Here we: (1) quantify the potential influence of gapfilled data on index scores from the 2015 global OHI assessment; (2) develop effective methods of tracking, quantifying, and communicating this information; and (3) provide general guidance for implementing gapfilling procedures for existing and emerging indicators, including regional OHI assessments. For the overall OHI global index score, the percent contribution of gapfilled data was relatively small (18.5%); however, it varied substantially among regions and goals. In general, smaller territorial jurisdictions and the food provision and tourism and recreation goals required the most gapfilling. We found the best approach for managing gapfilled data was to mirror the general framework used to organize, calculate, and communicate the Index data and scores. Quantifying gapfilling provides a measure of the reliability of the scores for different regions and components of an indicator. Importantly, this information highlights the importance of the underlying datasets used to calculate composite indicators and can inform and incentivize future data collection. PMID:27483378

  4. Veterans Health Administration and Medicare Outpatient Health Care Utilization by Older Rural and Urban New England Veterans

    ERIC Educational Resources Information Center

    Weeks, William B.; Bott, David M.; Lamkin, Rebecca P.; Wright, Steven M.

    2005-01-01

    Older veterans often use both the Veterans Health Administration (VHA) and Medicare to obtain health care services. The authors sought to compare outpatient medical service utilization of Medicare-enrolled rural veterans with their urban counterparts in New England. The authors combined VHA and Medicare databases and identified veterans who were…

  5. College Health Surveillance Network: Epidemiology and Health Care Utilization of College Students at US 4-Year Universities

    ERIC Educational Resources Information Center

    Turner, James C.; Keller, Adrienne

    2015-01-01

    Objective: This description of the College Health Surveillance Network (CHSN) includes methodology, demography, epidemiology, and health care utilization. Participants: Twenty-three universities representing approximately 730,000 enrolled students contributed data from January 1, 2011, through May 31, 2014. Methods: Participating schools uploaded…

  6. The Associations between Health Literacy, Reasons for Seeking Health Information, and Information Sources Utilized by Taiwanese Adults

    ERIC Educational Resources Information Center

    Wei, Mi-Hsiu

    2014-01-01

    Objective: To determine the associations between health literacy, the reasons for seeking health information, and the information sources utilized by Taiwanese adults. Method: A cross-sectional survey of 752 adults residing in rural and urban areas of Taiwan was conducted via questionnaires. Chi-squared tests and logistic regression were used for…

  7. Mental health service utilization in sub-Saharan Africa: is public mental health literacy the problem? Setting the perspectives right.

    PubMed

    Atilola, Olayinka

    2016-06-01

    The severely constrained resources for mental health service in less-developed regions like sub-Saharan Africa underscore the need for good public mental health literacy as a potential additional mental health resource. Several studies examining the level of public knowledge about the nature and dynamics of mental illness in sub-Saharan Africa in the last decade had concluded that such knowledge was poor and had called for further public enlightenment. What was thought to be mental health 'ignorance' has also been blamed for poor mainstream service utilization. These views however assume that non-alignment of the views of community dwellers in sub-Saharan Africa with the biomedical understanding of mental illness connotes 'ignorance', and that correcting such 'ignorance' will translate to improvements in service utilization. Within the framework of contemporary thinking in mental health literacy, this paper argues that such assumptions are not culturally nuanced and may have overrated the usefulness of de-contextualized public engagement in enhancing mental health service utilization in the region. The paper concludes with a discourse on how to contextualize public mental health enlightenment in the region and the wider policy initiatives that can improve mental health service utilization. PMID:25749253

  8. Optimal allocation of resources over health care programmes: dealing with decreasing marginal utility and uncertainty.

    PubMed

    Al, Maiwenn J; Feenstra, Talitha L; Hout, Ben A van

    2005-07-01

    This paper addresses the problem of how to value health care programmes with different ratios of costs to effects, specifically when taking into account that these costs and effects are uncertain. First, the traditional framework of maximising health effects with a given health care budget is extended to a flexible budget using a value function over money and health effects. Second, uncertainty surrounding costs and effects is included in the model using expected utility. Other approaches to uncertainty that do not specify a utility function are discussed and it is argued that these also include implicit notions about risk attitude. PMID:15678518

  9. Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012.

    PubMed

    Tomiyama, A J; Hunger, J M; Nguyen-Cuu, J; Wells, C

    2016-05-01

    The United States Equal Employment Opportunity Commission has proposed rules allowing employers to penalize employees up to 30% of health insurance costs if they fail to meet 'health' criteria, such as reaching a specified body mass index (BMI). Our objective was to examine cardiometabolic health misclassifications given standard BMI categories. Participants (N=40 420) were individuals aged 18+ in the nationally representative 2005-2012 National Health and Nutrition Examination Survey. Using the blood pressure, triglyceride, cholesterol, glucose, insulin resistance and C-reactive protein data, population frequencies/percentages of metabolically healthy versus unhealthy individuals were stratified by BMI. Nearly half of overweight individuals, 29% of obese individuals and even 16% of obesity type 2/3 individuals were metabolically healthy. Moreover, over 30% of normal weight individuals were cardiometabolically unhealthy. There was no significant race-by-BMI interaction, but there was a significant gender-by-BMI interaction, F(4,64)=3.812, P=0.008. Using BMI categories as the main indicator of health, an estimated 74 936 678 US adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy. Policymakers should consider the unintended consequences of relying solely on BMI, and researchers should seek to improve diagnostic tools related to weight and cardiometabolic health. PMID:26841729

  10. Health behaviour and body mass index among problem gamblers: results from a nationwide survey.

    PubMed

    Algren, Maria H; Ekholm, Ola; Davidsen, Michael; Larsen, Christina V L; Juel, Knud

    2015-06-01

    Problem gambling is a serious public health issue. The objective of this study was to investigate whether past year problem gamblers differed from non-problem gamblers with regard to health behaviour and body mass index (BMI) among Danes aged 16 years or older. Data were derived from the Danish Health and Morbidity Surveys in 2005 and 2010. Past year problem gambling was defined using the lie/bet questionnaire. Logistic regression analyses were used to examine the association between past year problem gambling and health behaviour and BMI. Problem gambling was associated with unhealthy behaviour and obesity. The odds of smoking was significantly higher among problem gamblers than among non-problem gamblers. Further, the odds of high-risk alcohol drinking and illicit drug use were significantly higher among problem gamblers. The prevalence of sedentary leisure activity, unhealthy diet pattern and obesity was higher among problem gamblers than among non-problem gamblers. The associations found in this study remained significant after adjustment for sex, age, educational and cohabiting status as well as other risk factors. Our findings highlight the presence of a potential, public health challenge and elucidate the need for health promotion initiatives targeted at problem gamblers. Furthermore, more research is needed in order to understand the underlying social mechanism of the association between problem gamblers and unhealthy behaviour. PMID:24390713

  11. Women's veteran identity and utilization of VA health services.

    PubMed

    Di Leone, Brooke A L; Wang, Joyce M; Kressin, Nancy; Vogt, Dawne

    2016-02-01

    Women have participated in the United States military since its founding. However, until the mid-20th century, there had been limited recognition of women as official members of the military, and women remain a statistical minority within military and veteran populations. It is therefore important to better understand women's veteran identity (which we define here as one's self-concept as derived from their veteran status) and associated implications for service use and experiences in the Department of Veterans Affairs (VA) health care setting. The present research examined the centrality of, and positive regard for, women's veteran identity among 407 female veterans deployed in support of the recent wars in Iraq and Afghanistan. Data were collected via a mailed national survey. Positive regard for veteran identity, but not veteran identity centrality,was positively associated with participants' age and length of time spent in the military. Results also showed that the centrality of women's veteran identity was positively related to their choice to use VA for health care and their feelings of belonging within VA, and that veteran identity centrality and positive regard for veteran identity are differentially associated with participants' military experiences (e.g., combat exposure, deployment sexual harassment) and mental health symptomatology (e.g., depression). PMID:25729892

  12. Health care utilization patterns in developing countries: role of the technology environment in "deriving" the demand for health care.

    PubMed Central

    Wouters, A. V.

    1992-01-01

    Health care services, in combination with several intermediate (proximate) determinants of health such as environmental sanitation and nutrition, directly influence health status. In the economics literature, this is referred to as the health production technology. Although many studies recognize that demand for health care depends on the health production technology, otherwise known as a "derived" demand, this review indicates that few of them have so far been able to fully incorporate this technology in estimating significant determinants of health care use. Understanding the technology environment could help explain why substantial portions of the population do not gain access to care even when financial factors do not appear to be a barrier. Also, low utilization of health services may simply reflect the low productivity of these services when other complementary factors such as nutrition or clean water and sanitation are lacking. Finally, since health-producing technology is often a multistep (multivisit) process, health care demand studies generally offer an incomplete picture of health care utilization patterns because they focus on a single event such as the first visit of an illness episode. Researchers should obtain more complete information on the interaction between all health production inputs, their availability and access to them. Multidisciplinary methodologies are likely to be useful. PMID:1638667

  13. A structured review of health utility measures and elicitation in advanced/metastatic breast cancer

    PubMed Central

    Hao, Yanni; Wolfram, Verena; Cook, Jennifer

    2016-01-01

    Background Health utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies. Methods Searches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases), online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center), and web sites of health technology assessment (HTA) bodies. Publications were selected based on the search strategy and the overall study objectives. Results A total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D). Other utility measures, such as the direct methods standard gamble (SG), time trade-off (TTO), and visual analog scale (VAS), were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL) instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer 23 (EORTC QLQ-BR23), Functional Assessment of Cancer Therapy – General questionnaire (FACT-G), and Utility-Based Questionnaire-Cancer (UBQ-C); most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex, income, and education, as well as disease progression, choice of utility elicitation method, and country settings, were identified

  14. Evidence-based decision-making 6: Utilization of administrative databases for health services research.

    PubMed

    Chowdhury, Tanvir Turin; Hemmelgarn, Brenda

    2015-01-01

    Health-care systems require reliable information on which to base health-care planning and make decisions, as well as to evaluate their policy impact. Administrative data provide important information about health services use, expenditures, clinical outcomes, and may be used to assess quality of care. With increased digitalization and accessibility of administrative databases, these data are more readily available for health service research purposes, aiding evidence-based decision-making. This chapter discusses the utility of administrative data for population-based studies of health and health care. PMID:25694328

  15. The Concept of Sasang Health Index and Constitution-Based Health Assessment: An Integrative Model with Computerized Four Diagnosis Methods

    PubMed Central

    Kim, Jaeuk U.; Ku, Boncho; Kim, Young-Min; Do, Jun-Hyeong; Jang, Eunsu; Jeon, Young Ju; Kim, Keun Ho; Kim, Jong Yeol

    2013-01-01

    Sasang constitutional medicine (SCM) shares its philosophy with that of personalized medicine: it provides constitution-specific treatment and healthcare individualized for each patient. In this work, we propose the concept of the Sasang Health Index (SHI) as an attempt to assess the individualized health status in the framework of SCM. From the target population of females in their fifties and older, we recruited 298 subjects and collected their physiological data, including complexion, radial pulse, and voice, and their questionnaire responses. The health status of each subject was evaluated by two Korean medical doctors independently, and the SHI model was obtained by combining all the integrative features of the phenotype data using a regression technique. As a result, most subjects belonged to either the healthy, subhealthy, or slightly diseased group, and the intraclass correlation coefficient between the two doctors' health scoring reached 0.95. We obtained an SHI model for each constitution type with adjusted R-squares of 0.50, 0.56, and 0.30, for the TE, SE, and SY constitution types, respectively. In the proposed SHI model, the significant characteristics used in the health assessment consisted of constitution-specific features in accordance with the classic literature and features common to all the constitution types. PMID:23843888

  16. Medicare-Certified Home Health Care: Urban-Rural Differences in Utilization

    ERIC Educational Resources Information Center

    Hartman, Lacey; Jarosek, Stephanie L.; Virnig, Beth A.; Durham, Sara

    2007-01-01

    Context: Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail. Purpose: To examine urban-rural differences in Medicare HHC utilization. Methods: The 2002 100% Medicare HHC claims and denominator files were…

  17. Community perceptions and factors influencing utilization of health services in Uganda

    PubMed Central

    Bakeera, Solome K; Wamala, Sarah P; Galea, Sandro; State, Andrew; Peterson, Stefan; Pariyo, George W

    2009-01-01

    Background Healthcare utilization has particular relevance as a public health and development issue. Unlike material and human capital, there is little empirical evidence on the utility of social resources in overcoming barriers to healthcare utilization in a developing country context. We sought to assess the relevance of social resources in overcoming barriers to healthcare utilization. Study Objective To explore community perceptions among three different wealth categories on factors influencing healthcare utilization in Eastern Uganda. Methods We used a qualitative study design using Focus Group Discussions (FGD) to conduct the study. Community meetings were initially held to identify FGD participants in the different wealth categories, ('least poor', 'medium' and 'poorest') using poverty ranking based on ownership of assets and income sources. Nine FGDs from three homogenous wealth categories were conducted. Data from the FGDs was analyzed using content analysis revealing common barriers as well as facilitating factors for healthcare service utilization by wealth categories. The Health Access Livelihood Framework was used to examine and interpret the findings. Results Barriers to healthcare utilization exist for all the wealth categories along three different axes including: the health seeking process; health services delivery; and the ownership of livelihood assets. Income source, transport ownership, and health literacy were reported as centrally useful in overcoming some barriers to healthcare utilization for the 'least poor' and 'poor' wealth categories. The 'poorest' wealth category was keen to utilize free public health services. Conversely, there are perceptions that public health facilities were perceived to offer low quality care with chronic gaps such as shortages of essential supplies. In addition to individual material resources and the availability of free public healthcare services, social resources are perceived as important in overcoming

  18. Trends in Mental Health Services Utilization and Stigma in US Soldiers From 2002 to 2011

    PubMed Central

    Wilk, Joshua E.; Thomas, Jeffrey L.; Bray, Robert M.; Rae Olmsted, Kristine L.; Brown, Janice M.; Williams, Jason; Kim, Paul Y.; Clarke-Walper, Kristina; Hoge, Charles W.

    2014-01-01

    Objectives. We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers. Methods. We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12 835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22 627). Results. HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care. Conclusions. Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention. PMID:25033143

  19. Successive intervals analysis of preference measures in a health status index.

    PubMed Central

    Blischke, W R; Bush, J W; Kaplan, R M

    1975-01-01

    The method of successive intervals, a procedure for obtaining equal intervals from category data, is applied to social preference data for a health status index. Several innovations are employed, including an approximate analysis of variance test for determining whether the intervals are of equal width, a regression model for estimating the width of the end intervals in finite scales, and a transformation to equalize interval widths and estimate item locations on the new scale. A computer program has been developed to process large data sets with a larger number of categories than previous programs. PMID:1219005

  20. Veterans' voices: use of the American Customer Satisfaction Index (ACSI) Survey to identify My HealtheVet personal health record users' characteristics, needs, and preferences

    PubMed Central

    2010-01-01

    Background Consumer research reveals considerable interest in the use of Personal Health Records (PHRs), yet adoption remains relatively low. Both adopters and nonadopters represent important perspectives from which to understand this paradox. Objective This study focuses on direct feedback from adopters obtained using the American Customer Satisfaction Index (ACSI) survey on the My HealtheVet PHR portal (http://www.myhealth.va.gov) of the Veterans Health Administration (VHA). The results represent a source of direct feedback with which to better understand veterans' needs and preferences. Methods The ACSI Survey was implemented in October 2007 to measure satisfaction and elicit information about characteristics and preferences of My HealtheVet PHR adopters. The data represent a continuous random sample of site visitors who have navigated at least four pages on the site. A total of 100 617 surveys were completed (17.2%). Results Satisfaction with My HealtheVet is high (8.3/10.0), and users are highly likely to return to the site (8.6/10.0) and recommend the site to other veterans (9.1/10.0). The majority of system adopters are male (91%), between the ages of 51 and 70 (68%), and served in the Vietnam War (60%). Most veterans currently visit the site to utilize pharmacy-related features. Conclusion VHA has used the ACSI to monitor satisfaction, and to better understand the characteristics, needs, and preferences of early adopters. The data provide an important source of direct feedback to inform program development. Future research will include monitoring the impact of enhancements and new features on satisfaction, and conducting additional research with nonadopters to identify barriers to adoption and use. PMID:20190065

  1. Relationship between Child Health Literacy and Body Mass Index in Overweight Children1

    PubMed Central

    Sharif, Iman; Blank, Arthur E.

    2009-01-01

    Objective To test the relationship between child health literacy and body mass index (BMI) -z score in overweight children. Methods Cross-sectional survey of overweight children and parents. Parent and child health literacy was measured by the Short Test of Functional Health Literacy (STOFHLA). Linear regression tested for predictors of childhood BMI z-score, adjusting for confounders. Results Of 171 total children, 107(62%) participated, of whom 78 (73%) had complete data for analysis. Mean child BMI Z-score (SD) was 2.3(0.40); median child age (Inter-quartile range) was 11.5(10–16); 53% were female; 80% were Medicaid recipients. Mean child STOFHLA was 22.9(9.0); mean parental STOFHLA was 29.1(8.6). Child STOFHLA correlated negatively with BMI Z-score (r=−0.37, p=0.0009) and positively with child eating self-efficacy (r=0.40, p<0.0001). After adjusting for confounders, child STOFHLA was independently associated with child BMI Z-score (standardized B=−0.43, p<0.0001). Overall adjusted r-squared for the regression model was 38%. Child STOFHLA contributed 13% to the overall model. Conclusions Child health literacy was negatively correlated with BMI Z-scores in overweight children, suggesting the need to consider health literacy in the intersection between self-efficacy and behavior change when planning interventions that aim to improve child BMI. PMID:19716255

  2. The ASAS Health Index (ASAS HI) - a new tool to assess the health status of patients with spondyloarthritis.

    PubMed

    Kiltz, U; van der Heijde, D; Boonen, A; Braun, J

    2014-01-01

    Within the variable course of ankylosing spondylitis (AS), peripheral arthritis, enthesitis, and involvement of other organs can add to the burden of the disease. The primary complaints of patients with spondyloarthritis (SpA) are pain, stiffness, fatigue, and limitation in activities and social participation. Instruments currently available for the assessment of patients with SpA focus predominantly on specific aspects of health such as pain, disease activity, and physical function and measure specific concepts like physical function and health-related quality of life (HR-QoL). However, the overall picture of impairments, limitations and restrictions in activities or social participation of patients with AS is not adequately assessed in SpA-specific questionnaires. Most of the existing questionnaires are not conceptualised with regard to their underlying construct. The International classification of functioning, disability and health (ICF) Core Set for AS may serve as an appropriate model and underlying construct to develop a health index, since the whole range of functioning and disability of patients with AS is captured. Based on these assumptions, ASAS developed for patients with SpA an instrument assessing health as operationalised by the ICF. The questionnaire was developed by preparing an item pool, linkage of the items to the comprehensive ICF core set for AS and test of the item pool in two cross-sectional studies. The analysis of the questionnaire and the response scale were done with Rasch analysis. Emphasis was on optimal targeting, the capacity of items to differentiate between different levels of health, and optimal coverage of items to the spectrum of ICF categories, so that the final questionnaire could represent as much of the entire range of difficulty levels as possible. The ASAS HI is a linear composite measure and includes 17 items which cover most of the ICF core set. Preliminary validity has been confirmed in a field test in 4 English

  3. Body shape index versus body mass index as correlates of health risk in young healthy sedentary men.

    PubMed

    Malara, Marzena; Kęska, Anna; Tkaczyk, Joanna; Lutosławska, Grażyna

    2015-01-01

    Recently a new simply calculated index of body composition -a body shape index (ABSI) has been introduced as an index more reliable than BMI of association between body composition and all-cause mortality. However, until now associations between ABSI and metabolic risk factors have not been evaluated. A total of 114 male university students not engaged in any planned physical activity participated in the present study. Anthropometric measurements (weight, height, waist circumference) were recorded. Body mass index (BMI) was calculated from weight and height, body shape index (ABSI) was calculated from waist circumference, weight, height and BMI. Blood was withdrawn after an overnight fast from the antecubital vein. Triacylglycerols, total cholesterol and HDL-cholesterol levels in plasma were determined using colorimetric methods and Randox commercial kits. Plasma LDL-cholesterol concentrations were calculated according to the Friedewald formula. Circulating insulin was assayed using a standard radioimmunological method with monoclonal antibodies against insulin and BioSource commercial kits. BMI was slightly, but significantly correlated only with circulating TG (r=0.330, p < 0.001) In contrast, ABSI was slightly, but significantly correlated with plasma levels of insulin (r=0.360, p<0.001), TC (r=0.270, p<0.002), LDL-C and non-HDL-C (r=0.300, p<0.001). In participants at the upper quartile of BMI circulating TG was higher (by 50%, p<0.05) than in their counterparts at the lower BMI quartile. Subjects representing the upper quartile of ABSI were characterized by higher plasma levels of insulin, TC, LDL-C and non-HDL in comparison with subjects at the lower ABSI quartile. (by 92 %, 11. %, 29 % and 21 % respectively, p<0.001). ABSI, a new simply calculated index of body fat seems to more accurately depict the variability in circulating insulin and lipoproteins than BMI at least in young, healthy male subjects. PMID:25890016

  4. Population prevalence of personality disorder and associations with physical health comorbidities and health care service utilization: A review.

    PubMed

    Quirk, Shae E; Berk, Michael; Chanen, Andrew M; Koivumaa-Honkanen, Heli; Brennan-Olsen, Sharon L; Pasco, Julie A; Williams, Lana J

    2016-04-01

    Personality disorder (PD), outcomes of diverse comorbid physical health conditions, and the associated burden on health service resources have seldom been studied at a population level. Consequently, there is limited evidence that might inform a public health approach to managing PD and associated mental and physical disability. A review was conducted of population-based studies examining the prevalence of PD and associations between physical comorbidities and service utilization. The prevalence of any PDs were common (4.4% -21.5%) among populations spanning England, Wales, Scotland, Western Europe, Norway, Australia, and the United States. Preliminary evidence supports associations between PDs from Clusters A and B and physical comorbidities, namely cardiovascular diseases and arthritis. PD appears to increase health care utilization, particularly in primary care. In order to facilitate rational population health planning, further population studies are required. (PsycINFO Database Record PMID:26461047

  5. College Health Surveillance Network: Epidemiology and Health Care Utilization of College Students at US 4-Year Universities

    PubMed Central

    Turner, James C.; Keller, Adrienne

    2015-01-01

    Abstract Objective: This description of the College Health Surveillance Network (CHSN) includes methodology, demography, epidemiology, and health care utilization. Participants: Twenty-three universities representing approximately 730,000 enrolled students contributed data from January 1, 2011, through May 31, 2014. Methods: Participating schools uploaded de-identified electronic health records from student health services monthly. Results: During this study, just over 800,000 individuals used the health centers, comprising 4.17 million patient encounters. Sixty percent of visits included primary care, 13% mental health, 9% vaccination, and 31% other miscellaneous services. The 5 most common specific diagnostic categories (with annual rates per 100 enrolled students) were preventive (16); respiratory (12); skin, hair, and nails; infectious non–sexually transmitted infection (5 each); and mental health (4). Utilization and epidemiologic trends are identified among subpopulations of students. Conclusions: CHSN data establish trends in utilization and epidemiologic patterns by college students and the importance of primary and behavioral health care services on campuses. PMID:26086428

  6. Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations

    PubMed Central

    Whitehead, J.; Shaver, John; Stephenson, Rob

    2016-01-01

    Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas. PMID:26731405

  7. Health-promoting lifestyle and body mass index among College of Nursing students in Kuwait: a correlational study.

    PubMed

    Al-Kandari, Fatimah; Vidal, Victoria L; Thomas, Deepa

    2008-03-01

    This cross-sectional, descriptive survey of 202 nursing students in Kuwait assessed their body mass index and health-promoting lifestyle to determine any association between them. The body mass index was calculated by dividing the weight by the height squared (kg/m(2)). The health-promoting lifestyle was measured using Walker's Health Promoting Lifestyle Profile II instrument. The participants had a normal body mass index with a tendency towards being overweight and obese, particularly for the males. The students also had a low positive health-promoting lifestyle. A significant association was noted between the sociodemographic variables, particularly age, marital status, and nationality, with the body mass index and Walker's Health Promoting Lifestyle Profile. A significant relationship was established between the body mass index and the overall Walker's Health Promoting Lifestyle Profile and the nutrition subcategory. The findings warranted interventions for improved health behaviors and implied the need for the integration of healthy lifestyle programs into the nursing curricula to meet the escalating demands of the students' role in health promotion and disease prevention. PMID:18257831

  8. Behavioral Health Services Utilization among Older Adults Identified within a State Abuse Hotline Database

    ERIC Educational Resources Information Center

    Schonfeld, Lawrence; Larsen, Rebecca G.; Stiles, Paul G.

    2006-01-01

    Purpose: This study examined the extent to which older adults identified in a statewide abuse hotline registry utilized behavioral health services. This is important as mental health issues have been identified as a high priority for filling gaps in services for victims of mistreatment. Design and Methods: We compared Medicaid and Medicare claims…

  9. Caregiver Factors Predicting Service Utilization among Youth Participating in a School-Based Mental Health Intervention

    ERIC Educational Resources Information Center

    Burnett-Zeigler, Inger; Lyons, John S.

    2010-01-01

    Large numbers of children and adolescents experience diagnosable psychiatric disturbances; however, the majority of those with need do not utilize mental health services. Characteristics of caregivers are important predictors of which youth will access and continue to use services over time. In recent years school-based mental health intervention…

  10. Home Health Care Utilization: A Review of the Research for Social Work

    ERIC Educational Resources Information Center

    Kadushin, Goldie

    2004-01-01

    The author reviewed the literature to identify the variables associated with home health care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Home health care was defined as in-home skilled nursing,…