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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. 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

  19. 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.

  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. 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

  4. 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

  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. 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

  16. 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

  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

    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

  19. 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

  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. 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

  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. 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

  15. 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

  16. 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.

  17. 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

  18. 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

  19. 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.

  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. 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

  2. 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…

  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. 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

  15. 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

  16. 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

  17. 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

  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. 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.

  3. 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

  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. 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

  7. 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

  8. 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…

  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. 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

  13. 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

  14. 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

  15. 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

  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. [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

  20. 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…

  1. 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…

  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. 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…

  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. 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

  7. 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…

  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. 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

  11. 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...

  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. 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…

  16. 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

  17. 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…

  18. 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.

  19. 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…

  20. 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…

  1. 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…

  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. "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

  10. 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

  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. 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…

  15. 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…

  16. 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…

  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. 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

  5. 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.

  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. 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…

  8. 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...

  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. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  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 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…

  4. 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…

  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. 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

  9. 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.

  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. 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

  17. 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

  18. 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

  19. 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

  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. 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…

  7. 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…

  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. 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…

  1. 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…

  2. 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…

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  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. 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

  10. 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

  11. 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

  12. 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

  13. 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

  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. 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…

  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. 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,…

  10. 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

  11. Increased Health Service Utilization Costs in the Year Prior to Institutionalization: Findings from the Canadian Study of Health and Aging

    PubMed Central

    Naslund, John A.; Sauter, Agnes H.; Gutman, Gloria; Beattie, B. Lynn

    2014-01-01

    Objectives The objective of this study was to characterize patterns of formal health service utilization costs during older adults’ transition from community to institutional care. Methods Participants were 127 adults (age ≥ 65) from the British Columbia sample (N = 2,057) of the Canadian Study of Health and Aging who transitioned from community to institutional care between 1991 and 2001. Health service utilization costs were measured using Cost-Per-Day-At-Risk at five time points: > 12 months, 6–12 months, and ≤ 6 months preinstitutionalization, and ≤ 6 months and 6–12 months postinstitutionalization. Cost-Per-Day-At-Risk was measured for Continuing Care, Medical Services Plan, and PharmaCare costs by calculating total health service use over time, divided by the number of days the participant was alive. Results Significant differences in Cost-Per-Day-At-Risk were observed for Continuing Care, Medical Services Plan, and PharmaCare costs over time. All health service utilization costs increased significantly during the 6–12 months and ≤ 6 months prior to institutionalization. Postinstitutionalization Continuing Care costs continued to increase at ≤ 6 months before decreasing at 6–12 months, while decreases occurred for Medical Services Plan and PharmaCare costs relative to preinstitutionalization costs. Conclusions The increases in costs observed during the year prior to institutionalization, characterized by a flurry of health service utilization, provide evidence of distinct cost patterns over the transition period. PMID:24883162

  12. Information-seeking behavior: a survey of health sciences faculty use of indexes and databases.

    PubMed

    Curtis, K L; Weller, A C

    1993-10-01

    This study investigated information-seeking behavior, including use of major bibliographic tools by medical, pharmacy, nursing, and science faculty at the University of Illinois at Chicago. The study assessed the impact of availability of locally mounted databases, determined needs for modification of instructional programs, identified the need for promotional material, and established a baseline for subsequent studies. Results reflected a wide variation in the number and format of secondary services used by faculty. Over 70% of all faculty from the colleges of medicine, pharmacy, and nursing used Index Medicus or MEDLINE. There were statistically significant differences between colleges in their use of mediated and end-user searching of MEDLINE. Colleges exhibited significant differences in use of Current Contents, PsycLIT, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Chemical Abstracts, and Science Citation Index. Statistically significant differences also were found among several clinical departments. The study concluded that, as new formats to bibliographic tools become available, traditional formats continue to be used; training sessions must be tailored to the audience; and the availability of local resources and their use by faculty needs to be understood. PMID:8251974

  13. Information-seeking behavior: a survey of health sciences faculty use of indexes and databases.

    PubMed Central

    Curtis, K L; Weller, A C

    1993-01-01

    This study investigated information-seeking behavior, including use of major bibliographic tools by medical, pharmacy, nursing, and science faculty at the University of Illinois at Chicago. The study assessed the impact of availability of locally mounted databases, determined needs for modification of instructional programs, identified the need for promotional material, and established a baseline for subsequent studies. Results reflected a wide variation in the number and format of secondary services used by faculty. Over 70% of all faculty from the colleges of medicine, pharmacy, and nursing used Index Medicus or MEDLINE. There were statistically significant differences between colleges in their use of mediated and end-user searching of MEDLINE. Colleges exhibited significant differences in use of Current Contents, PsycLIT, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Chemical Abstracts, and Science Citation Index. Statistically significant differences also were found among several clinical departments. The study concluded that, as new formats to bibliographic tools become available, traditional formats continue to be used; training sessions must be tailored to the audience; and the availability of local resources and their use by faculty needs to be understood. PMID:8251974

  14. Access, utilization, and interest in mHealth applications among veterans receiving outpatient care for PTSD.

    PubMed

    Erbes, Christopher R; Stinson, Rebecca; Kuhn, Eric; Polusny, Melissa; Urban, Jessica; Hoffman, Julia; Ruzek, Josef I; Stepnowsky, Carl; Thorp, Steven R

    2014-11-01

    Mobile health (mHealth) refers to the use of mobile technology (e.g., smartphones) and software (i.e., applications) to facilitate or enhance health care. Several mHealth programs act as either stand-alone aids for Veterans with post-traumatic stress disorder (PTSD) or adjuncts to conventional psychotherapy approaches. Veterans enrolled in a Veterans Affairs outpatient treatment program for PTSD (N = 188) completed anonymous questionnaires that assessed Veterans' access to mHealth-capable devices and their utilization of and interest in mHealth programs for PTSD. The majority of respondents (n = 142, 76%) reported having access to a cell phone or tablet capable of running applications, but only a small group (n = 18) reported use of existing mHealth programs for PTSD. Age significantly predicted ownership of mHealth devices, but not utilization or interest in mHealth applications among device owners. Around 56% to 76% of respondents with access indicated that they were interested in trying mHealth programs for such issues as anger management, sleep hygiene, and management of anxiety symptoms. Findings from this sample suggest that Veterans have adequate access to, and interest in, using mHealth applications to warrant continued development and evaluation of mobile applications for the treatment of PTSD and other mental health conditions. PMID:25373044

  15. Linguistic Adaptation and Psychometric Properties of Tamil Version of General Oral Health Assessment Index-Tml

    PubMed Central

    Appukuttan, DP; Vinayagavel, M; Balasundaram, A; Damodaran, LK; Shivaraman, P; Gunasshegaran, K

    2015-01-01

    Background: Oral health has an impact on quality of life hence for research purpose validation of a Tamil version of General Oral Health Assessment Index would enable it to be used as a valuable tool among Tamil speaking population. Aim: In this study, we aimed to assess the psychometric properties of translated Tamil version of General Oral Health Assessment Index (GOHAI-Tml). Subjects and Methods: Linguistic adaptation involved forward and backward blind translation process. Reliability was analyzed using test-retest, Cronbach alpha, and split half reliability. Inter-item and item-total correlation were evaluated using Spearman rank correlation. Convenience sampling was done, and 265 consecutive patients aged 20–70 years attending the outpatient department were recruited. Subjects were requested to fill a self-reporting questionnaire along with Tamil GOHAI version. Clinical examination was done on the same visit. Concurrent validity was measured by assessing the relationship between GOHAI scores and self-perceived oral health and general health status, satisfaction with oral health, need for dental treatment and esthetic satisfaction. Discriminant validity was evaluated by comparing the GOHAI scores with the objectively assessed clinical parameters. Exploratory factor analysis was done to examine the factor structure. Results: Mean GOHAI-Tml was 52.7 (6.8, range 22–60, median 54). The mean number of negative impacts was 2 (2.4, range 0–11, median 1). The Spearman rank correlation for test-retest ranged from 0.8 to 0.9 (P < 0.001) for all the 12 items between visits. The Cronbach alpha for 265 samples was 0.8 suggesting good internal consistency and homogeneity between items. Item scale correlation ranged from 0.4 to 0.8 (P < 0.001). Concurrent and discriminant validity was established. Principal component analysis resulted in extraction of four factors which together accounted for 66.4% (7.9/12) variance. Conclusion: GOHAI-Tml has shown acceptable

  16. Utility of the Neurobehavioral Symptom Inventory Validity-10 index to detect symptom exaggeration: An analogue simulation study.

    PubMed

    Sullivan, Karen A; Lange, Rael T; Edmed, Shannon L

    2016-01-01

    The Neurobehavioral Symptom Inventory (NSI) has been recommended by the interagency Traumatic Brain Injury (TBI) Outcome Workgroup as an outcome measure for TBI research. A new symptom exaggeration index-the NSI Validity-10-can be calculated from its items, but its utility has not been evaluated in a malingering simulation study. Data from a prior analogue study were reanalyzed to examine the NSI Validity-10 test properties. The data were from a sample of 85 Australian undergraduate students. A battery of measures was completed under 1 of 3 experimental conditions: control (i.e., honest responding, n = 24), feign postconcussional disorder (PCD; n = 29), and feign posttraumatic stress disorder (PTSD; n = 32). Participants who feigned PTSD or PCD had significantly higher scores on the NSI Validity-10 compared with controls. There were minimal differences between the 2 feigning groups. Using the combined data from the feigning groups and assuming a 35% symptom exaggeration base rate, the optimal NSI Validity-10 cutoff score was ≥10. This cutoff score identified "probable exaggeration" (sensitivity = .75, specificity = 1.0, positive predictive power = 1.0, negative predictive power = .88). Diagnostic efficiency statistics for 25% and 45% base rates were also generated. The cutoff score identified in this study is lower than previously reported. Its properties are promising, but its usage requires careful consideration. PMID:26943718

  17. Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach

    PubMed Central

    2012-01-01

    Background Mental health is of special importance regarding socioeconomic inequalities in health. On the one hand, mental health status mediates the relationship between economic inequality and health; on the other hand, mental health as an "end state" is affected by social factors and socioeconomic inequality. In spite of this, in examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. As a first attempt in Iran, the objectives of this paper were to measure socioeconomic inequality in mental health, and then to untangle and quantify the contributions of potential determinants of mental health to the measured socioeconomic inequality. Methods In a cross-sectional observational study, mental health data were taken from an Urban Health Equity Assessment and Response Tool (Urban HEART) survey, conducted on 22 300 Tehran households in 2007 and covering people aged 15 and above. Principal component analysis was used to measure the economic status of households. As a measure of socioeconomic inequality, a concentration index of mental health was applied and decomposed into its determinants. Results The overall concentration index of mental health in Tehran was -0.0673 (95% CI = -0.070 - -0.057). Decomposition of the concentration index revealed that economic status made the largest contribution (44.7%) to socioeconomic inequality in mental health. Educational status (13.4%), age group (13.1%), district of residence (12.5%) and employment status (6.5%) also proved further important contributors to the inequality. Conclusions Socioeconomic inequalities exist in mental health status in Iran's capital, Tehran. Since the root of this avoidable inequality is in sectors outside the health system, a holistic mental health policy approach which includes social and economic determinants should be adopted to redress the inequitable distribution of mental health. PMID:22449237

  18. Measuring Health Utilities in Children and Adolescents: A Systematic Review of the Literature

    PubMed Central

    Thorrington, Dominic; Eames, Ken

    2015-01-01

    Background The objective of this review was to evaluate the use of all direct and indirect methods used to estimate health utilities in both children and adolescents. Utilities measured pre- and post-intervention are combined with the time over which health states are experienced to calculate quality-adjusted life years (QALYs). Cost-utility analyses (CUAs) estimate the cost-effectiveness of health technologies based on their costs and benefits using QALYs as a measure of benefit. The accurate measurement of QALYs is dependent on using appropriate methods to elicit health utilities. Objective We sought studies that measured health utilities directly from patients or their proxies. We did not exclude those studies that also included adults in the analysis, but excluded those studies focused only on adults. Methods and Findings We evaluated 90 studies from a total of 1,780 selected from the databases. 47 (52%) studies were CUAs incorporated into randomised clinical trials; 23 (26%) were health-state utility assessments; 8 (9%) validated methods and 12 (13%) compared existing or new methods. 22 unique direct or indirect calculation methods were used a total of 137 times. Direct calculation through standard gamble, time trade-off and visual analogue scale was used 32 times. The EuroQol EQ-5D was the most frequently-used single method, selected for 41 studies. 15 of the methods used were generic methods and the remaining 7 were disease-specific. 48 of the 90 studies (53%) used some form of proxy, with 26 (29%) using proxies exclusively to estimate health utilities. Conclusions Several child- and adolescent-specific methods are still being developed and validated, leaving many studies using methods that have not been designed or validated for use in children or adolescents. Several studies failed to justify using proxy respondents rather than administering the methods directly to the patients. Only two studies examined missing responses to the methods administered with

  19. Development of a Summarized Health Index (SHI) for Use in Predicting Survival in Sea Turtles

    PubMed Central

    Li, Tsung-Hsien; Chang, Chao-Chin; Cheng, I-Jiunn; Lin, Suen-Chuain

    2015-01-01

    Veterinary care plays an influential role in sea turtle rehabilitation, especially in endangered species. Physiological characteristics, hematological and plasma biochemistry profiles, are useful references for clinical management in animals, especially when animals are during the convalescence period. In this study, these factors associated with sea turtle surviving were analyzed. The blood samples were collected when sea turtles remained alive, and then animals were followed up for surviving status. The results indicated that significantly negative correlation was found between buoyancy disorders (BD) and sea turtle surviving (p < 0.05). Furthermore, non-surviving sea turtles had significantly higher levels of aspartate aminotranspherase (AST), creatinine kinase (CK), creatinine and uric acid (UA) than surviving sea turtles (all p < 0.05). After further analysis by multiple logistic regression model, only factors of BD, creatinine and UA were included in the equation for calculating summarized health index (SHI) for each individual. Through evaluation by receiver operating characteristic (ROC) curve, the result indicated that the area under curve was 0.920 ± 0.037, and a cut-off SHI value of 2.5244 showed 80.0% sensitivity and 86.7% specificity in predicting survival. Therefore, the developed SHI could be a useful index to evaluate health status of sea turtles and to improve veterinary care at rehabilitation facilities. PMID:25803431

  20. Health status, socioeconomic status and utilization of outpatient services for members of a prepaid group practice.

    PubMed

    Freeborn, D K; Pope, C R; Davis, M A; Mullooly, J P

    1977-02-01

    When evaluating the effectiveness of medical care programs, one concern is whether receipt of care is based upon health care needs or upon socioeconomic status. This study describes the relation between health status and socioeconomic status and attempts to determine which has the greater effect on ambulatory care utilization. The study setting was an operating HMO serving a cross-sectional membership of nearly 200,000 persons. Outpatient utilization data were derived from the medical records of a five per cent sample of health plan members for 1969 and 1970. Social, economic, situational, and attitudinal data were provided by 2,603 respondents in a household interview survey. Since a population's perceived health status may reflect health need, information from the survey provided measures of health status that ranged from specific symptoms and complaints to a general measure of perceived health status. Although the findings varied somewhat according to which variables were considered, they generally showed health status to correlate more highly than socioeconomic factors with the utilization of services in this medical care system. An exception was the use of preventive services, which was not significantly related to health status measures but rather, for women, to education and, to a lesser extent, income. PMID:839867

  1. A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

    PubMed Central

    Peters, Melissa; Boeldt, Debra L.; Ariniello, Lauren; Kim, Ju Young; Sheard, Judith; Komatireddy, Ravi; Barrett, Paddy

    2016-01-01

    Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers–some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program–making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases

  2. A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors.

    PubMed

    Bloss, Cinnamon S; Wineinger, Nathan E; Peters, Melissa; Boeldt, Debra L; Ariniello, Lauren; Kim, Ju Young; Sheard, Judith; Komatireddy, Ravi; Barrett, Paddy; Topol, Eric J

    2016-01-01

    Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers-some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program-making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or

  3. Report of health and environmental effects of increased coal utilization by the Committee on Health and Environmental Effects of Increased Coal Utilization.

    PubMed

    1980-06-01

    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 facilitiesThe 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 major areas of

  4. Health care access and utilization among ex-offenders in Baltimore: implications for policy.

    PubMed

    Hawkins, Anita Smith; O'Keefe, Anne Marie; James, Xanthia

    2010-05-01

    The U.S. has the highest rate of incarceration in the world, releasing 12 million ex-offenders each year. These ex-offenders are disproportionately male, Black, poor, under-educated, and unhealthy, and return to our nation's poorest neighborhoods. Through a survey questionnaire and focus groups, this study examined the health status, health needs, access to and utilization of health care services among a sample of ex-offenders living in transitional housing in Baltimore City. More than half reported at least two major, chronic health problems. Only 40% had any form of health coverage; even more predictive of the ability to obtain health services was being able to name a specific provider (doctor, clinic or health organization). Recommendations for halting the downward spiral of poverty and sickness for this population and their communities include providing assistance with accessing, understanding, and navigating our complex and consumer-unfriendly health care system. PMID:20453363

  5. Mental Health Care Utilization: How Race, Ethnicity and Veteran Status are Associated with Seeking Help.

    PubMed

    De Luca, Susan M; Blosnich, John R; Hentschel, Elizabeth A W; King, Erika; Amen, Sally

    2016-02-01

    As veterans disproportionately experience higher rates of mental illness than civilians, conflicting results surround the impact of race/ethnicity on treatment utilization. This study utilized the CDC's Texas Behavioral Risk Factor Surveillance System data, a random-digit dialed telephone survey of non-institutionalized adults. A subset of Texas respondents (n = 8563) were asked questions related to mental health treatment, stigma, help-seeking attitudes and emotional support. While no differences were found in health care utilization between non-Hispanic white veterans and non-veterans, there were distinct patterns among racial/ethnic minority veterans and non-veterans. Black and Latino non-veterans reported significantly lower health care utilization compared to non-Hispanic white non-veterans. Among veterans, there were no differences in reported utilization rates comparing non-Hispanic whites and Latinos and also non-Hispanic whites and Blacks. Our study adds to the literature by examining health care utilization among a diverse group of veterans by focusing on Veterans Administration (VA) and non-VA services to veterans. PMID:26659853

  6. Increased cardiopulmonary disease risk in a community-based sample with chemical odor intolerance: implications for women's health and health-care utilization.

    PubMed

    Baldwin, C M; Bell, I R

    1998-01-01

    Chemical intolerance, or reported illness from odors of common environmental chemicals (e.g., car exhaust, pesticides), is emerging as an important environmental and public health-care issue. Epidemiologic methods provide relevant heuristic devices for studies of complex disorders, such as chemical intolerance. The authors examined personal and reported parental cardiopulmonary disease prevalence rates in a community sample of chemically intolerant and control individuals. A county government (Tucson, Arizona) employee and kin subset (N = 181; 113 households) completed standard health questionnaires. Investigators determined chemical intolerance (n = 41/181) from self-reports of individuals who felt "moderately" to "severely" ill from exposure to at least three of five chemicals (i.e., car exhaust, pesticides, paint, new carpet, and perfume) on a Chemical Odor Intolerance Index. The authors chose the control group (n = 57/181) on the basis of self-reports of "never" feeling ill on the Chemical Odor Intolerance Index. The chemically intolerant group, which primarily comprised women (78% versus 51% of controls, p < .05), was significantly more likely to report-and to have sought--medical attention for heart problems, bronchitis, asthma, and pneumonia. Reports of heart problems in the chemically intolerant index cases and the occurrence of heart disease in both of their parents were significant (Fisher's p < .05). The chemically intolerant individuals were also significantly more likely to report maternal histories of chest problems (e.g., inhalant allergens, tuberculosis) than controls. The findings of the study suggested that the chemically intolerant individuals (a preponderance of whom were women [sex-related risk]) were more likely to have (a) reported cardiopulmonary problems (i.e., greater health risk); (b) actively sought medical care for these problems (i.e., increased medical utilization); and (c) reported more parental illnesses-particularly heart disease

  7. Assessing the utilization of maternal and child health care among married adolescent women: evidence from India.

    PubMed

    Singh, Lucky; Rai, Rajesh Kumar; Singh, Prashant Kumar

    2012-01-01

    This study explores the prevalence and factors associated with the utilization of maternal and child health care services among married adolescent women in India using the third round of the National Family Health Survey (2005-06). The findings suggest that the utilization of maternal and child health care services among adolescent women is far from satisfactory in India. A little over 10% of adolescent women utilized antenatal care, about 50% utilized safe delivery services and about 41% of the children of adolescent women received full immunization. Large differences by urban-rural residence, educational attainment, religion, economic status and region were evident. Both gross effect and fixed effect binary logit models yielded statistically significant socioeconomic and demographic factors. Women's education, wealth quintile and region are the most important determinants for the utilization of maternal and child health care services. Health care programmes should focus more on educating adolescents, providing financial support, creating awareness and counselling households with married adolescent women. Moreover, there should be substantial financial assistance for the provision of delivery and child care for married women below the age of 19 years. PMID:21933465

  8. User fees, health staff incentives, and service utilization in Kabarole District, Uganda.

    PubMed Central

    Kipp, W.; Kamugisha, J.; Jacobs, P.; Burnham, G.; Rubaale, T.

    2001-01-01

    OBJECTIVE: To determine the impact of user fees on the utilization of health services in a community-based cost-sharing scheme in Kabarole District, western Uganda. METHODS: Of the 38 government health units that had introduced user-fee financing schemes, 11 were included in the study. Outpatient utilization was assessed as the median number of visits per month before and after cost sharing began. FINDINGS: After the introduction of cost sharing, overall utilization of general outpatient services, assessed by combining the data from all the participating units, dropped by 21.3%. Utilization increased, however, in facilities located in remote areas, while it decreased in those located in urban or semi-urban areas. The increased utilization in remote facilities was considered to be largely attributable to health workers' incentive payments derived from cost-sharing revenues. CONCLUSIONS: Incentive payments led the health workers to offer improved services. Other factors may also have been influential, such as an improved drug supply to health facilities and increased public identification with community projects in remote areas. PMID:11731810

  9. Awareness and utilization of preventive care services among the elderly under National Health Insurance.

    PubMed

    Chen, Chun-Chih; Lin, Yen-Ju; Lin, Ying-Tzu

    2013-12-01

    This empirical study investigates the factors affecting the awareness and the utilization of preventive care among the elderly in Taiwan. We use data obtained from the 2005 National Health Interview Survey. A recursive bivariate probit model is adopted to analyze the factors affecting the awareness and the utilization of preventive care. The probability of awareness of free preventive care under the National Health Insurance is higher for those who are younger, Mainlanders, have received more education, have a spouse, exercise regularly, have better self-rated health status, and have chronic diseases; the probability of awareness is lower for those who are aborigines and who live in the south and the east. Awareness of preventive care services, having a spouse, living alone, having better health status, and the existence of chronic diseases increase the probability of preventive care utilization; working reduces the probability of preventive care utilization. Our result supports the views in Arrow (Am Econ Rev 53(5):941-973, 1963) that health information is an important factor determining the demand for medical care. Policymakers may enhance such preventive care service utilization by increasing the awareness of such services among the elderly. PMID:23754318

  10. Did Copayment Changes Reduce Health Service Utilization among CHIP Enrollees? Evidence from Alabama

    PubMed Central

    Sen, Bisakha; Blackburn, Justin; Morrisey, Michael A; Kilgore, Meredith L; Becker, David J; Caldwell, Cathy; Menachemi, Nir

    2012-01-01

    Objective To explore whether health care utilization changed among enrollees in Alabama's CHIP program, ALL Kids, following copayment increases at the beginning of fiscal year 2004. Data Sources Data on all ALL Kids enrollees over 1999–2009 are obtained from claims files and the state's administrative database. Study Design We use pooled month-level data for all enrollees and conduct covariate-adjusted segmented regression models. Health services considered are inpatient care, emergency department (ED) visits, brand-name prescription drugs, generic prescription drugs, physician office visits and outpatient-services, ambulance services, allergy treatments, and non-preventive dental services. Physician well-visits, preventive dental services, and service use by Native-Americans—which saw no copayment increases—serve as counterfactuals. Principal Findings There are significant declines in utilization for inpatient care, physician visits, brand-name medications, and ED visits following the copayment increases. By and large, utilization did not decline, or declined only temporarily, for those services and for those enrollees that who not subject to increased copayments. Conclusions Copayment increases reduced utilization of many health services among ALL Kids enrollees. Concerns remain regarding the long-term health consequences to low-income children of copayment-induced reductions in health care utilization. PMID:22352979

  11. Determination of the health of Lunyangwa wetland using Wetland Classification and Risk Assessment Index

    NASA Astrophysics Data System (ADS)

    Wanda, Elijah M. M.; Mamba, Bhekie B.; Msagati, Titus A. M.; Msilimba, Golden

    2016-04-01

    Wetlands are major sources of various ecological goods and services including storage and distribution of water in space and time which help in ensuring the availability of surface and groundwater throughout the year. However, there still remains a poor understanding of the range of values of water quality parameters that occur in wetlands either in its impacted state or under natural conditions. It was thus imperative to determine the health of Lunyangwa wetland in Mzuzu City in Malawi in order to classify and determine its state. This study used the Escom's Wetland Classification and Risk Assessment Index Field Guide to determine the overall characteristics of Lunyangwa wetland and to calculate its combined Wetland Index Score. Data on site information, field measurements (i.e. EC, pH, temperature and DO) and physical characteristics of Lunyangwa wetland were collected from March, 2013 to February, 2014. Results indicate that Lunyangwa wetland is a largely open water zone which is dominated by free-floating plants on the water surface, beneath surface and emergent in substrate. Furthermore, the wetland can be classified as of a C ecological category (score = 60-80%), which has been moderately modified with moderate risks of the losses and changes occurring in the natural habitat and biota in the wetland. It was observed that the moderate modification and risk were largely because of industrial, agricultural, urban/social catchment stressors on the wetland. This study recommends an integrated and sustainable management approach coupled with continuous monitoring and evaluation of the health of the wetland for all stakeholders in Mzuzu City. This would help to maintain the health of Lunyangwa wetland which is currently at risk of being further modified due to the identified catchment stressors.

  12. Impact of Individual-, Environmental-, and Policy-Level Factors on Health Care Utilization Among US Farmworkers

    PubMed Central

    Mayer, Joni A.; Gabbard, Susan; Kronick, Richard G.; Roesch, Scott C.; Malcarne, Vanessa L.; Zuniga, Maria L.

    2011-01-01

    Objectives. We examined individual-, environmental-, and policy-level correlates of US farmworker health care utilization, guided by the behavioral model for vulnerable populations and the ecological model. Methods. The 2006 and 2007 administrations of the National Agricultural Workers Survey (n = 2884) provided the primary data. Geographic information systems, the 2005 Uniform Data System, and rurality and border proximity indices provided environmental variables. To identify factors associated with health care use, we performed logistic regression using weighted hierarchical linear modeling. Results. Approximately half (55.3%) of farmworkers utilized US health care in the previous 2 years. Several factors were independently associated with use at the individual level (gender, immigration and migrant status, English proficiency, transportation access, health status, and non-US health care utilization), the environmental level (proximity to US–Mexico border), and the policy level (insurance status and workplace payment structure). County Federally Qualified Health Center resources were not independently associated. Conclusions. We identified farmworkers at greatest risk for poor access. We made recommendations for change to farmworker health care access at all 3 levels of influence, emphasizing Federally Qualified Health Center service delivery. PMID:21330594

  13. Posttraumatic stress disorder symptoms, physical health, and health care utilization 50 years after repeated exposure to a toxic gas.

    PubMed

    Ford, Julian D; Schnurr, Paula P; Friedman, Matthew J; Green, Bonnie L; Adams, Gary; Jex, Steve

    2004-06-01

    The posttraumatic sequelae of contaminant exposure are a contemporary international concern due to the threats posed to military personnel and civilians by war and bioterrorism. The role of PTSD symptoms as a mediator between potentially traumatic toxin exposure and physical health outcomes was examined with structural equation modeling in a probability sample of 302 male World War II-era U.S. military veterans 50 years after exposure to mustard gas tests. Controlling for age and psychological distress, the most parsimonious structural model involved PTSD symptoms mediating the relationship between toxin exposure and physical health problems, and physical health problems mediating the relationship between PTSD symptoms and outpatient health care utilization. Implications for researchers, mental health clinicians, and health care providers are discussed. PMID:15253090

  14. Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation

    PubMed Central

    2016-01-01

    Objectives: The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide. Methods: Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization. Results: The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size. Conclusions: It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation. PMID:26841887

  15. A comparison of EuroQol 5-Dimension health-related utilities using Italian, UK, and US preference weights in a patient sample.

    PubMed

    Mozzi, Adelaide; Meregaglia, Michela; Lazzaro, Carlo; Tornatore, Valentina; Belfiglio, Maurizio; Fattore, Giovanni

    2016-01-01

    Weights associated with the EuroQol 5-Dimension 3-Level (EQ-5D-3L) instrument represent preferences for health states elicited from general population's samples. Weights have not been calculated for every country; however, empirical research shows that cross-country differences exist. This empirical study aims at investigating the impact of recently developed Italian weights in comparison with UK and US scores on health-related utility calculation using a sample of patients with Crohn's disease. The study is based on a survey on health-related quality of life in patients (n=552) affected by active Crohn's disease conducted in Italy from 2012 to 2013. Utilities computed through the Italian algorithm (mean: 0.76; SD: 0.20; median: 0.81) are generally higher than US (mean: 0.69; SD: 0.22; median: 0.77) and UK (mean: 0.57; SD: 0.32; median: 0.69) utilities, except for extremely severe health states where US values outweigh the Italian ones. UK preference weights generate the highest number of negative results. All the three value distributions are left-skewed due to very low scores associated with the most serious health states (ie, three or four levels equal to 3). As expected, despite the tariff set considered, more severe disease (Harvey Bradshaw Index >16) reduces the mean conditional EQ-5D-3L index (P<0.0001). Kendall's rank correlation between EQ Visual Analog Scale score and EQ-5D-3L index is positive (P<0.0001), even though patients tend to value their health-related quality of life more when responding to EQ-5D-3L questions than on EQ Visual Analog Scale. Regardless of the tariff set considered, ordinary least-square results highlight that more severe disease (Harvey Bradshaw Index >16) reduces the mean conditional EQ-5D-3L index (P<0.0001). Results reveal remarkable differences among the three national tariff sets and especially when severe health states occur, suggesting the need for country-specific preference weights when evaluating utilities, which can be

  16. A comparison of EuroQol 5-Dimension health-related utilities using Italian, UK, and US preference weights in a patient sample

    PubMed Central

    Mozzi, Adelaide; Meregaglia, Michela; Lazzaro, Carlo; Tornatore, Valentina; Belfiglio, Maurizio; Fattore, Giovanni

    2016-01-01

    Weights associated with the EuroQol 5-Dimension 3-Level (EQ-5D-3L) instrument represent preferences for health states elicited from general population’s samples. Weights have not been calculated for every country; however, empirical research shows that cross-country differences exist. This empirical study aims at investigating the impact of recently developed Italian weights in comparison with UK and US scores on health-related utility calculation using a sample of patients with Crohn’s disease. The study is based on a survey on health-related quality of life in patients (n=552) affected by active Crohn’s disease conducted in Italy from 2012 to 2013. Utilities computed through the Italian algorithm (mean: 0.76; SD: 0.20; median: 0.81) are generally higher than US (mean: 0.69; SD: 0.22; median: 0.77) and UK (mean: 0.57; SD: 0.32; median: 0.69) utilities, except for extremely severe health states where US values outweigh the Italian ones. UK preference weights generate the highest number of negative results. All the three value distributions are left-skewed due to very low scores associated with the most serious health states (ie, three or four levels equal to 3). As expected, despite the tariff set considered, more severe disease (Harvey Bradshaw Index >16) reduces the mean conditional EQ-5D-3L index (P<0.0001). Kendall’s rank correlation between EQ Visual Analog Scale score and EQ-5D-3L index is positive (P<0.0001), even though patients tend to value their health-related quality of life more when responding to EQ-5D-3L questions than on EQ Visual Analog Scale. Regardless of the tariff set considered, ordinary least-square results highlight that more severe disease (Harvey Bradshaw Index >16) reduces the mean conditional EQ-5D-3L index (P<0.0001). Results reveal remarkable differences among the three national tariff sets and especially when severe health states occur, suggesting the need for country-specific preference weights when evaluating utilities

  17. Impact of angina frequency on health utility values of patients with chronic stable angina

    PubMed Central

    2014-01-01

    Background Chronic angina is a profoundly symptomatic disease. We evaluated the relationship between angina frequency and health utility. Methods We used data from stable angina patients reporting ≥3 attacks/week enrolled in the Efficacy of Ranolazine in Chronic Angina (ERICA) trial. Angina frequency was classified using the Seattle Angina Questionnaire angina frequency (SAQAF) domain into no (100); monthly (61-99); weekly (31-60); and daily (0-30) angina. EuroQol (EQ)-5D health utility scores were derived from SAQ data using two mapping equations. Median EQ-5D utility scores for each SAQAF classification after the 6-week trial period were calculated (reported as: Equation 1/Equation 2). Changes in EQ-5D utility scores from baseline to end-of-trial for patients achieving and not achieving a ≥20-point improvement in SAQAF score and improving and not improving ≥1 SAQAF classification were compared. Results Median EQ-5D utility scores (n = 548) were 0.68/0.60. Compared to patients reporting no angina symptoms (n = 28; 0.89/0.87) patients reporting monthly (n = 188; 0.80/0.76), weekly (n = 283; 0.72/0.65) and daily (n = 49; 0.65/0.54) symptoms had poorer health utility (p < 0.001 for both equations). Patients improving ≥1SAQAF classification (n = 254/541, 47%) experienced a median 0.05/0.07 greater improvement in EQ-5D health utility compared to those not improving ≥1 classification (p < 0.001 for both equations). Patients improving ≥20-points on the SAQAF (n = 355/541, 66%) experienced a median 0.06/0.07 greater improvement in health utility compared to those not achieving a ≥20-point improvement (p < 0.001 for both). Conclusions Chronic angina patient health utility decreases as angina frequency increases. Patients reporting clinically important improvement in angina frequency experience a tangible improvement in health utility. Clinical trial registration NCT00091429 PMID:24628859

  18. Methods for measuring utilization of mental health services in two epidemiologic studies

    PubMed Central

    NOVINS, DOUGLAS K.; BEALS, JANETTE; CROY, CALVIN; MANSON, SPERO M.

    2015-01-01

    Objectives of Study Psychiatric epidemiologic studies often include two or more sets of questions regarding service utilization, but the agreement across these different questions and the factors associated with their endorsement have not been examined. The objectives of this study were to describe the agreement of different sets of mental health service utilization questions that were included in the American Indian Service Utilization Psychiatric Epidemiology Risk and Protective Factors Project (AI-SUPERPFP), and compare the results to similar questions included in the baseline National Comorbidity Survey (NCS). Methods Responses to service utilization questions by 2878 AI-SUPERPFP and 5877 NCS participants were examined by calculating estimates of service use and agreement (κ) across the different sets of questions. Logistic regression models were developed to identify factors associated with endorsement of specific sets of questions. Results In both studies, estimates of mental health service utilization varied across the different sets of questions. Agreement across the different question sets was marginal to good (κ = 0.27–0.69). Characteristics of identified service users varied across the question sets. Limitations Neither survey included data to examine the validity of participant responses to service utilization questions. Recommendations for Further Research Question wording and placement appear to impact estimates of service utilization in psychiatric epidemiologic studies. Given the importance of these estimates for policy-making, further research into the validity of survey responses as well as impacts of question wording and context on rates of service utilization is warranted. PMID:18767205

  19. A Review of Acculturation Measures and Their Utility in Studies Promoting Latino Health

    PubMed Central

    Wallace, Phyllis M.; Pomery, Elizabeth A.; Latimer, Amy E.; Martinez, Josefa L.; Salovey, Peter

    2010-01-01

    The authors reviewed the acculturation literature with the goal of identifying measures used to assess acculturation in Hispanic populations in the context of studies of health knowledge, attitudes, and behavior change. Twenty-six acculturation measures were identified and summarized. As the Hispanic population continues to grow in the United States, there is a need to develop rigorous acculturation measures that include health indicators. Findings suggest that multidimensional acculturation scales are robust measurement tools when assessing nationality, cultural awareness, media and language preferences, and health status. Furthermore, aspects of Hispanic cultural lifestyle, such as beliefs about nutrition and physical activity, affect health care utilization, treatment, and prevention. Health communication researchers should consider aspects of cultural values and beliefs, and their impact on health status, for future research and health promotion interventions. PMID:20582238

  20. Effects of Diabetic Case Management on Knowledge, Self-Management Abilities, Health Behaviors, and Health Service Utilization for Diabetes in Korea

    PubMed Central

    Shin, Soon Ae; Lee, Kunsei; Lin, Vivian; Liu, George; Shin, Eunyoung

    2015-01-01

    Purpose This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. Materials and Methods The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. Results The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. Conclusion This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program. PMID:25510771

  1. Predicting Health Care Utilization among Latinos: Health Locus of Control Beliefs or Access Factors?

    ERIC Educational Resources Information Center

    De Jesus, Maria; Xiao, Chenyang

    2014-01-01

    There are two competing research explanations to account for Latinos' underutilization of health services relative to non-Latino Whites in the United States. One hypothesis examines the impact of health locus of control (HLOC) beliefs, while the other focuses on the role of access factors on health care use. To date, the relative strength of…

  2. World Health Organization 5-item well-being index: validation of the Brazilian Portuguese version.

    PubMed

    de Souza, Camila Morelatto; Hidalgo, Maria Paz Loayza

    2012-04-01

    The psychological well-being dimension and depressive symptoms are both important variables in an individual's health. In this study, we evaluated the World Health Organization 5-item well-being index (WHO-Five) internal and external validities, and accuracy in detecting depression. A total of 1,128 individuals between 18 and 65 years old from a rural Brazilian population were included. Cronbach's alpha and factor analysis were performed for internal validation. Demographic variables means were compared, receiver operating characteristic (ROC) curve was constructed, and sensitivity, specificity and positive and negative predictive values for different cutoff points were calculated for external validation and accuracy in detecting depression. Cronbach's alpha was 0.83, and only one factor was responsible for 59% of common variances, with an eigenvalue of 2.96. Higher WHO-Five scores were associated with being man, from oldest age category and retired. It was also related to better general health self-perception and negative screening in the Beck Depression Inventory (BDI). Based on BDI, the area under the curve was 67.37. A sensitivity of 66/75% and a negative predictive value of 91/92% for cutoffs <19/20 were detected. WHO-Five showed internal and external validities when used to measure the well-being dimension and to be a useful tool for depression screening. PMID:21912931

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

    PubMed Central

    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 inAuence 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 from The National Longitudinal Study of Adolescent Health, a nationally representative sample of adolescents in grades 7-12 (N = 13,428), we used principal components analysis to define 3 school social capital factors: “connectedness” (feel part of/close to people/safe in school), “treatment” (get along with teachers/students, teachers treat students fairly), and “parental involvement” (school administrator reported percent family/parent self-reported participation in Parent Teacher Organization, average daily school attendance). We examined the associations between individual- and school-level social capital and individual BMI using multilevel modeling techniques. RESULTS In girls, both feeling connected to one's school (b = −0.06, p < .05) and attending schools with overall high connectedness (b = −0.43, p < .01) were associated with lower BM Is. In boys only attending a school with high "treatment" was inversely associated with BMI (b = −0.61, p < .01), adjusting for individual and school demographics. CONCLUSIONS Although further studies are needed, our findings suggest enhancing school social capital as a novel approach to addressing student obesity. PMID:25388592

  4. Associations between Pittsburgh Sleep Quality Index Factors and Health Outcomes in Women with Posttraumatic Stress Disorder

    PubMed Central

    Casement, Melynda D.; Harrington, Kelly M.; Miller, Mark W.; Resick, Patricia A.

    2012-01-01

    Objective The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure of subjective sleep disturbance in clinical populations, including individuals with posttraumatic stress disorder (PTSD). Although the severity of sleep disturbance is generally represented by a global symptom score, recent factor analytic studies suggest that the PSQI is better characterized by a two- or three-factor model than a one-factor model. This study examined the replicability of two- and three-factor models of the PSQI, as well as the relationship between PSQI factors and health outcomes, in a female sample with PTSD. Methods The PSQI was administered to 319 women with PTSD related to sexual or physical assault. Confirmatory factor analyses tested the relative fit of one-, two-, and three-factor solutions. Bivariate correlations were performed to examine the shared variance between PSQI sleep factors and measures of PTSD, depression, anger, and physical symptoms. Results Confirmatory factor analyses supported a 3-factor model with Sleep Efficiency, Perceived Sleep Quality, and Daily Disturbances as separate indices of sleep quality. The severity of symptoms represented by the PSQI factors was positively associated with the severity of PTSD, depression, and physical symptoms. However, these health outcomes correlated as much or more with the global PSQI score as with PSQI factor scores. Conclusions These results support the multidimensional structure of the PSQI. Yet, the global PSQI score has as much or more explanatory power as individual PSQI factors in predicting health outcomes. PMID:22542787

  5. The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data

    PubMed Central

    de Souza, Leonardo Cordeiro; Lugon, Jocemir Ronaldo

    2015-01-01

    ABSTRACT OBJECTIVE: The use of the rapid shallow breathing index (RSBI) is recommended in ICUs, where it is used as a predictor of mechanical ventilation (MV) weaning success. The aim of this study was to compare the performance of the RSBI calculated by the traditional method (described in 1991) with that of the RSBI calculated directly from MV parameters. METHODS: This was a prospective observational study involving patients who had been on MV for more than 24 h and were candidates for weaning. The RSBI was obtained by the same examiner using the two different methods (employing a spirometer and the parameters from the ventilator display) at random. In comparing the values obtained with the two methods, we used the Mann-Whitney test, Pearson's linear correlation test, and Bland-Altman plots. The performance of the methods was compared by evaluation of the areas under the ROC curves. RESULTS: Of the 109 selected patients (60 males; mean age, 62 ± 20 years), 65 were successfully weaned, and 36 died. There were statistically significant differences between the two methods for respiratory rate, tidal volume, and RSBI (p < 0.001 for all). However, when the two methods were compared, the concordance and the intra-observer variation coefficient were 0.94 (0.92-0.96) and 11.16%, respectively. The area under the ROC curve was similar for both methods (0.81 ± 0.04 vs. 0.82 ± 0.04; p = 0.935), which is relevant in the context of this study. CONCLUSIONS: The satisfactory performance of the RSBI as a predictor of weaning success, regardless of the method employed, demonstrates the utility of the method using the mechanical ventilator. PMID:26785962

  6. Cognitive Appraisals of Specialty Mental Health Services and Their Relation to Mental Health Service Utilization in the Rural Population

    ERIC Educational Resources Information Center

    Deen, Tisha L.; Bridges, Ana J.; McGahan, Tara C.; Andrews, Arthur R., III

    2012-01-01

    Purpose: Rural individuals utilize specialty mental health services (eg, psychiatrists, psychologists, counselors, and social workers) at lower rates than their urban counterparts. This study explores whether cognitive appraisals (ie, individual perceptions of need for services, outcome expectancies, and value of a positive therapeutic outcome) of…

  7. Influence of self-perceived oral health and socioeconomic predictors on the utilization of dental care services by schoolchildren.

    PubMed

    Piovesan, Chaiana; Antunes, José Leopoldo Ferreira; Guedes, Renata Saraiva; Ardenghi, Thiago Machado

    2011-01-01

    The influence of socioeconomic factors and self-rated oral health on children's dental health assistance was assessed. This study followed a cross-sectional design, with a multistage random sample of 792 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. A dental examination provided information on the prevalence of dental caries (DMFT index). Data about the use of dental service, socioeconomic status, and self-perceived oral health were collected by means of structured interviews. These associations were assessed using Poisson regression models (prevalence ratio; 95% confidence interval). The prevalence of regular use of dental service was 47.8%. Children from low socioeconomic backgrounds and those who rated their oral health as "poor" used the service less frequently. The distribution of the kind of oral healthcare assistance used (public/private) varied across socioeconomic groups. The better-off children were less likely to have used the public service. Clinical, socioeconomic, and psychosocial factors were strong predictors for the utilization of dental care services by schoolchildren. PMID:21359493

  8. Estimation of utility values from visual analog scale measures of health in patients undergoing cardiac surgery

    PubMed Central

    Oddershede, Lars; Andreasen, Jan Jesper; Ehlers, Lars

    2014-01-01

    Introduction In health economic evaluations, mapping can be used to estimate utility values from other health outcomes in order to calculate quality adjusted life-years. Currently, no methods exist to map visual analog scale (VAS) scores to utility values. This study aimed to develop and propose a statistical algorithm for mapping five dimensions of health, measured on VASs, to utility scores in patients suffering from cardiovascular disease. Methods Patients undergoing coronary artery bypass grafting at Aalborg University Hospital in Denmark were asked to score their health using the five VAS items (mobility, self-care, ability to perform usual activities, pain, and presence of anxiety or depression) and the EuroQol 5 Dimensions questionnaire. Regression analysis was used to estimate four mapping models from patients’ age, sex, and the self-reported VAS scores. Prediction errors were compared between mapping models and on subsets of the observed utility scores. Agreement between predicted and observed values was assessed using Bland–Altman plots. Results Random effects generalized least squares (GLS) regression yielded the best results when quadratic terms of VAS scores were included. Mapping models fitted using the Tobit model and censored least absolute deviation regression did not appear superior to GLS regression. The mapping models were able to explain approximately 63%–65% of the variation in the observed utility scores. The mean absolute error of predictions increased as the observed utility values decreased. Conclusion We concluded that it was possible to predict utility scores from VAS scores of the five dimensions of health used in the EuroQol questionnaires. However, the use of the mapping model may be inappropriate in more severe conditions. PMID:24453497

  9. Utilization of maternal health care services in post-conflict Nepal

    PubMed Central

    Bhandari, Tulsi Ram; Sarma, Prabhakaran Sankara; Kutty, Vellappillil Raman

    2015-01-01

    Background Despite a decade-long armed conflict in Nepal, the country made progress in reducing maternal mortality and is on its way to achieve the Millennium Development Goal Five. This study aimed to assess the degree of the utilization of maternal health care services during and after the armed conflict in Nepal. Methods This study is based on Nepal Demographic and Health Survey data 2006 and 2011. The units of analysis were women who had given birth to at least one child in the past 5 years preceding the survey. First, we compared the utilization of maternal health care services of 2006 with that of 2011. Second, we merged the two data sets and applied logistic regression to distinguish whether the utilization of maternal health care services had improved after the peace process 2006 was underway. Results In 2011, 85% of the women sought antenatal care at least once. Skilled health workers for delivery care assisted 36.1% of the women, and 46% of the women attended postnatal care visit at least once. These figures were 70%, 18.7%, and 16%, respectively, in 2006. Similarly, women were more likely to utilize antenatal care at least once (odds ratio [OR] =2.18, confidence interval [CI] =1.95–2.43), skilled care at birth (OR =2.58, CI =2.36–2.81), and postnatal care at least once (OR =4.13, CI =3.75–4.50) in 2011. Conclusion The utilization of maternal health care services tended to increase continuously during both the armed conflict and the post-conflict period in Nepal. However, the increasing proportion of the utilization was higher after the Comprehensive Peace Process Agreement 2006. PMID:26346111

  10. The CDC Clear Communication Index is a new evidence-based tool to prepare and review health information.

    PubMed

    Baur, Cynthia; Prue, Christine

    2014-09-01

    This article presents the Centers for Disease Control and Prevention Clear Communication Index (the Index), a tool that emphasizes the primary audience's needs and provides a set of evidence-based criteria to develop and assess public communication products for diverse audiences. The Index consists of four open-ended introductory questions and 20 scored items that affect information clarity and audience comprehension, according to the scientific literature. A research team fielded an online survey to test the Index's validity. Respondents answered 10 questions about either an original health material or one redesigned with the Index. For 9 out of 10 questions, the materials revised using the Index were rated higher than the original materials. Regardless of education level, respondents rated the revised materials more favorably than the original ones. The results indicate that the Index performed as intended and made it more likely that audiences could correctly identify the intended main message and understand the words and numbers in the materials. The results also support the widely held view that audiences are more positive about clearly designed materials. The Index shows that an evidence-based scoring rubric can assess and improve the clarity of health materials. PMID:24951489

  11. Health state utility valuation in radioactive iodine-refractory differentiated thyroid cancer

    PubMed Central

    Fordham, Beth A; Kerr, Cicely; de Freitas, Hayley M; Lloyd, Andrew J; Johnston, Karissa; Pelletier, Corey L; Tremblay, Gabriel; Forsythe, Anna; McIver, Bryan; Cohen, Ezra EW

    2015-01-01

    Purpose The aim of this study was to elicit utilities for radioactive iodine-refractory differentiated thyroid cancer (RR-DTC) and evaluate the impact of treatment response and toxicities on quality of life. Patients and methods RR-DTC health states were developed based on data from a previous qualitative study and iterative review by clinical experts. Following piloting, health states underwent valuation by 100 members of the UK public during time trade-off interviews. Mean utilities and descriptive distribution statistics were calculated, and a logistic regression analysis was conducted. Results The demographic characteristics of the study sample were generally reflective of the UK population. Clear differentiation in valuation between health states was observed. No response/stable disease had an adjusted utility value of 0.87, with a corresponding gain of +0.04 following a treatment response and a decline of −0.35 for disease progression. Adverse events were associated with utility decrements between −0.47 (grade III diarrhea) and −0.05 (grade I/II alopecia). Conclusion The trade-off interviews derived utility weights show clear differentiation between RR-DTC health states in response to treatment. The values reported in this study are suitable for cost-effectiveness evaluations for new treatments in RR-DTC. PMID:26604709

  12. Potholes in the information highway: the use of health service utilization data by Alberta health care managers.

    PubMed

    Casebeer, A; Johnson, D

    2000-01-01

    Reviews and consultations with regional health authority decision makers have indicated that both data quality and access can limit effective use of health services information when assessing outcomes, planning changes, testing solutions and making decisions. To further a more system-wide understanding of these data utilization issues, we asked senior managers, board members and information analysts in Alberta regional health authorities (n = 111) about the availability of, organizational supports for and barriers to the use of health service utilization data. Eighty percent of respondents stated that the lack of data impeded problem resolution, and 83 percent of managers stated that health service data alerted them to new problems. Examples of useful data related to good standardization and linkage of data sets, or to capacity for valid comparison and trending. Given the limitations highlighted in relation to meeting even the simplest needs of standardization, linkage, comparison and trending, Alberta health care managers indicate frustration in trying to use health service data as currently construed and distributed, particularly within their current frameworks and fast-paced timelines for decision making. PMID:11182922

  13. The Prostate Health Index: a new test for the detection of prostate cancer

    PubMed Central

    Loeb, Stacy

    2014-01-01

    A major focus in urologic research is the identification of new biomarkers with improved specificity for clinically-significant prostate cancer. A promising new test based on prostate-specific antigen (PSA) is called the Prostate Health Index (PHI), which has recently been approved in the United States, Europe and Australia. PHI is a mathematical formula that combines total PSA, free PSA and [-2] proPSA. Numerous international studies have consistently shown that PHI outperforms its individual components for the prediction of overall and high-grade prostate cancer on biopsy. PHI also predicts the likelihood of progression during active surveillance, providing another noninvasive modality to potentially select and monitor this patient population. This article reviews the evidence on this new blood test with significant promise for both prostate cancer screening and treatment decision-making. PMID:24688603

  14. Psychocultural Correlates of Mental Health Service Utilization Among African American and European American Girls.

    PubMed

    Yasui, Miwa; Hipwell, Alison E; Stepp, Stephanie D; Keenan, Kate

    2015-11-01

    Structural equation modeling was used to examine the effects of cultural factors (ethnic identity, perceived discrimination), family relations, and child problem type on mental health service utilization in a community sample of 1,480 adolescent girls (860 African American, 620 European American) between ages 15 and 17 years enrolled in the Pittsburgh Girls Study. Results revealed ethnic identity, caregiver attachment, and conduct disorder were related to service use among African American girls. Among European American girls, correlate patterns differed by clinical need. Findings highlight the need for research on health disparities to examine racially specific influences on service utilization. PMID:25380787

  15. Psychocultural Correlates of Mental Health Service Utilization Among African American and European American Girls

    PubMed Central

    Hipwell, Alison E.; Stepp, Stephanie D.; Keenan, Kate

    2015-01-01

    Structural equation modeling was used to examine the effects of cultural factors (ethnic identity, perceived discrimination), family relations, and child problem type on mental health service utilization in a community sample of 1,480 adolescent girls (860 African American, 620 European American) between ages 15 and 17 years enrolled in the Pittsburgh Girls Study. Results revealed ethnic identity, caregiver attachment, and conduct disorder were related to service use among African American girls. Among European American girls, correlate patterns differed by clinical need. Findings highlight the need for research on health disparities to examine racially specific influences on service utilization. PMID:25380787

  16. The air quality health index and emergency department visits for urticaria in Windsor, Canada.

    PubMed

    Kousha, Termeh; Valacchi, Giuseppe

    2015-01-01

    Ambient air pollution exposure has been associated with several health conditions, limited not only to respiratory and cardiovascular systems but also to cutaneous tissues. However, few epidemiological studies examined pollution exposure on skin problems. Basically, the common mechanism by which pollution may affect skin physiology is by induction of oxidative stress and inflammation. Urticaria is among the skin pathologies that have been associated with pollution. Based on the combined effects of three ambient air pollutants, ozone (O₃), nitrogen dioxide (NO₂), and fine particulate matter (PM) with a median aerodynamic diameter of less than 2.5 μm (PM(2.5)), on mortality, the Air Quality Health Index (AQHI) in Canada was developed. The aim of this study was to examine the associations of short-term changes in AQHI with emergency department (ED) visits for urticaria in Windsor-area hospitals in Canada. Diagnosed ED visits were retrieved from the National Ambulatory Care Reporting System (NACRS). A time-stratified case-crossover design was applied to 2905 ED visits (males = 1215; females = 1690) for urticaria from April 2004 through December 2010. Odds ratios (OR) and their corresponding 95% confidence intervals (95%CI) for ED visits associated with increase by one unit of risk index were calculated employing conditional logistic regression. Positive and significant results were observed between AQHI levels and OR for ED visits for urticaria in Windsor for lags 2 and 3 days. A distributed lag nonlinear model technique was applied to daily counts of ED visits for lags 0 to 10 and significant results were obtained from lag 2 to lag 5 and for lag 9. These findings demonstrated associations between ambient air pollution and urticarial confirming that air pollution affects skin conditions. PMID:25849769

  17. Looking twice at the gender equity index for public health impact

    PubMed Central

    2013-01-01

    Background It has been shown that gender equity has a positive impact on the everyday activities of people (decision making, income allocation, application and observance of norms/rules) which affect their health. Gender equity is also a crucial determinant of health inequalities at national level; thus, monitoring is important for surveillance of women’s and men’s health as well as for future health policy initiatives. The Gender Equity Index (GEI) was designed to show inequity solely towards women. Given that the value under scrutiny is equity, in this paper a modified version of the GEI is proposed, the MGEI, which highlights the inequities affecting both sexes. Methods Rather than calculating gender gaps by means of a quotient of proportions, gaps in the MGEI are expressed in absolute terms (differences in proportions). The Spearman’s rank coefficient, calculated from country rankings obtained according to both indexes, was used to evaluate the level of concordance between both classifications. To compare the degree of sensitivity and obtain the inequity by the two methods, the variation coefficient of the GEI and MGEI values was calculated. Results Country rankings according to GEI and MGEI values showed a high correlation (rank coef. = 0.95). The MGEI presented greater dispersion (43.8%) than the GEI (19.27%). Inequity towards men was identified in the education gap (rank coef. = 0.36) when using the MGEI. According to this method, many countries shared the same absolute value for education but with opposite signs, for example Azerbaijan (−0.022) and Belgium (0.022), reflecting inequity towards women and men, respectively. This also occurred in the empowerment gap with the technical and professional job component (Brunei:-0.120 vs. Australia, Canada Iceland and the U.S.A.: 0.120). Conclusion The MGEI identifies and highlights the different areas of inequities between gender groups. It thus overcomes the shortcomings of the GEI related to the

  18. Can Walmart make us healthier? Prescription drug prices and health care utilization.

    PubMed

    Borrescio-Higa, Florencia

    2015-12-01

    This paper analyzes how prices in the retail pharmaceutical market affect health care utilization. Specifically, I study the impact of Walmart's $4 Prescription Drug Program on utilization of antihypertensive drugs and on hospitalizations for conditions amenable to drug therapy. Identification relies on the change in the availability of cheap drugs introduced by Walmart's program, exploiting variation in the distance to the nearest Walmart across ZIP codes in a difference-in-differences framework. I find that living close to a source of cheap drugs increases utilization of antihypertensive medications by 7 percent and decreases the probability of an avoidable hospitalization by 6.2 percent. PMID:26376457

  19. Comparison of Health Care Resource Utilization by Immigrants Versus Native Elderly People.

    PubMed

    Franchi, Carlotta; Baviera, Marta; Sequi, Marco; Cortesi, Laura; Tettamanti, Mauro; Roncaglioni, Maria Carla; Pasina, Luca; Dignefa, Codjo Djade; Fortino, Ida; Bortolotti, Angela; Merlino, Luca; Mannucci, Pier Mannuccio; Nobili, Alessandro

    2016-02-01

    To compare the utilization of health care resources (drug prescriptions, hospital admissions and health care services) by immigrant versus native elderly people (65 years or more), by using administrative database of the Lombardy Region. For each immigrant (an older people born out of Italy), one person born in Lombardy (native) was randomly selected and matched by age, sex and general practitioner. The 25,508 immigrants selected were less prescribed with at least one drug (OR 0.72, 95 % CI 0.67-0.76) and had a lesser use of health care services (OR 0.79, 95 % CI 0.75-0.84) than natives. No statistically significant differences were found for hospital admission rates (OR 0.99, 95 % CI 0.99-1.04). A lower rate of health care resource utilization was observed in elderly immigrants who had been living in the host region for as many as 10 years. PMID:25576178

  20. The Relationship between Commercial Health Care Prices and Medicare Spending and Utilization

    PubMed Central

    Romley, John A; Axeen, Sarah; Lakdawalla, Darius N; Chernew, Michael E; Bhattacharya, Jay; Goldman, Dana P

    2015-01-01

    Objective To explore the relationship between commercial health care prices and Medicare spending/utilization across U.S. regions. Data Sources Claims from large employers and Medicare Parts A/B/D over 2007–2009. Study Design We compared prices paid by commercial health plans to Medicare spending and utilization, adjusted for beneficiary health and the cost of care, across 301 hospital referral regions. Principal Findings A 10 percent lower commercial price (around the average level) is associated with 3.0 percent higher Medicare spending per member per year, and 4.3 percent more specialist visits (p < .01). Conclusions Commercial health care prices are negatively associated with Medicare spending across regions. Providers may respond to low commercial prices by shifting service volume into Medicare. Further investigation is needed to establish causality. PMID:25429755

  1. Humpback whale populations share a core skin bacterial community: towards a health index for marine mammals?

    PubMed

    Apprill, Amy; Robbins, Jooke; Eren, A Murat; Pack, Adam A; Reveillaud, Julie; Mattila, David; Moore, Michael; Niemeyer, Misty; Moore, Kathleen M T; Mincer, Tracy J

    2014-01-01

    as a useful index for health and skin disorder monitoring of threatened and endangered marine mammals. PMID:24671052

  2. Humpback Whale Populations Share a Core Skin Bacterial Community: Towards a Health Index for Marine Mammals?

    PubMed Central

    Apprill, Amy; Robbins, Jooke; Eren, A. Murat; Pack, Adam A.; Reveillaud, Julie; Mattila, David; Moore, Michael; Niemeyer, Misty; Moore, Kathleen M. T.; Mincer, Tracy J.

    2014-01-01

    serve as a useful index for health and skin disorder monitoring of threatened and endangered marine mammals. PMID:24671052

  3. Validation of the Geriatric Oral Health Assessment Index in complete denture wearers.

    PubMed

    Campos, J A D B; Zucoloto, M L; Geremias, R F; Nogueira, S S; Maroco, J

    2015-07-01

    To perform a validation of the Geriatric Oral Health Assessment Index (GOHAI) for complete denture wearers and present a proposal for estimation of perceived oral health. This is a cross-sectional study with non-probabilistic sampling. A total of 211 subjects with a mean age of 62·5 (s.d. = 11·4) years participated, being 169 female. The GOHAI was applied in a personal interview. The construct/convergent/discriminant validity was tested using structural equation modelling. Confirmatory factor analysis was used to verify the fit of three proposals of the GOHAI: three-factor, one-factor and second-order hierarchical models. The stability of the models was evaluated in independent samples. The three-factor model presented an inadequate fit, and items 3, 4 and 9 were removed. The new structure presented an acceptable fit and strong invariance in independent samples. The convergent, discriminant validity and internal consistency were below adequate. The one-factor model presented an adequate fit to the sample. Convergent validity was compromised. A strong invariance of the one-factor model was observed. To calculate the overall scores of the GOHAI factors (three-factor model) or of the oral health perception (one-factor model), a matrix of regression weights for each item in the model was presented as a suggestion. We found an adequate fit of the both structures of the GOHAI for denture wearers, but the three-factor structure was more parsimonious. We suggested considering the weights of the regression model to calculate the overall score of perceived oral health or of its factors in different samples. PMID:25754792

  4. Factors associated with the utilization and costs of health and social services in frail elderly patients

    PubMed Central

    2012-01-01

    Background Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients. Methods Hierarchical analysis was applied to estimate the effects of patient and municipality-level variables on services utilization. Results The variation in the use of health care services was entirely due to patient-related variables, whereas in the social services, 9% of the variation was explained by the municipality-level and 91% by the patient-level characteristics. Health-related quality of life explained a major part of variation in the costs of health care services. Those who had reported improvement in their health status during the preceding year were more frequent users of social care services. Low informal support, poor functional status and poor instrumental activities of daily living, living at a residential home, and living alone were associated with higher social services expenditure. Conclusions The results of this study showed municipality-level variation in the utilization of social services, whereas health care services provided for frail elderly people seem to be highly equitable across municipalities. Another important finding was that the utilization of social and health services were connected. Those who reported improvement in their health status during the preceding year were more frequently also using social services. This result suggests that if municipalities continue to limit the provision of support services only for those who are in the highest need, this saving in the social sector may, in the long run, result in

  5. Economic evaluation of mental health interventions: an introduction to cost-utility analysis.

    PubMed

    Luyten, Jeroen; Naci, Huseyin; Knapp, Martin

    2016-05-01

    Finite resources need to be allocated over an ever-increasing range of competing health policies and interventions. Economic evaluation has been developed as a methodology to inform decision makers on the efficiency of particular resource allocations. In this paper we summarize cost-utility analysis, one of the most widely-used forms of economic evaluation in healthcare. We discuss its main elements, interpretation, limitations and relevance to the domain of mental health. PMID:27075444

  6. Utilization of the Primary Health Care Services in the Tshwane Region of Gauteng Province, South Africa

    PubMed Central

    Nteta, Thembi P.; Mokgatle-Nthabu, Matilda; Oguntibeju, Oluwafemi O.

    2010-01-01

    Background In South Africa, the provision of primary health care is a basic service designed to be cost effective and bring healthcare as close as possible to the population, particularly to those people of low economic status. It is a service which is provided free of charge by the South African government and as part of the millennium health goals, it is intended that the service should be accessible to the populace and be effectively utilized. Objective This study was designed to investigate the accessibility and utilization of the primary health care services in three community health care centres in the Tshwane of the Gauteng Province, South Africa. Methodology Data were obtained from participants attending three Community Health Care Centres in the Tshwane Region using self-administered structured questionnaires. A document review of the Community Health Care Centres records was conducted to investigate the utilization trends of the services provided and descriptive statistics were used to analyze the data obtained. Results The results showed that the Community Health Care Centres in the Tshwane Region are accessible to most participants who lived within 5 km of such centres and who traveled 30 minutes or less to the clinic. Using a taxi or walking were found to be the most common means of transport used to gain access to such a clinic. The findings showed that generally, participants were satisfied with the services provided. Conclusion Participants of this study have access to the community health care centres in the Tshwane Region and there seems to be effective utilization by patients attending them. PMID:21085475

  7. Uninsurance, Underinsurance, and Health Care Utilization in Mexico by US Border Residents

    PubMed Central

    Su, Dejun; Pratt, William; Stimpson, Jim P.; Wong, Rebeca; Pagán, José A.

    2013-01-01

    Using data from the 2008 Cross-Border Utilization of Health Care Survey, we examined the relationship between United States (US) health insurance coverage plans and the use of health care services in Mexico by US residents of the US-Mexico border region. We found immigrants were far more likely to be uninsured than their native-born counterparts (63 versus 27.8 percent). Adults without health insurance coverage were more likely to purchase medications or visit physicians in Mexico compared to insured adults. However, adults with Medicaid coverage were more likely to visit dentists in Mexico compared to uninsured adults. Improving health care access for US residents in the southwestern border region of the country will require initiatives that target not only providing coverage to the large uninsured population but also improving access to health care services for the large underinsured population. PMID:23624848

  8. Perceived Health Status and Utilization of Specialty Care: Racial and Ethnic Disparities in Patients with Chronic Diseases

    ERIC Educational Resources Information Center

    Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.

    2010-01-01

    Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…

  9. Leadership attributes: a key to optimal utilization of the community health nursing workforce.

    PubMed

    Ganann, Rebecca; Underwood, Jane; Matthews, Sue; Goodyear, Rosemarie; Stamler, Lynnette Leeseberg; Meagher-Stewart, Donna Marie; Munroe, Val

    2010-05-01

    This research examined leadership attributes that support the optimal utilization and practice of community health nurses (CHNs). Community health nursing is facing challenges in workforce capacity and sustainability. To meet current and future demands on the community sector, it is essential to understand workplace attributes that facilitate effective utilization of existing human resources and recruitment of new nurses. This pan-Canadian, mixed-methods study included a demographic analysis of CHNs in Canada, a survey involving responses from approximately 6,700 CHNs to identify enablers and barriers to community health nursing practice and 23 focus groups to examine organizational attributes that "best" support optimal practice within the public health nursing subsector. Nursing leadership was identified as an important attribute in organizations' utilization and support of CHNs working to work effectively. This effectiveness, in turn, will enhance community health programs and overall healthcare system efficiency. This paper highlights findings related to the role of nursing leadership and leadership development in optimizing community health nursing practice. PMID:20530996

  10. Measurement of patient-derived utility values for periodontal health using a multi-attribute scale.

    PubMed

    Bellamy, C A; Brickley, M R; McAndrew, R

    1996-09-01

    Periodontal health states are difficult to quantify and no formal scale quantifying patients' utilities for periodontal health states exits. Multi-attribute utility (MAU) techniques were used to develop such a scale. The MAU scale may be used to quantify patients' assessment of their current periodontal health and that of possible treatment outcomes. Such data, combined with probability values in formal decision analysis techniques would result in improved rationality of treatment planning for periodontal disease. 20 patients attending for routine undergraduate care were interviewed. Data from these interviews were sorted into groups of common interest (domains). Intra-domain health statements were complied from the interview content. 21 patients ranked the intra-domain statements on a scale of 0-100. This same group of patients also performed an inter-domain weighting. Mean results showed that patients were 2X as concerned with how they felt and with the prognosis of possible outcomes, than with how they looked and what facts they knew about their oral health. However, the real value of utilities research lies in application of individual results to treatment planning as there is a wide range of opinion regarding outcome health states. PMID:8891929

  11. The influence of women's empowerment on maternal health care utilization: evidence from Albania.

    PubMed

    Sado, Lantona; Spaho, Alma; Hotchkiss, David R

    2014-08-01

    Women in Albania receive antenatal care and postnatal care at lower levels than in other countries in Europe. Moreover, there are large socio-economic and regional disparities in maternal health care use. Previous research in low- and middle-income countries has found that women's status within the household can be a powerful force for improving the health, longevity, and mental and physical capacity of mothers and the well-being of children, but there is very little research on this issue in the Balkans. The aim of this paper is to investigate the influence of women's empowerment within the household on antenatal and postnatal care utilization in Albania. The research questions are explored through the use of bivariate and multivariate analyses based on nationally representative data from the 2008-09 Albania Demographic and Health Survey. The linkages between women's empowerment and maternal health care utilization are analyzed using two types of indicators of women's empowerment: decision making power and attitudes toward domestic violence. The outcome variables are indicators of the utilization of antenatal care and postnatal care. The findings suggest that use of maternal health care services is influenced by women's roles in decision-making and the attitudes of women towards domestic violence, after controlling for a number of socio-economic and demographic factors which are organized at individual, household, and community level. The study results suggest that policy actions that increase women's empowerment at home could be effective in helping assure good maternal health. PMID:24929918

  12. A Revised Australian Dietary Guideline Index and Its Association with Key Sociodemographic Factors, Health Behaviors and Body Mass Index in Peri-Retirement Aged Adults.

    PubMed

    Thorpe, Maree G; Milte, Catherine M; Crawford, David; McNaughton, Sarah A

    2016-03-01

    The Dietary Guideline Index, a measure of diet quality, was updated to reflect the 2013 Australian Dietary Guidelines. This paper describes the revision of the index (DGI-2013) and examines its use in older adults. The DGI-2013 consists of 13 components reflecting food-based daily intake recommendations of the Australian Dietary Guidelines. In this cross-sectional study, the DGI-2013 score was calculated using dietary data collected via an 111-item food frequency questionnaire and additional food-related behaviour questions. The DGI-2013 score was examined in Australian adults (aged 55-65 years; n = 1667 men; 1801 women) according to sociodemographics, health-related behaviours and BMI. Women scored higher than men on the total DGI-2013 and all components except for dairy. Those who were from a rural area (men only), working full-time (men only), with lower education, smoked, did not meet physical activity guidelines, and who had a higher BMI, scored lower on the DGI-2013, highlighting a group of older adults at risk of poor health. The DGI-2013 is a tool for assessing compliance with the Australian Dietary Guidelines. We demonstrated associations between diet quality and a range of participant characteristics, consistent with previous literature. This suggests that the DGI-2013 continues to demonstrate convergent validity, consistent with the original Dietary Guideline Index. PMID:26978399

  13. A Revised Australian Dietary Guideline Index and Its Association with Key Sociodemographic Factors, Health Behaviors and Body Mass Index in Peri-Retirement Aged Adults

    PubMed Central

    Thorpe, Maree G.; Milte, Catherine M.; Crawford, David; McNaughton, Sarah A.

    2016-01-01

    The Dietary Guideline Index, a measure of diet quality, was updated to reflect the 2013 Australian Dietary Guidelines. This paper describes the revision of the index (DGI-2013) and examines its use in older adults. The DGI-2013 consists of 13 components reflecting food-based daily intake recommendations of the Australian Dietary Guidelines. In this cross-sectional study, the DGI-2013 score was calculated using dietary data collected via an 111-item food frequency questionnaire and additional food-related behaviour questions. The DGI-2013 score was examined in Australian adults (aged 55–65 years; n = 1667 men; 1801 women) according to sociodemographics, health-related behaviours and BMI. Women scored higher than men on the total DGI-2013 and all components except for dairy. Those who were from a rural area (men only), working full-time (men only), with lower education, smoked, did not meet physical activity guidelines, and who had a higher BMI, scored lower on the DGI-2013, highlighting a group of older adults at risk of poor health. The DGI-2013 is a tool for assessing compliance with the Australian Dietary Guidelines. We demonstrated associations between diet quality and a range of participant characteristics, consistent with previous literature. This suggests that the DGI-2013 continues to demonstrate convergent validity, consistent with the original Dietary Guideline Index. PMID:26978399

  14. Improvement in Health State Utility after Sacroiliac Joint Fusion: Comparison to Normal Populations

    PubMed Central

    Cher, Daniel J.; Polly, David W.

    2015-01-01

    Study Design Prospective cohort study. Objective The sacroiliac joint (SIJ) is an important cause of lower back pain. The degree to which minimally invasive surgical fusion of the SIJ improves health state utility has not been previously documented. Methods Health state utility values were calculated using the EuroQOL-5D (EQ-5D) and Short Form-36 (SF-36) at baseline and 6 and 12 months after SIJ fusion surgery in subjects participating in a prospective, multicenter clinical trial (n = 172). Values were compared with individuals who participated in a nationally representative cross-sectional survey (National Health Measurement Study [NHMS], n = 3,844). Health utility values in the SIJ cohort were compared with those of the NMHS participants using both weighted linear regression and calculation of “health quantile” (i.e., percentile of health normalized to the NHMS cohort adjusted for age and gender). Results Baseline health state utility was significantly depressed in SIJ patients compared with normal subjects (SF-6D 0.509 versus 0.789, SF-36 physical component summary 31.7 versus 49.2, SF-36 mental component summary 8.5 versus 53.8, EQ-5D 0.433 versus 0.868; all p < 0.0001 after adjustment for age and gender). In the SIJ cohort, all the measures improved by 6 months postoperatively, and improvements were sustained at 12 months. Baseline health quantile was low (fifth percentile) in the SIJ cohort and improved significantly at follow-up. Conclusions Quality of life is markedly impaired in patients with SIJ pain compared with age- and gender-matched cohorts. SIJ fusion in this cohort resulted in a substantial improvement in health state utility, bringing the population back toward the expected levels of overall health. The quantile approach helps to explain the degree to which health is improved compared with age- and gender-matched cohorts. PMID:26933610

  15. Incarceration and Women's Health: The Utility of Effective Health Education Programming--A Commentary

    ERIC Educational Resources Information Center

    Robertson-James, Candace; Nunez, Ana

    2012-01-01

    The health and well-being of incarcerated women is a significant public health concern. Compared with non-incarcerated women, incarcerated women in the United States are more often from minority populations, younger (between the ages of 18 and 34 years), of low socioeconomic status, unemployed and mothers to children under 18 years of age. More…

  16. Public Health Monitoring of Privilege and Deprivation With the Index of Concentration at the Extremes

    PubMed Central

    Waterman, Pamela D.; Spasojevic, Jasmina; Li, Wenhui; Maduro, Gil; Van Wye, Gretchen

    2016-01-01

    Objectives. We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring. Methods. We used New York City data centered around 2010 to assess cross-sectional associations at the census tract and community district levels, for (1) diverse ICE measures plus the US poverty rate, with (2) infant mortality, premature mortality (before age 65 years), and diabetes mortality. Results. Point estimates for rate ratios were consistently greatest for the novel ICE that jointly measured extreme concentrations of income and race/ethnicity. For example, the census tract–level rate ratio for infant mortality comparing the bottom versus top quintile for an ICE contrasting low-income Black versus high-income White equaled 2.93 (95% confidence interval [CI] = 2.11, 4.09), but was 2.19 (95% CI = 1.59, 3.02) for low versus high income, 2.77 (95% CI = 2.02, 3.81) for Black versus White, and 1.56 (95% CI = 1.19, 2.04) for census tracts with greater than or equal to 30% versus less than 10% below poverty. Conclusions. The ICE may be a useful metric for public health monitoring, as it simultaneously captures extremes of privilege and deprivation and can jointly measure economic and racial/ethnic segregation. PMID:26691119

  17. Can the Air Pollution Index be used to communicate the health risks of air pollution?

    PubMed

    Li, Li; Lin, Guo-Zhen; Liu, Hua-Zhang; Guo, Yuming; Ou, Chun-Quan; Chen, Ping-Yan

    2015-10-01

    The validity of using the Air Pollution Index (API) to assess health impacts of air pollution and potential modification by individual characteristics on air pollution effects remain uncertain. We applied distributed lag non-linear models (DLNMs) to assess associations of daily API, specific pollution indices for PM10, SO2, NO2 and the weighted combined API (APIw) with mortality during 2003-2011 in Guangzhou, China. An increase of 10 in API was associated with a 0.88% (95% confidence interval (CI): 0.50, 1.27%) increase of non-accidental mortality at lag 0-2 days. Harvesting effects appeared after 2 days' exposure. The effect estimate of API over lag 0-15 days was statistically significant and similar with those of pollutant-specific indices and APIw. Stronger associations between API and mortality were observed in the elderly, females and residents with low educational attainment. In conclusion, the API can be used to communicate health risks of air pollution. PMID:26057478

  18. Couples’ reports of household decision-making and the utilization of maternal health services in Bangladesh

    PubMed Central

    Story, William T.; Burgard, Sarah A.

    2012-01-01

    This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service use focus on women’s reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands’ involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized. PMID:23068556

  19. Direct-to-consumer advertising and its utility in health care decision making: a consumer perspective.

    PubMed

    Deshpande, Aparna; Menon, Ajit; Perri, Matthew; Zinkhan, George

    2004-01-01

    The growth in direct-to-consumer advertising(DTCA)over the past two decades has facilitated the communication of prescription drug information directly to consumers. Data from a 1999 national survey are employed to determine the factors influencing consumers' opinions of the utility of DTC ads for health care decision making. We also analyze whether consumers use DTC ad information in health care decision making and who are the key drivers of such information utilization. The study results suggest that consumers have positive opinions of DTCA utility, varying across demographics and perceptions of certain advertisement features. Specifically, consumers value information about both risks and benefits, but the perception of risk information is more important in shaping opinions of ad utility than the perception of benefit information. Consumers still perceive, however that the quality of benefit information in DTC ads is better than that of risk information. Opinions about ad utility significantly influence whether information from DTC ads is used in health care decision making. PMID:15764449

  20. Understanding utilization of outpatient clinics for children with special health care needs in southern Israel.

    PubMed

    Peres, Hagit; Glazer, Yael; Landau, Daniella; Marks, Kyla; Abokaf, Hana'a; Belmaker, Ilana; Cohen, Arnon; Shoham-Vardi, Ilana

    2014-10-01

    To understand the pattern of utilization of ambulatory care by parents of children with special health care needs (CSHCN) and to explore parental challenges in coping with health maintenance of their infants after discharge from a neonatal intensive care unit (NICU). CSHCN require frequent utilization of outpatient ambulatory clinics especially in their first years of life. Multiple barriers are faced by families in disadvantaged populations which might affect adherence to medical referrals. Our study attempts to go beyond quantitative assessment of adherence rates, and capture the influence of parental agency as a critical factor ensuring optimal utilization of healthcare for CSHCN. A prospective, mixed-methods, cohort study followed 158 Jewish and Bedouin-Arab infants in the first year post discharge from NICU in southern Israel. Rates of utilization of ambulatory clinics were obtained from medical records, and quantitative assessment of factors affecting it was based on structured interviews with parents at baseline. Qualitative analysis was based on home visits or telephone in-depth interviews conducted about 1 year post-discharge, to obtain a rich, multilayered, experiential perspectives and explained perceptions by parents. Adherence to post-discharge referrals was generally good, but environmental, cultural, and financial obstacles to healthcare, magnified by communication barriers, forced parents with limited resources to make difficult choices affecting utilization of healthcare services. Improving concordance between primary caregivers and health care providers is crucial, and further development of supportive healthcare for CSHCN in concordance with parental limitations and preferences is needed. PMID:24414986

  1. Comparison of General Population, Patient, and Carer Utility Values for Dementia Health States

    PubMed Central

    Mulhern, Brendan; Banerjee, Sube; Tait, Rhian; Watchurst, Caroline; Smith, Sarah C.; Young, Tracey A.; Knapp, Martin; Brazier, John E.

    2015-01-01

    Utility values to estimate quality-adjusted life years (QALYs) for use in cost-utility analyses are usually elicited from members of the general population. Public attitudes and understanding of dementia in particular may mean that values elicited from the general population may differ from patients and carers for dementia health states. This study examines how the population impacts utility values elicited for dementia health states using interviewer-administered time tradeoff valuation of health states defined by the dementia-specific preference-based measures DEMQOL-U (patient-report) and DEMQOL-Proxy-U (carer-report). Eight DEMQOL-U states were valued by 78 members of the UK general population and 71 patients with dementia of mild severity. Eight DEMQOL-Proxy-U states were valued by 77 members of the UK general population and 71 carers of patients with dementia of mild severity. Random-effects generalized least squares regression estimated the impact of population, dementia health state, and respondent sociodemographic characteristics on elicited values, finding that values for dementia health states differed by population and that the difference varied across dementia health states. Patients with dementia and carers of patients with dementia gave systematically lower values than members of the general population that were not due to differences in the sociodemographic characteristics of the populations. Our results suggest that the population used to produce dementia health state values could impact the results of cost-utility analyses and potentially affect resource allocation decisions; yet, currently, only general population values are available for usage. PMID:25385749

  2. Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices.

    PubMed

    Ladapo, Joseph A; Turakhia, Mintu P; Ryan, Michael P; Mollenkopf, Sarah A; Reynolds, Matthew R

    2016-05-01

    Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p <0.0001). In conclusion, remote monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care. PMID:26996767

  3. Utilization of agricultural by-products in healthful food products: Organogelators, antioxidants, and spreadable products

    Technology Transfer Automated Retrieval System (TEKTRAN)

    It was found that several agricultural by-products could be utilized for healthful food products. Three major applications that our research group has been focusing on will be discussed: 1) plant waxes for trans-fat free, low saturated fat-containing margarine and spread products, 2) extracts of cor...

  4. Kindergarten Screening and Parent Engagement to Enhance Mental Health Service Utilization

    ERIC Educational Resources Information Center

    Girio, Erin L.

    2010-01-01

    The majority of youth in need of mental health services do not receive intervention as many are not identified as having a problem or their families experience practical or attitudinal barriers that interfere with service utilization. The school environment provides a unique point of access to reach all children, yet this setting has been…

  5. Trends in the Utilization of Specific Health Care Services among Older Manitobans: 1985 to 2000

    ERIC Educational Resources Information Center

    Finlayson, Marcia; Lix, Lisa; Finlayson, Greg; Fong, Terry

    2005-01-01

    This paper examines 16-year trends in the utilization of hospital and physician services by Manitobans aged 75 and more, using data from the Manitoba Population Health Research Data Repository. Trends are examined across five measures of hospital services (separations, short-stay days, long-stay days, cataract surgeries, and hip/knee replacements)…

  6. Implementation and Utilization Characteristics of a Rural, School-Linked Mental Health Program

    ERIC Educational Resources Information Center

    Evans, Garret D.; Radunovich, Heidi Liss; Cornette, Michelle M.; Wiens, Brenda A.; Roy, Antara

    2008-01-01

    We examined variables associated with treatment engagement in a real-world therapeutic setting. The model of care examined involved school-linked mental health care for children and their families in a rural county. Service utilization characteristics, as well as child- and treatment-specific variables were examined in relation to their impact on…

  7. Online Health Information (OHI) Utilization among Selected Worksite Employees in Taiwan

    ERIC Educational Resources Information Center

    Hou, Su-I; Hsiao, Tun-Jen; Hou, Peng-Hsi

    2012-01-01

    Purpose: This study compared Internet and online health information (OHI) utilization among selected employees age 40-49 and 50-64 years, and examined the influence of age, gender, education, and worksite. Methods: A questionnaire was administered to participants from two worksites in Taiwan. Results: A total of 527 employees completed the survey…

  8. The Effects on Student Utilization of Moving an On-Campus Health Center Off Campus.

    ERIC Educational Resources Information Center

    Klotz, Addie L.

    The effects of moving the San Fernando Valley State College Student Health Services to a professional medical building two miles off-campus are assessed. Anticipating a series reduction in student utilization, an intensive publicity program was undertaken to make students aware of the service and its new location. Unexpected positive results of…

  9. Major Differences: Variations in Undergraduate and Graduate Student Mental Health and Treatment Utilization across Academic Disciplines

    ERIC Educational Resources Information Center

    Lipson, Sarah Ketchen; Zhou, Sasha; Wagner, Blake, III; Beck, Katie; Eisenberg, Daniel

    2016-01-01

    This article explores variations in mental health and service utilization across academic disciplines using a random sample of undergraduate and graduate students (N = 64,519) at 81 colleges and universities. We report prevalence of depression, anxiety, suicidality, and self-injury, and rates of help-seeking across disciplines, including results…

  10. Graduate Student Mental Health: Needs Assessment and Utilization of Counseling Services

    ERIC Educational Resources Information Center

    Hyun, Jenny K.; Quinn, Brian C.; Madon, Temina; Lustig, Steve

    2006-01-01

    This study examined the mental health needs, knowledge, and utilization of counseling services among graduate students at a large university in the western United States. Almost half of graduate student respondents reported having had an emotional or stress related problem over the past year, and over half reported knowing a colleague who had an…

  11. Service utilization in community health centers in China: a comparison analysis with local hospitals

    PubMed Central

    Pan, Xilong; Dib, Hassan H; Wang, Xiaohang; Zhang, Hong

    2006-01-01

    Background Being an important part of China's Urban Health Care Reform System, Community Health Centers (CHCs) have been established throughout the entire country and are presently undergoing substantial reconstruction. However, the services being delivered by the CHCs are far from reaching their performance targets. In order to assess the role of the CHCs, we examined their performance in six cities located in regions of South-East China. The purpose of this investigation was to identify the utilization and the efficiency of community health resources that are able to provide basic medical and public health services. Methods The study was approved by Peking University Health Science Center Institutional Reviewing Board (NO: IRB00001052-T1). Data were collected from all the local health bureaux and processed using SPSS software. Methods of analysis mainly included: descriptive analysis, paired T-test and one-way ANOVA. Results The six main functions of the CHCs were not fully exploited and the surveys that were collected on their efficiency and utilization of resources indicate that they have a low level of performance and lack the trust of local communities. Furthermore, the CHCs seriously lack funding support and operate under difficult circumstances, and residents have less positive attitudes towards them. Conclusion The community health service must be adjusted according to the requirements of urban medical and health reform, taking into account communities' health needs. More research is required on the living standards and health needs of residents living within the CHC's range, taking into consideration the users' needs in expanding the newly implemented service, and at the same time revising the old service system so as to make the development of CHCs realistic and capable of providing a better service to patients. Several suggestions are put forward for an attainable scheme for developing a community health service. PMID:16887022

  12. The Bioenergetic Health Index is a sensitive measure of oxidative stress in human monocytes

    PubMed Central

    Chacko, Balu K.; Zhi, Degui; Darley-Usmar, Victor M.; Mitchell, Tanecia

    2015-01-01

    Metabolic and bioenergetic dysfunction are associated with oxidative stress and thought to be a common underlying mechanism of chronic diseases such as atherosclerosis, diabetes, and neurodegeneration. Recent findings support an emerging concept that circulating leukocytes and platelets can act as sensors or biomarkers of mitochondrial function in patients subjected to metabolic diseases. It is proposed that systemic stress-induced alterations in leukocyte bioenergetics are the consequence of several factors including reactive oxygen species. This suggests that oxidative stress mediated changes in leukocyte mitochondrial function could be used as an indicator of bioenergetic health in individuals. To test this concept, we investigated the effect of the redox cycling agent, 2,3 dimethoxynaphthoquinone (DMNQ) on the bioenergetic profiles of monocytes isolated from healthy human subjects using the extracellular flux analyzer. In addition, we tested the hypothesis that the bioenergetic health index (BHI), a single value that represents the bioenergetic health of individuals, is dynamically sensitive to oxidative stress in human monocytes. DMNQ decreased monocyte ATP-linked respiration, maximal respiration, and reserve capacity and caused an increase in proton leak and non-mitochondrial respiration compared to monocytes not treated with DMNQ. The BHI was a more sensitive indicator of the DMNQ-dependent changes in bioenergetics than any individual parameter. These data suggest that monocytes are susceptible to oxidative stress mediated by DMNQ and this can be accurately assessed by the BHI. Taken together, our findings suggest that the BHI has the potential to act as a functional biomarker of the impact of systemic oxidative stress in patients with metabolic disorders. PMID:26748041

  13. The Bioenergetic Health Index is a sensitive measure of oxidative stress in human monocytes.

    PubMed

    Chacko, Balu K; Zhi, Degui; Darley-Usmar, Victor M; Mitchell, Tanecia

    2016-08-01

    Metabolic and bioenergetic dysfunction are associated with oxidative stress and thought to be a common underlying mechanism of chronic diseases such as atherosclerosis, diabetes, and neurodegeneration. Recent findings support an emerging concept that circulating leukocytes and platelets can act as sensors or biomarkers of mitochondrial function in patients subjected to metabolic diseases. It is proposed that systemic stress-induced alterations in leukocyte bioenergetics are the consequence of several factors including reactive oxygen species. This suggests that oxidative stress mediated changes in leukocyte mitochondrial function could be used as an indicator of bioenergetic health in individuals. To test this concept, we investigated the effect of the redox cycling agent, 2,3 dimethoxynaphthoquinone (DMNQ) on the bioenergetic profiles of monocytes isolated from healthy human subjects using the extracellular flux analyzer. In addition, we tested the hypothesis that the bioenergetic health index (BHI), a single value that represents the bioenergetic health of individuals, is dynamically sensitive to oxidative stress in human monocytes. DMNQ decreased monocyte ATP-linked respiration, maximal respiration, and reserve capacity and caused an increase in proton leak and non-mitochondrial respiration compared to monocytes not treated with DMNQ. The BHI was a more sensitive indicator of the DMNQ-dependent changes in bioenergetics than any individual parameter. These data suggest that monocytes are susceptible to oxidative stress mediated by DMNQ and this can be accurately assessed by the BHI. Taken together, our findings suggest that the BHI has the potential to act as a functional biomarker of the impact of systemic oxidative stress in patients with metabolic disorders. PMID:26748041

  14. Health Care Service Utilization of Dementia Patients before and after Institutionalization: A Claims Data Analysis

    PubMed Central

    Schwarzkopf, Larissa; Hao, Yi; Holle, Rolf; Graessel, Elmar

    2014-01-01

    Background Community-based and institutional dementia care has been compared in cross-sectional studies, but longitudinal information on the effect of institutionalization on health care service utilization is sparse. Methods We analyzed claims data from 651 dementia patients via Generalized Estimation Equations to assess health care service utilization profiles and corresponding expenditures from four quarters before to four quarters after institutionalization. Results In all domains, utilization increased in the quarter of institutionalization. Afterwards, the use of drugs, medical aids, and non-physician services (e.g., occupational therapy and physiotherapy) remained elevated, but use of in- and outpatient treatment decreased. Cost of care showed corresponding profiles. Conclusion Institutional dementia care seems to be associated with an increased demand for supportive services but not necessarily for specialized medical care. PMID:25337076

  15. Mental health utilization of new-to-care Iraq and Afghanistan Veterans following suicidal ideation assessment.

    PubMed

    Denneson, Lauren M; Corson, Kathryn; Helmer, Drew A; Bair, Matthew J; Dobscha, Steven K

    2014-07-30

    We evaluated the impact of brief structured suicidal ideation (SI) assessments on mental health care among new-to-care Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans. National datasets provided military, demographic, and clinical information. For all new-to-care OEF/OIF veterans administered depression screens (PHQ-2: Patient Health Questionnaire-2) and structured SI assessments in primary care or ambulatory mental health settings of three Veterans Affairs (VA) Medical Centers between April 2008 and September 2009 (N=465), generalized estimating equations were used to examine associations between SI and number of subsequent-year specialty mental health visits and antidepressant prescriptions. Approximately one-third of the veterans reported SI. In multivariate models, PTSD and anxiety diagnoses, severe depression symptoms, being married, and SI assessment by a mental health clinician were associated with more mental health visits in the subsequent year. Depression, PTSD, and anxiety diagnoses, and SI assessment by a mental health clinician were associated with receiving antidepressants. Presence of SI did not significantly affect subsequent year mental health utilization when adjusting for diagnostic and clinician variables, but inaugural visits involving mental health clinicians were consistently associated with subsequent mental health care. PMID:24726814

  16. The usefulness of “corrected” body mass index vs. self-reported body mass index: comparing the population distributions, sensitivity, specificity, and predictive utility of three correction equations using Canadian population-based data

    PubMed Central

    2014-01-01

    Background National data on body mass index (BMI), computed from self-reported height and weight, is readily available for many populations including the Canadian population. Because self-reported weight is found to be systematically under-reported, it has been proposed that the bias in self-reported BMI can be corrected using equations derived from data sets which include both self-reported and measured height and weight. Such correction equations have been developed and adopted. We aim to evaluate the usefulness (i.e., distributional similarity; sensitivity and specificity; and predictive utility vis-à-vis disease outcomes) of existing and new correction equations in population-based research. Methods The Canadian Community Health Surveys from 2005 and 2008 include both measured and self-reported values of height and weight, which allows for construction and evaluation of correction equations. We focused on adults age 18–65, and compared three correction equations (two correcting weight only, and one correcting BMI) against self-reported and measured BMI. We first compared population distributions of BMI. Second, we compared the sensitivity and specificity of self-reported BMI and corrected BMI against measured BMI. Third, we compared the self-reported and corrected BMI in terms of association with health outcomes using logistic regression. Results All corrections outperformed self-report when estimating the full BMI distribution; the weight-only correction outperformed the BMI-only correction for females in the 23–28 kg/m2 BMI range. In terms of sensitivity/specificity, when estimating obesity prevalence, corrected values of BMI (from any equation) were superior to self-report. In terms of modelling BMI-disease outcome associations, findings were mixed, with no correction proving consistently superior to self-report. Conclusions If researchers are interested in modelling the full population distribution of BMI, or estimating the prevalence of obesity in a

  17. Body mass index and health status in diabetic and non-diabetic individuals

    PubMed Central

    Jerant, A; Bertakis, K D; Franks, P

    2015-01-01

    Background/Objectives: There is controversy regarding the existence of a body mass index (BMI) mortality paradox in diabetes, whereby the optimal BMI category is higher than it is in non-diabetic persons. To explore possible pathways to a mortality paradox, we examined the relationship of BMI with physical and mental health status in diabetic and non-diabetic persons. Subjects/Methods: We examined adjusted SF-12 Physical and Mental Component Summary (PCS-12 and MCS-12) scores by BMI (kg m−2) category (underweight, <20; normal weight, 20 to <25; overweight, 25 to <30; obese, 30 to <35; severely obese ⩾35) in adult diabetic and non-diabetic respondents to the 2000–2011 United States national Medical Expenditure Panel Surveys (N=119 161). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, comorbidity, urbanicity, geographic region and survey year. Results: In non-diabetic persons the adjusted mean PCS-12 score was highest (that is, most optimal) in the normal-weight category, whereas for diabetic persons the optimal adjusted mean PCS-12 score was in the overweight category (adjusted difference between non-diabetic and diabetic persons in the difference in PCS-12 means for overweight versus normal-weight category=0.8 points, 95% confidence interval; CI 0.1, 1.6; P=0.03). This paradoxical pattern was not evident for the MCS-12, and the adjusted difference between non-diabetic and diabetic persons in the difference in MCS-12 means for overweight versus obese persons was not significant (−0.3 points, 95% CI −0.9, 0.4; P=0.43). The findings were not significantly moderated by smoking status, cancer diagnosis or time period. Conclusions: The optimal BMI category for physical health status (but not mental health status) was higher among diabetic than non-diabetic persons. The findings are consistent with a BMI physical health status paradox in diabetes and, in turn, a mortality paradox. PMID:25915741

  18. Assigning values to intermediate health states for cost-utility analysis: theory and practice.

    PubMed

    Cohen, B J

    1996-01-01

    Cost-utility analysis (CUA) was developed to guide the allocation of health care resources under a budget constraint. As the generally stated goal of CUA is to maximize aggregate health benefits, the philosophical underpinning of this method is classic utilitarianism. Utilitarianism has been criticized as a basis for social choice because of its emphasis on the net sum of benefits without regard to the distribution of benefits. For example, it has been argued that absolute priority should be given to the worst off when making social choices affecting basic needs. Application of classic utilitarianism requires use of strength-of-preference utilities, assessed under conditions of certainty, to assign quality-adjustment factors to intermediate health states. The two methods commonly used to measure strength-of-preference utility, categorical scaling and time tradeoff, produce rankings that systematically give priority to those who are better off. Alternatively, von Neumann-Morgenstern utilities, assessed under conditions of uncertainty, could be used to assign values to intermediate health states. The theoretical basis for this would be Harsanyi's proposal that social choice be made under the hypothetical assumption that one had an equal chance of being anyone in society. If this proposal is accepted, as well as the expected-utility axioms applied to both individual choice and social choice, the preferred societal arrangement is that with the highest expected von Neumann-Morgenstern utility. In the presence of risk aversion, this will give some priority to the worst-off relative to classic utilitarianism. Another approach is to raise the values obtained by time-tradeoff assessments to a power a between 0 and 1. This would explicitly give priority to the worst off, with the degree of priority increasing as a decreases. Results could be presented over a range of a. The results of CUA would then provide useful information to those holding a range of philosophical points

  19. The gender gap in primary health care resource utilization in Central Asia.

    PubMed

    Cashin, Cheryl E; Borowitz, Michael; Zuess, Olga

    2002-09-01

    There is a large gender gap in life expectancy in some countries of the former Soviet Union. Life expectancy of males is as much as 13 years less than that of females, and a significant portion of the excess male mortality is caused by cardiovascular disease. Although effective primary health care is necessary to manage cardiovascular disease and reduce acute episodes and mortality, the primary health care system is under-utilized by adult males in the region. This study combines disaggregated utilization data with cost data to analyze patterns of per capita primary care resource consumption in urban and rural regions of Kazakhstan and Uzbekistan. The results show that both in absolute and per capita terms, the principal users of primary health are women of reproductive age and children under five. Based on a combination of utilization and cost of services, women of reproductive age consume approximately 1.5 times the average per capita primary health care resources, while men in the same age group consume approximately one-half of the average. Children under five consume about three to five times the average per capita primary care resources. Based on the results of the study, regional government health purchasers worked together with providers to develop a new per capita payment system with age/sex adjustments and incentives for outreach to bring adult men into the primary care system. PMID:12135992

  20. Effect of diabetic case management intervention on health service utilization in Korea.

    PubMed

    Shin, Soon Ae; Kim, Hyeongsu; Lee, Kunsei; Lin, Vivian; Liu, George

    2015-12-01

    This study is to estimate the effectiveness of a diabetic case management programme on health-care service utilization. The study population included 6007 as the intervention group and 956,766 as the control group. As the indicators of health-care service utilization, numbers of medical ambulatory consultations, days of medication prescribed and medical expenses for one year were used, and we analysed the claim data of the health insurance from 2005 to 2007. The study population was classified into three subgroups based on the number of medical ambulatory consultations per year before this intervention. In the under-serviced subgroup, the intervention group showed a significant increase in the number of consultations (3.2), days of prescribed medication (66.4) and medical expenses (287,900 KRW) compared with the control group. Conversely, in the over-serviced subgroup, the intervention group showed a less decrease days of prescribed medication (1.6) compared with the control group. This showed that the case management programme led the intervention group to optimize their utilization of health-care services by subgroups. It is necessary to evaluate the appropriateness of health-care usage and clinical outcome to show the direct effectiveness of the case management programme by subgroups. PMID:24821209

  1. Explaining health care utilization for panic attacks using cusp catastrophe modeling.

    PubMed

    Katerndahl, David

    2008-10-01

    Despite increased health care utilization, patients with panic disorder continue to report unmet needs. The objective was to compare the fit of linear and Cusp Catastrophe Modeling in explaining changes in utilization of emergency, general and mental health settings, and self-treatments for panic symptoms. This community-based study surveyed 97 subjects with panic attacks drawn from a sample of randomly-selected adults from randomly-selected households. The stressor (splitting) variable used was Phobic Anxiety while predisposing variables included Family Health Care Utilization, Perceived Life Threat and Need For Treatment, and Treatment Experience. Outcomes consisted of the number of sites and self-treatments used for panic symptoms when first seeking care and during the 2 months prior to survey. Use of mental health sites and self-treatments demonstrated superior modeling with cusp catastrophe approaches using treatment experience as the predisposing variable, accounting for 47% and 38% of variances respectively, improving the fit by over 20% compared to the best linear models in both cases. Cusp catastrophe modeling accounted for more variance than all linear models when describing use of mental health settings and self-treatments. Cusp catastrophe may explain bimodal distributions in behavior, delays in behavior change, and sudden shifts in behavior in stressful situations. PMID:18765074

  2. VA Health Service Utilization for Homeless and Low-income Veterans

    PubMed Central

    Gabrielian, Sonya; Yuan, Anita H.; Andersen, Ronald M.; Rubenstein, Lisa V.; Gelberg, Lillian

    2016-01-01

    Background The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program—the VA’s Housing First effort—is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. Objectives We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. Research Design We performed a secondary database analysis of Veterans (n = 62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. Results HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. Conclusions Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care. PMID:24714583

  3. The Influence of Parenting on Early Childhood Health and Health Care Utilization

    PubMed Central

    Hubert, Michele; Hastings, Paul D.; Stack, Dale M.; Schwartzman, Alex E.

    2014-01-01

    Objective This study examined whether parenting, specifically parental support, structure, and behavioral control, predicted early childhood health care use and moderated the negative effects of socioeconomic disadvantage. Methods A sample of 250 parent–child dyads from a longitudinal intergenerational research program participated. Results Greater parental support was associated with increased rates of nonemergency care and a higher ratio of outpatient to emergency room (ER) services, a pattern reflecting better health and service use. Support also moderated the negative effects of disadvantaged family background. Greater behavioral control by parents predicted lower rates of both nonemergency care and ER visits. Structured parenting and behavioral control were associated with lower rates of respiratory illness. Conclusions This study highlights the importance of considering parenting practices when examining variations in early childhood health and health care, and the relevance of parental behavior in designing interventions for high-risk populations. PMID:25016605

  4. Development and utilization of professional standards in health education and promotion: US and UK experiences.

    PubMed

    Speller, Viv; Smith, Becky J; Lysoby, Linda

    2009-06-01

    This article defines standards, discusses the components of standards development, and provides an overview of the use of standards in the credentialing processes of health promotion and education specialists. Credentialing or registering agencies related to health promotion and education in the US and UK are identified and their role in credentialing processes is discussed. Examples outlining the development and application of professional standards in both the UK and US are presented. In order to advance the development of international competencies in health promotion, and move towards agreement between different country accrediting systems, there needs to be additional clarification and/or standardization of health promotion terminology at the global level, and further in-depth work to review the implementation of different systems on the ground to enhance our common understanding of the standards employed and competencies required in order to assist the development and utilization of standards for health promotion and education specialists in various countries/regions. PMID:19477861

  5. Utility of the International Classification of Functioning, Disability and Health (ICF) for educational psychologists’ work

    PubMed Central

    Aljunied, Mariam; Frederickson, Norah

    2014-01-01

    Despite embracing a bio-psycho-social perspective, the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) assessment framework has had limited application to date with children who have special educational needs (SEN). This study examines its utility for educational psychologists’ work with children who have Autism Spectrum Disorders (ASD). Mothers of 40 children with ASD aged eight to 12 years were interviewed using a structured protocol based on the ICF framework. The Diagnostic Interview for Social and Communication Disorder (DISCO) was completed with a subset of 19 mothers. Internal consistency and inter-rater reliability of the interview assessments were found to be acceptable and there was evidence for concurrent and discriminant validity. Despite some limitations, initial support for the utility of the ICF model suggests its potential value across educational, health and care fields. Further consideration of its relevance to educational psychologists in new areas of multi-agency working is warranted. PMID:26157197

  6. Psychosocial Predictors of Mental Health Service Utilization among Women During their Mid-Sixties

    PubMed Central

    Pahl, Kerstin; Brook, Judith S.; Zhang, Chenshu; Brook, David W.

    2014-01-01

    This longitudinal study examined the longitudinal pathways to the utilization of mental health services among women in their mid-sixties. Earlier educational level, psychological symptoms, cigarette use, and physical diseases, and later psychological symptoms were examined as predictors of mental health services utilization. The sample consisted of a prospective cohort of women (N=511) who were followed from young adulthood (mean age = 32) to late midlife (mean age = 65). Using structural equation modeling, the results supported a mediational model showing that earlier low educational level and greater psychological symptoms predicted increased cigarette smoking. Cigarette smoking predicted later physical diseases and symptoms. Physical diseases and symptoms were related to financial difficulty and later psychological symptoms and, ultimately, the use of mental health services. PMID:24878632

  7. Psychosocial Predictors of Mental Health Service Utilization Among Women During their Mid-Sixties.

    PubMed

    Pahl, Kerstin; Brook, Judith S; Zhang, Chenshu; Brook, David W

    2016-04-01

    This prospective study examined the longitudinal pathways to the utilization of mental health services among women in their mid-sixties. Earlier educational level, psychological symptoms, cigarette use, and physical diseases and later psychological symptoms were examined as predictors of mental health services utilization. The sample consisted of a prospective cohort of women (N = 511) who were followed from young adulthood (mean age = 32) to late midlife (mean age = 65). Using structural equation modeling, the results supported a mediational model showing that earlier low educational level and greater psychological symptoms predicted increased cigarette smoking. Cigarette smoking predicted later physical diseases and symptoms. Physical diseases and symptoms were related to financial difficulty and later psychological symptoms and, ultimately, the use of mental health services by women in the mid-sixties. PMID:24878632

  8. Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data

    PubMed Central

    Saxena, Deepak; Vangani, Ruchi; Mavalankar, Dileep V.; Thomsen, Sarah

    2013-01-01

    Background Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Methods Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3) carried out during 2007–2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes – Institutional delivery, antenatal care (ANC), and use of modern contraception – and selected intermediary and structural determinants of health using multiple logistic regression. Results Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Discussion and conclusions Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste) has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic education and

  9. The Rural – Urban Divide: Health Services Utilization Among Older Mexicans in Mexico

    PubMed Central

    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 services” of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). Findings Results showed that older Mexicans living in the most rural areas (populations of 2500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Conclusions Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health. PMID:21029168

  10. Longitudinal Analysis of Changes in Illicit Drug Use and Health Services Utilization

    PubMed Central

    French, Michael T; Fang, Hai; Balsa, Ana I

    2011-01-01

    Objective To analyze the relationships between illicit drug use and three types of health services utilization: emergency room utilization, hospitalization, and medical attention required due to injury(s). Data Waves 1 and 2 (11,253 males and 13,059 females) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Study Design We derive benchmark estimates by employing standard cross-sectional data models to pooled waves of NESARC data. To control for potential bias due to time-invariant unobserved individual heterogeneity, we reestimate the relationships with fixed-effects models. Principal Findings The cross-sectional data models suggest that illicit drug use is positively and significantly related to health services utilization in almost all specifications. Conversely, the only significant (p<.05) relationships in the fixed-effects models are the odds of receiving medical attention for an injury and the number of injuries requiring medical attention for men, and the number of times hospitalized for men and women. Conclusions Failing to control for time-invariant individual heterogeneity could lead to biased coefficients when estimating the effects of illicit drug use on health services utilization. Moreover, it is important to distinguish between types of drug user (casual versus heavy) and estimate gender-specific models. PMID:21143479

  11. Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan

    PubMed Central

    Memon, Zahid; Zaidi, Shehla; Riaz, Atif

    2016-01-01

    Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers.

  12. Repeated measures of body mass index and risk of health related outcomes.

    PubMed

    Claessen, Heiner; Brenner, Hermann; Drath, Christoph; Arndt, Volker

    2012-03-01

    Most studies examining the association between body mass index (BMI) and mortality neglected changes in weight over time, which may have led to underestimation of the true association. The aim of this study is to examine the relationship between BMI and health related outcomes while accounting for variations of BMI over time. The association between BMI and both mortality and occupational disability was examined in a follow-up of 5,554 male construction workers in Württemberg/Germany, who participated at least two times in routine occupational health examinations between 1986 and 2005. Using Cox proportional hazards model with time dependent variables, hazard ratios were calculated with normal weight (<25 kg/m²) as reference after adjustment for potential confounding factors. Overall, an U-shaped association between baseline BMI and mortality (370 events) as well as occupational disability (658 events) was observed, with lowest risk at BMI levels between 25 and 30 kg/m². Men with a baseline BMI ≥ 30 kg/m² experienced a 10% higher mortality and disability risk than normal weight men. The association between BMI and occupational disability became stronger after accounting for temporal variability of BMI with a significant increased risk of 1.26 (95% confidence interval: 1.01-1.56) among obese men. In contrast, the association between BMI and mortality did not materially change after accounting for time dependent effects. Stable obesity as defined by a BMI of 30 kg/m² and above increases risk of disability in male construction workers. Accounting for changes of BMI over time is crucial for disclosing full impact of obesity. PMID:22388768

  13. The Healthy Meal Index: A tool for measuring the healthfulness of meals served to children.

    PubMed

    Kasper, Nicole; Mandell, Cami; Ball, Sarah; Miller, Alison L; Lumeng, Julie; Peterson, Karen E

    2016-08-01

    Family meals have been associated with higher diet quality and reduced risk of obesity in children. Observational studies of the family meal have been employed with increasing frequency, yet there is currently no tool available for measuring the healthfulness of food served during the meal. Here we present the development and validation of the Healthy Meal Index (HMI), a novel tool for scoring the healthfulness of foods served to children during a meal, as well as sociodemographic predictors of meal scores. Parents of 233 children, aged 4-8 years, self-recorded three home dinners. A research assistant obtained a list of foods available during the meal (meal report) via phone call on the night of each video-recorded meal. This meal report was coded into component food groups. Subsequently, meals were scored based on the availability of more healthy "Adequacy foods" and the absence of "Moderation foods", (of which reduced consumption is recommended, according to pediatric dietary guidelines). Adjusted linear regression tested the association of sociodemographic characteristics with HMI scores. A validation study was conducted in a separate sample of 133 children with detailed meal data. In adjusted models, female children had higher HMI Moderation scores (p = 0.02), but did not differ in HMI Adequacy or Total scores. Parents with more education served meals with higher HMI Adequacy (p = 0.001) and Total scores (p = 0.001), though no significant difference was seen in HMI Moderation score (p = 0.21). The validation study demonstrated that the HMI was highly correlated with servings of foods and nutrients estimated from observations conducted by research staff. The HMI is a valuable tool for measuring the quality of meals served to children. PMID:26994739

  14. Dietary Inflammatory Index (DII) and risk of colorectal cancer in Iowa Women's Health Study

    PubMed Central

    Shivappa, Nitin; Prizment, Anna E; Blair, Cindy K.; Jacobs, David R.; Steck, Susan E.; Hébert, James R.

    2014-01-01

    Background Colorectal cancer (CRC), the third most common cancer in the United States, has a natural history that usually encompasses several decades. Dietary components have been implicated in the etiology of CRC, perhaps through their effect on inflammation. Methods We examined the ability of the dietary inflammatory index (DII) to predict CRC in the Iowa Women's Health Study. The DII was computed based on dietary intake assessed by a 121-item food frequency questionnaire in this cohort of 34,703 women, aged 55–69 years, free of any self-reported prior malignancy at enrollment in 1986. Incident CRC cases were identified through linkage with the State Health Registry of Iowa (a Surveillance, Epidemiology and End Results program member). Cox proportional hazards regression was used to estimate hazard ratios (HR). Through the end of 2010, 1636 incident CRCs were identified, including 1329 colon and 325 rectal cancers. Results Multivariable analysis, adjusting for BMI, smoking status, pack-years of smoking, hormone replacement therapy, education, diabetes and total energy intake, revealed positive associations between higher DII and CRC risk (HR for DIIcontinuous: 1.07 per unit increase in DII (corresponding to 0.5 standard deviation unit increase); 95%CI 1.01- 1.13; HR for DIIquintiles: Q5vsQ1=1.20; 95%CI 1.01- 1.43). HRs for DII were similar for colon cancer and rectal cancer, though not statistically significant for rectal cancer. Conclusions These results indicate that a pro-inflammatory diet, as indicated by higher DII scores, was associated with higher risk of developing CRC. Impact Pro-inflammatory diets are associated with increased risk of CRC. PMID:25155761

  15. Utilization and Cost of Health Services in Individuals With Traumatic Brain Injury

    PubMed Central

    Dismuke, Clara E.; Walker, Rebekah J.; Egede, Leonard E.

    2015-01-01

    Traumatic Brain Injury (TBI) has gained attention in the past decade as a “signature injury” in the conflicts in Iraq and Afghanistan. TBI is a major burden for both the military and civilian population in the US and worldwide. It is a leading cause of death and disability in the US and a major health services resource burden. We seek to answer two questions. What is the evidence regarding the association of TBI with health services utilization and costs in the US and worldwide? What is the evidence regarding racial/ethnic, gender, geographic, socio-economic and other disparities in health services utilization and cost in the US and worldwide? To attain this goal we searched several databases using key words to perform a systematic review of the literature since 2000. We found 36 articles to be eligible for inclusion in the review. The evidence demonstrates a wide variation in health services utilization and costs depending on population of study and severity of TBI. The evidence also supports the existence of racial/ethnic, gender, insurance, geographic disparities in the US as well as other unique disparities worldwide. PMID:26153156

  16. Does distrust in providers affect health-care utilization in China?

    PubMed Central

    Duckett, Jane; Hunt, Kate; Munro, Neil; Sutton, Matt

    2016-01-01

    How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence. PMID:27117483

  17. Effect of Health Literacy on the Utilization of Advance Directives Based on the Health Belief Model

    ERIC Educational Resources Information Center

    Henkelman, Wallace J.

    2010-01-01

    Research has demonstrated that only a small proportion of individuals in the United States complete advance directives as part of their planning for end-of-life care. This study sought to determine if health literacy is a significant factor in advance directive completion as has been posited by previous researchers. Analysis of the data collected…

  18. Body mass index, poor diet quality and health related quality of life are associated with mortality in rural older adults

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In an aging population, potentially modifiable factors impacting mortality such as diet quality, body mass index (BMI), and health-related quality of life (HRQOL) are of interest. Surviving members of the Geisinger Rural Aging Study (GRAS) (n = 5,993; aged =74 years) were contacted in the fall of 20...

  19. Weighted Health Status in the Medicare Population: Development of the Weighted Index for the Medicare Current Beneficiary Survey (WHIMCBS).

    ERIC Educational Resources Information Center

    Doctor, Jason N.; Chan, Leighton; MacLehose, Richard F.; Patrick, Donald L.

    2001-01-01

    Developed an approach to constructing an aggregate index of health at the population level with data from Medicare beneficiaries using the 1991 (n=12,667), 1995 (n=15,590), and 1997 (n=17,058) Medicare Current Beneficiary Survey (MCBS). Findings suggest that in addition to mortality, morbidity appears to play a significant role in years of healthy…

  20. Barriers to mental health services utilization in the Niger Delta region of Nigeria: service users’ perspectives

    PubMed Central

    Jack-Ide, Izibeloko Omi; Uys, Leana

    2013-01-01

    Introduction There is only one neuro-psychiatric hospital for over four million people in the Niger Delta region of Nigeria. Low-income groups in urban and rural areas who access care through public mental health clinics are at greater risk of not accessing the needed mental health care. This study aimed to explored barriers that prevent people from utilizing mental health services, and to identifies key factors to increase access and improved service delivery. Methods A qualitative study was conducted among 20 service users attending the outpatient clinic of Rumuigbo neuropsychiatric hospital. Ten participants were caregivers and 10 were clients, both having accessed services for at least one year. Results The mean age was 37.7 years, 60% were males, 40% were unemployed and only 15% had a regular monthly income, while 65% live in rural areas. Barriers observed in mental health services use were physical, financial and cultural. These include absence of service in rural communities, poor knowledge of mental health services, stigma, transportation problems, waiting time at the facility and cost of service. Conclusion Stigma remains a strong barrier to accessing mental health services, and extensive efforts need to be made to overcome ignorance and discrimination. Mental health services need to be provided throughout the health care system to enable people to access them locally and affordably, preventing the need to travel and promoting service uptake and treatment continuation. PMID:23785564

  1. Health care utilization among rural women of child-bearing age: a Nigerian experience

    PubMed Central

    Odetola, Titilayo Dorothy

    2015-01-01

    Introduction Despite the availability of primary health care services in virtually every community and village in Nigeria, clients travel long distances to reach secondary and tertiary health care institutions. Against this backdrop, the researcher sought to find the factors that influence choice of health institutions among pregnant women. Methods A descriptive study was carried out across three levels of health care institutions with a total sample size of 160 clients who were randomly selected. A thoroughly validated 45- item questionnaire was used to explore clients’ perceptions about what factors influence where they access health care services. Results Major findings revealed that level of education, proximity to place of residence, affordability and quality of services rendered, spousal and significant other's influences were active determinants of choice for health institutions among pregnant women in Nigeria. Conclusion This study elicited information on why some types of institutions were preferred. The study has implications for community health nurses and policy makers on what should be done to make health institutions appropriately utilized by community in Nigeria.

  2. Diagnostic accuracy and clinical utility of a new noninvasive index for hepatic steatosis in patients with hepatitis B virus infection

    PubMed Central

    Zhang, Zhiqiao; Wang, Gongsui; Kang, Kaifu; Wu, Guobiao; Wang, Peng

    2016-01-01

    The aim of the present study was to construct a cost-effective noninvasive diagnostic index for prediction of hepatic steatosis in patients with hepatitis B virus(HBV) infection. From January 2011 to January 2015, a total of 364 consecutive subjects who underwent liver biopsies were enrolled. The Receiver-operating characteristic(ROC) curves and Obuchowski measure were constructed to evaluate the diagnostic accuracy of the new index. The AUROCs of steatosis index of patients with HBV infection (SIHBV) in predicting of steatosis were 0.929 (95% confidence interval:0.889–0.970, P < 0.05) in the model group and 0.855 (0.794–0.917, P < 0.05) in the validation group respectively. Comparisons of AUROCs demonstrated that SIHBV was significantly superior to Korean Score, fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product(LAP), and fatty liver disease (FLD) index for prediction of hepatic steatosis in model group and validation group(all P < 0.01). Especially for patients with hepatic steatosis percentage of 5.0–9.9% and 10.0–19.9%, SIHBV had a sensitivity of 63.6% and 79.2%, whereas it were 29.1% and 45.8% for Ultrasonography (all P < 0.05). In conclusion, as a cost-effective, simple, noninvasive, and readily available method, SIHBV may act as a massive screening tool before further examinations such as MRI, CT, transient elastography, or liver biopsy, especially for developing countries. PMID:27597515

  3. Diagnostic accuracy and clinical utility of a new noninvasive index for hepatic steatosis in patients with hepatitis B virus infection.

    PubMed

    Zhang, Zhiqiao; Wang, Gongsui; Kang, Kaifu; Wu, Guobiao; Wang, Peng

    2016-01-01

    The aim of the present study was to construct a cost-effective noninvasive diagnostic index for prediction of hepatic steatosis in patients with hepatitis B virus(HBV) infection. From January 2011 to January 2015, a total of 364 consecutive subjects who underwent liver biopsies were enrolled. The Receiver-operating characteristic(ROC) curves and Obuchowski measure were constructed to evaluate the diagnostic accuracy of the new index. The AUROCs of steatosis index of patients with HBV infection (SIHBV) in predicting of steatosis were 0.929 (95% confidence interval:0.889-0.970, P < 0.05) in the model group and 0.855 (0.794-0.917, P < 0.05) in the validation group respectively. Comparisons of AUROCs demonstrated that SIHBV was significantly superior to Korean Score, fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product(LAP), and fatty liver disease (FLD) index for prediction of hepatic steatosis in model group and validation group(all P < 0.01). Especially for patients with hepatic steatosis percentage of 5.0-9.9% and 10.0-19.9%, SIHBV had a sensitivity of 63.6% and 79.2%, whereas it were 29.1% and 45.8% for Ultrasonography (all P < 0.05). In conclusion, as a cost-effective, simple, noninvasive, and readily available method, SIHBV may act as a massive screening tool before further examinations such as MRI, CT, transient elastography, or liver biopsy, especially for developing countries. PMID:27597515

  4. The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from Medicaid adult vision benefits.

    PubMed

    Lipton, Brandy J; Decker, Sandra L

    2015-12-01

    Increasing the proportion of adults that have regular, comprehensive eye exams and reducing visual impairment due to uncorrected refractive error and other common eye health problems are federal health objectives. We examine the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. Using a difference-in-difference-in-difference approach, we find that Medicaid beneficiaries with vision coverage are 4.4 percentage points (p<0.01) more likely to have seen an eye doctor in the past year, 5.3 percentage points (p<0.01) less likely to report needing but not purchasing eyeglasses or contacts due to cost, 2.0 percentage points (p<0.05) less likely to report difficulty seeing with usual vision correction, and 1.2 percentage points (p<0.01) less likely to have a functional limitation due to vision. PMID:26588999

  5. Health Care Costs, Utilization and Patterns of Care following Lyme Disease

    PubMed Central

    Adrion, Emily R.; Aucott, John; Lemke, Klaus W.; Weiner, Jonathan P.

    2015-01-01

    Background Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome – a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. Objectives 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. Methods This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Results Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses. Conclusions Lyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care

  6. Assessment of health needs and willingness to utilize health care resources of adolescents in a suburban population.

    PubMed

    Marks, A; Malizio, J; Hoch, J; Brody, R; Fisher, M

    1983-03-01

    We investigated whether adolescents living in a middle-class suburb believed that their health needs were being met, and the extent to which they were willing to utilize local health care resources for a range of problems. Self-administered, anonymous questionnaires were completed by 649 students in grades 9 through 12. The mean age of respondents was 15.4 years; 52% were female, and 95% white. They had ready access to medical care: 90% used a specific private physician. From a list of 15 health problems, 60% indicated that they had seen a health provider for at least one of them, most often for stomach pains (22%), headaches (18%), and coughing (16%). From an identical list, 48% indicated that there was at least one problem for which they had never seen a health provider but would like to, most often for a weight problem (14%), birth control (10%), and emotional upset (9%). Although 20% regularly used illegal drugs, 24% were sexually active, and 38% thought they had a weight problem, only 1%, 4%, and 10%, respectively, had sought care for these matters. A majority of students would not choose to go to a private physician for care related to sexuality, substance abuse, or emotional upset, and would not be willing to seek care for these problems with their parents' knowledge. Ready access to private primary care did not assure attention to important health needs among these suburban adolescents. PMID:6827422

  7. A review of health utilities using the EQ-5D in studies of cardiovascular disease

    PubMed Central

    2010-01-01

    Background The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease. Methods A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included. Results Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients. Conclusions The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area. PMID:20109189

  8. [Epidemiology and Public Health: tendencies of the Brazilian epidemiology production regarding volume, indexation and investigation areas - 2001 to 2006].

    PubMed

    Turci, Silvana Rubano Barretto; Guilam, Maria Cristina Rodrigues; Câmara, Maria Clara Coelho

    2010-07-01

    This article examines and interprets the trends of epidemiological production in Brazil in the Public Health context. CAPES indicators from 2001 to 2006 were used as database. We analyzed 26 programs and select the 10 major ones to analyze their bibliographic production in indexed journals. It was observed that the total production of epidemiological articles accounted for 40% of production in Public Health and 55% of the production was published in international journals, especially Cadernos de Saúde Pública, Revista de Saúde Pública and Ciência & Saúde Coletiva. The most prevalent themes were public health nutrition, maternal and infant health and, infectious diseases, particularly AIDS. Environmental e worker's heath, oral health, violence and health of the elderly have been ratified as objects of study for the discipline, while meta-analysis and geoprocessing appear as a useful tool for health services. We conclude that the epidemiological production tends to increase in indexed publications, covering various topics and a wide spectrum of relevant issues to Brazilian health policy. PMID:20694320

  9. Is health, measured by work ability index, affected by 12-hour rotating shift schedules?

    PubMed

    Yong, Mei; Nasterlack, Michael; Pluto, Rolf-Peter; Elmerich, Kathrin; Karl, Dorothee; Knauth, Peter

    2010-07-01

    Two forms of continuously forward rotating 12-h shift schedules exist at BASF's Ludwigshafen site. These shift schedules were compared with a daytime working system to investigate potential differential effects on employee's health status assessed with the Work Ability Index (WAI). In the 3 x 12 system, a 12-h day shift is followed 24 h later by a 12-h night shift, and after a day off the employee returns to the day shift. The 4 x 12 schedule follows the same pattern except that there are 2 days off between the night and next day shift. A total of 924 participants (278 3 x 12 and 321 4 x 12 shiftworkers and 325 day workers) were recruited. A self-administered questionnaire was used to obtain information about shiftwork schedule, demographic characteristics, and lifestyle and social factors, and the WAI was applied. The outcomes of interest were the WAI sum score and its seven dimensions. In examining the relationship with the WAI categories, a Proportional Odds Model (POM) was used to identify the potential determinants. Logistic regression models were used to estimate the impact of age on single dimensions of WAI after adjustment for potential confounding factors. Increasing age and obesity (BMI > or = 30) were the only significant determinants of poorer WAI. Although a positive association was found linking the second WAI dimension (work ability in relation to job demands) with age, an inverse association was demonstrated consistently between age and the third and fourth WAI dimensions, i.e., number of diagnosed diseases and estimated work impairment due to disease, after adjustment for potential confounders. The age-dependency was moderate overall, but seemed to be stronger among shift- than day workers, although this difference did not reach statistical significance. There was no significant differential impact of the working time systems on the WAI sum score or on the individual WAI dimensions. Thus, there is no indication of an excessive adverse health impact

  10. The Affordable Care Act, health care reform, prescription drug formularies and utilization management tools.

    PubMed

    Ung, Brian L; Mullins, C Daniel

    2015-01-01

    The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability. PMID:25217142

  11. Utilizing social networking sites to promote adolescents' health: a pragmatic review of the literature.

    PubMed

    Francomano, Jesse A; Harpin, Scott B

    2015-01-01

    Social networking site use has exploded among youth in the last few years and is being adapted as an important tool for healthcare interventions and serving as a platform for adolescents to gain access to health information. The aim of this study was to examine the strengths, weaknesses, and best practices of utilizing Facebook in adolescent health promotion and research via pragmatic literature review. We also examine how sites can facilitate ethically sound healthcare for adolescents, particularly at-risk youth. We conducted a literature review of health and social sciences literature from the past 5 years related to adolescent health and social network site use. Publications were grouped by shared content then categorized by themes. Five themes emerged: access to healthcare information, peer support and networking, risk and benefits of social network site use in care delivery, overcoming technological barriers, and social network site interventions. More research is needed to better understand how such Web sites can be better utilized to provide access to adolescents seeking healthcare. Given the broad reach of social network sites, all health information must be closely monitored for accurate, safe distribution. Finally, consent and privacy issues are omnipresent in social network sites, which calls for standards of ethical use. PMID:25393833

  12. Utility of qualitative research findings in evidence-based public health practice.

    PubMed

    Jack, Susan M

    2006-01-01

    Epidemiological data, derived from quantitative studies, provide important information about the causes, prevalence, risk correlates, treatment and prevention of diseases, and health issues at a population level. However, public health issues are complex in nature and quantitative research findings are insufficient to support practitioners and administrators in making evidence-informed decisions. Upshur's Synthetic Model of Evidence (2001) situates qualitative research findings as a credible source of evidence for public health practice. This article answers the following questions: (1) where does qualitative research fit within the paradigm of evidence-based practice and (2) how can qualitative research be used by public health professionals? Strategies for using qualitative research findings instrumentally, conceptually, and symbolically are identified by applying Estabrooks' (1999) conceptual structure of research utilization. Different research utilization strategies are illustrated through the use of research examples from the field of work on intimate partner violence against women. Recommendations for qualitative researchers disseminating findings and for public health practitioners/policy makers considering the use of qualitative findings as evidence to inform decisions are provided. PMID:16684207

  13. The role of military social support in understanding the relationship between PTSD, physical health, and healthcare utilization in women veterans.

    PubMed

    Lehavot, Keren; Der-Martirosian, Claudia; Simpson, Tracy L; Shipherd, Jillian C; Washington, Donna L

    2013-12-01

    Posttraumatic stress disorder (PTSD) is a significant predictor of both poorer physical health and increased health care utilization, whereas adequate social support is associated with better physical health and less health care utilization. However, research has not previously examined the simultaneous effects of PTSD and social support on health and health care utilization. This study examined both the independent and interactive effects of PTSD and a particular type of social support (postactive-duty social support from military friends) on self-reported physical health and number of Veterans Health Administration (VHA) visits in the last year. These relationships were examined in a representative, national sample of 3,524 women veterans who completed telephone interviews as part of the National Survey of Women Veterans in 2008-2009. Regression analyses were conducted using these cross-sectional data to examine main effects of PTSD and military social support on physical health and VHA utilization and their interaction. Screening positive for PTSD was associated with poorer health (B = -3.19, SE = 1.47) and increased VHA utilization (B = 0.98, SE = 0.16), whereas greater military social support was associated with better health (B = 0.97, SE = 0.44) and less frequent VHA utilization (B = -0.15, SE = 0.05). Neither moderation model was significant, such that military social support behaved in a similar way regardless of PTSD status. PMID:24203114

  14. Emergency department utilization by patients not meeting Health Plan and Employer Data and Information Set (HEDIS) criteria for persistent asthma.

    PubMed

    Hsu, Robert T; Crawford, William W; Klaustermeyer, William B

    2008-01-01

    Emergency hospital utilization rates for asthma remain high despite advances in asthma controller medications and the presence of widely accepted asthma treatment guidelines. To explore this phenomenon, we analyzed administrative data to determine characteristics of patients seen in the emergency department (ED) for asthma. Complete pharmacy and diagnostic coding records were obtained from consecutive adults (aged 19-56 years) treated for asthma in the ED of a closed-network health maintenance organization between April and July of 2002. Subjects were stratified into asthma severity categories (persistent or non-persistent) based on the National Committee for Quality Assurance 2006 Health Plan and Employer Data and Information Set (HEDIS) criteria for persistent asthma. Eighty-one unique patients made a total of 89 ED visits for asthma during the study period. Of the 89 total ED visits for asthma, 44 (49%) occurred in patients that did not meet HEDIS criteria for persistent asthma. Of the 81 unique patients making asthma-related ED visits, 41 (51%) did not meet HEDIS criteria for persistent asthma. Over one-half (51%) of this nonpersistent population were not given either asthma reliever or asthma controller medications during the 12-month period before their index ED visit. Over the 24-month period before their index ED visit, 37% of nonpersistent patients were dispensed neither asthma reliever nor controller medications. Patients that do not meet HEDIS criteria for persistent asthma account for a substantial percentage of asthma-related ED visits. These patients have a history of low use of asthma medications before their ED visit. PMID:18321427

  15. Utilizing the CIPP Model as a Means to Develop an Integrated Service-Learning Component in a University Health Course

    ERIC Educational Resources Information Center

    Powell, Brent; Conrad, Eric

    2015-01-01

    Purpose: To examine the enhancement of a university health course through the utilization of the CIPP Model as a means to develop an integrated service-learning component. Methods: The CIPP model was utilized in two concurrent semesters of an undergraduate health course in order to design and evaluate the implementation of a drug and alcohol…

  16. The John Bryden memorial lecture: Improving health with the community health index and developments in record linkage.

    PubMed

    Sullivan, Frank

    2014-01-01

    Dr. John Bryden was the executive officer of European Federation for Medical Informatics for a decade between 1998 and 2008. When he retired from active work within the federation, he was awarded an honorary fellowship. In one of his early papers from the 1960s, he described how some relatively novel machines called computers might replace the punched cards that were being used at the time. He saw, before many others, that computers could be used for the care of individual patients and even more so for groups of patients. He implemented a unique patient identifier (community health index) which has enabled Scotland to link electronic medical record data for clinical management of chronic disease deterministically. An example was the development of the Glasgow Coma Scale. One benefit of demonstrating significant value in projects such as this at an early stage of record linkage was that the governance framework for the use of data became relatively permissive. Another major success was diabetes care; it became possible to apply insights from the aggregate data to improve services and make them more efficient. Scotland has developed safe havens for data where not only the physical environment but also the people, mechanisms and projects are all subject to control to ensure safety and confidentiality. Similar moves are under way in Europe. TRANSFoRm (www.transformproject.eu) led by King's college in London is mainly focused on primary care data. Excellence in medical informatics is possible as a result of the work of its pioneers, including John Bryden's first paper suggesting that computers might be useful. PMID:25479345

  17. Financial Incentives, Workplace Wellness Program Participation, and Utilization of Health Care Services and Spending.

    PubMed

    Fronstin, Paul; Roebuck, M Christopher

    2015-08-01

    This paper analyzes data from a large employer that enhanced financial incentives to encourage participation in its workplace wellness programs. It examines, first, the effect of financial incentives on wellness program participation, and second, it estimates the impact of wellness program participation on utilization of health care services and spending. The Patient Protection and Affordable Care Act of 2010 (PPACA) allows employers to provide financial incentives of as much as 30 percent of the total cost of coverage when tied to participation in a wellness program. Participation in health risk assessments (HRAs) increased by 50 percentage points among members of unions that bargained in the incentive, and increased 22 percentage points among non-union employees. Participation in the biometric screening program increased 55 percentage points when financial incentives were provided. Biometric screenings led to an average increase of 0.31 annual prescription drug fills, with related spending higher by $56 per member per year. Otherwise, no significant effects of participation in HRAs or biometric screenings on utilization of health care services and spending were found. The largest increase in medication utilization as a result of biometric screening was for statins, which are widely used to treat high cholesterol. This therapeutic class accounted for one-sixth of the overall increase in prescription drug utilization. Second were antidepressants, followed by ACE inhibitors (for hypertension), and thyroid hormones (for hypothyroidism). Biometric screening also led to significantly higher utilization of biologic response modifiers and immunosuppressants. These specialty medications are used to treat autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, and are relatively expensive compared with non-specialty medications. The added spending associated with the combined increase in fills of 0.02 was $27 per member per year--about one-half of the

  18. Assessing the Health of the U.S. West Coast with a Regional-Scale Application of the Ocean Health Index

    PubMed Central

    Best, Benjamin D.; Doney, Scott C.; Katona, Steven K.; McLeod, Karen L.; Rosenberg, Andrew A.; Samhouri, Jameal F.

    2014-01-01

    Management of marine ecosystems increasingly demands comprehensive and quantitative assessments of ocean health, but lacks a tool to do so. We applied the recently developed Ocean Health Index to assess ocean health in the relatively data-rich US west coast region. The overall region scored 71 out of 100, with sub-regions scoring from 65 (Washington) to 74 (Oregon). Highest scoring goals included tourism and recreation (99) and clean waters (87), while the lowest scoring goals were sense of place (48) and artisanal fishing opportunities (57). Surprisingly, even in this well-studied area data limitations precluded robust assessments of past trends in overall ocean health. Nonetheless, retrospective calculation of current status showed that many goals have declined, by up to 20%. In contrast, near-term future scores were on average 6% greater than current status across all goals and sub-regions. Application of hypothetical but realistic management scenarios illustrate how the Index can be used to predict and understand the tradeoffs among goals and consequences for overall ocean health. We illustrate and discuss how this index can be used to vet underlying assumptions and decisions with local stakeholders and decision-makers so that scores reflect regional knowledge, priorities and values. We also highlight the importance of ongoing and future monitoring that will provide robust data relevant to ocean health assessment. PMID:24941007

  19. Assessing the health of the U.S. west coast with a regional-scale application of the Ocean Health Index.

    PubMed

    Halpern, Benjamin S; Longo, Catherine; Scarborough, Courtney; Hardy, Darren; Best, Benjamin D; Doney, Scott C; Katona, Steven K; McLeod, Karen L; Rosenberg, Andrew A; Samhouri, Jameal F

    2014-01-01

    Management of marine ecosystems increasingly demands comprehensive and quantitative assessments of ocean health, but lacks a tool to do so. We applied the recently developed Ocean Health Index to assess ocean health in the relatively data-rich US west coast region. The overall region scored 71 out of 100, with sub-regions scoring from 65 (Washington) to 74 (Oregon). Highest scoring goals included tourism and recreation (99) and clean waters (87), while the lowest scoring goals were sense of place (48) and artisanal fishing opportunities (57). Surprisingly, even in this well-studied area data limitations precluded robust assessments of past trends in overall ocean health. Nonetheless, retrospective calculation of current status showed that many goals have declined, by up to 20%. In contrast, near-term future scores were on average 6% greater than current status across all goals and sub-regions. Application of hypothetical but realistic management scenarios illustrate how the Index can be used to predict and understand the tradeoffs among goals and consequences for overall ocean health. We illustrate and discuss how this index can be used to vet underlying assumptions and decisions with local stakeholders and decision-makers so that scores reflect regional knowledge, priorities and values. We also highlight the importance of ongoing and future monitoring that will provide robust data relevant to ocean health assessment. PMID:24941007

  20. Predictors of and health services utilization related to depressive symptoms among elderly Koreans.

    PubMed

    Shin, Jin Hee; Do, Young Kyung; Maselko, Joanna; Brouwer, Rebecca J N; Song, Sang Wook; Østbye, Truls

    2012-07-01

    While the prevalence, comorbidity, risk profile and health care utilization for late-life depression have been described for many Western countries, much less is known about the recent epidemiology of late-life depression in East Asian countries such as Korea. We investigated predictors for depressive symptoms and the association between depressive symptoms and the utilization of both medical care and preventive services in elderly Koreans. Data were obtained from a nationally representative sample of Koreans aged 60 and above (2226 men, 2911 women) who participated in the 2008 wave of the Korean Longitudinal Study of Ageing. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression scale. Risk factors considered included sociodemographics, health behaviors, chronic diseases, and physical function. Health care utilization factors included hospitalization, outpatient clinic use and basic medical checkup. Being female, being unmarried, and having less education, lower household income, physical inactivity and lower weight were associated with depressive symptoms. Presence of chronic diseases and limited physical function also showed a significant association with depressive symptoms. Depressive symptoms were associated with increased odds of hospitalization and outpatient visits, but decreased the odds of utilization of basic medical checkup after controlling for potential confounders. Findings on most risk factors, except lower weight, were consistent with reports from Western countries. It is important to recognize the burden of depressive symptoms in the elderly. The interaction of such symptoms with chronic diseases should be acknowledged and considered in the clinical setting as well as in health care planning and policymaking. PMID:22531571

  1. Veterans Affairs databases are accurate for gout-related health care utilization: a validation study

    PubMed Central

    2013-01-01

    Introduction The aim of this study was to assess the accuracy of Veterans Affairs (VA) databases for gout-related health care utilization. Methods This retrospective study utilized VA administrative and clinical databases. A random sample of gout patients with visits (outpatient, inpatient or emergent/urgent care) with or without the diagnosis of gout (International Classification of Diseases, ninth revision, common modification ICD-9-CM code of 274.x or 274.xx) at the Birmingham VA hospital was selected. A blinded abstractor performed a review of VA electronic health records for the documentation of gout or gout-related terms (gouty arthritis, tophaceous gout, tophus/tophi, acute gout, chronic gout, podagra, urate stones, urate or uric acid crystals and so on) in the chief complaint, history of present illness or assessment and plan for the visit; this constituted the gold standard for gout-related utilization. The accuracy of database-derived gout-related claims was assessed by calculating sensitivity, specificity, and positive and negative predictive values (PPV and NPV). Results Of 108 potential visits, 85 outpatient, inpatient or urgent care/emergency room visits to a health care provider (85 patients: 84 men and 1 woman with a mean age of 63 years) and retrievable data from medical records constituted the analyzed dataset. Administrative claims for gout-related utilization with ICD-9 code for gout were accurate with a PPV of 86%, specificity of 95%, sensitivity of 86% and NPV of 95%. Conclusions VA databases are accurate for gout-related visits. These findings support their use for studies of health services and outcome studies. It remains to be seen if these findings are generalizable to other settings and databases. PMID:24377421

  2. Urban Aboriginal mobility in Canada: examining the association with health care utilization.

    PubMed

    Snyder, Marcie; Wilson, Kathi

    2012-12-01

    In recent decades, Indigenous peoples across the globe have become increasingly urbanized. Growing urbanization has been associated with high rates of geographic mobility between rural areas and cities, as well as within cities. In Canada, over 54 percent of Aboriginal peoples are urban and change their place of residence at a higher rate than the non-Aboriginal population. High rates of mobility may affect the delivery and use of health services. The purpose of this paper is to examine the association between urban Aboriginal peoples' mobility and conventional (physician/nurse) as well as traditional (traditional healer) health service use in two distinct Canadian cities: Toronto and Winnipeg. Using data from Statistics Canada's 2006 Aboriginal Peoples Survey, this analysis demonstrates that mobility is a significant predisposing correlate of health service use and that the impact of mobility on health care use varies by urban setting. In Toronto, urban newcomers were more likely to use a physician or nurse compared to long-term residents. This was in direct contrast to the effect of residency on physician and nurse use in Winnipeg. In Toronto, urban newcomers were less likely to use a traditional healer than long-term residents, indicating that traditional healing may represent an unmet health care need. The results demonstrate that distinct urban settings differentially influence patterns of health service utilization for mobile Aboriginal peoples. This has important implications for how health services are planned and delivered to urban Aboriginal movers on a local, and potentially global, scale. PMID:23078674

  3. Development of a 5 year life expectancy index in older adults using predictive mining of electronic health record data

    PubMed Central

    Mathias, Jason Scott; Agrawal, Ankit; Feinglass, Joe; Cooper, Andrew J; Baker, David William; Choudhary, Alok

    2013-01-01

    Objective Incorporating accurate life expectancy predictions into clinical decision making could improve quality and decrease costs, but few providers do this. We sought to use predictive data mining and high dimensional analytics of electronic health record (EHR) data to develop a highly accurate and clinically actionable 5 year life expectancy index. Materials and methods We developed the index using EHR data for 7463 patients ≥50 years old with ≥1 visit(s) in 2003 to a large, academic, multispecialty group practice. We extracted 980 attributes from the EHRs of the practices and affiliated hospitals. Correlation feature selection with greedy stepwise search was used to find the attribute subset with best average merit. Rotation forest ensembling with alternating decision tree as underlying classifier was used to predict 5 year mortality. Model performance was compared with the modified Charlson Comorbidity Index and the Walter life expectancy method. Results Within 5 years of the last visit in 2003, 838 (11%) patients had died. The final model included 24 attributes: two demographic (age, sex), 10 comorbidity (eg, cardiovascular disease), one vital sign (mean diastolic blood pressure), two medications (loop diuretic use, digoxin use), six laboratory (eg, mean albumin), and three healthcare utilization (eg, the number of hospitalizations 1 year prior to the last visit in 2003). The index showed very good discrimination (c-statistic 0.86) and outperformed comparators. Conclusions The EHR based index successfully distinguished adults ≥50 years old with life expectancy >5 years from those with life expectancy ≤5 years. This information could be used clinically to optimize preventive service use (eg, cancer screening in the elderly). PMID:23538722

  4. Evaluation of Social Media Utilization by Latino Adolescents: Implications for Mobile Health Interventions

    PubMed Central

    Vyas, Amita; Turner, Monique; Glick, Sara; Wood, Susan

    2015-01-01

    Background Trends in social media use, including sending/receiving short message service (SMS) and social networking, are constantly changing, yet little is known about adolescent’s utilization and behaviors. This longitudinal study examines social media utilization among Latino youths, and differences by sex and acculturation. Objectives The purpose of this study was to examine Latino adolescents’ social media utilization and behavior over a 16-month period, and to assess whether changes in use differed by sex and acculturation. Methods This study included 555 Latino youths aged 13-19 who completed baseline and 16-month follow-up surveys. Prevalence of social media utilization and frequency, by sex and acculturation categories, was examined using generalized estimating equations. Results Women are more likely to use SMS, but men are significantly more likely to SMS a girl/boyfriend (P=.03). The use of Internet by men and women to research health information increased over time. Facebook use declined over time (P<.001), whereas use of YouTube (P=.03) and Instagram (P<.001) increased, especially among women and more US acculturated youths. Conclusion Social media is ubiquitous in Latino adolescents’ lives and may be a powerful mode for public health intervention delivery. PMID:26420553

  5. Homebound older adults: Prevalence, characteristics, health care utilization and quality of care.

    PubMed

    Musich, Shirley; Wang, Shaohung S; Hawkins, Kevin; Yeh, Charlotte S

    2015-01-01

    The purpose of this study was to estimate prevalence rates of homebound older adults, their characteristics and the impact of homebound status on health care utilization, expenditures and quality of medical care measures. Surveys were sent to new enrollees (n = 25,725) in AARP(®) Medicare Supplement plans (insured through UnitedHealthcare) to screen for serious chronic conditions, ambulatory disabilities and eligibility for care coordination programs. Health care utilization and expenditures were determined from paid claims. Member-level quality measures considered compliance with medication adherence and care patterns. Among survey respondents, 19.6% were classified as being homebound. The strongest predictors of being homebound included serious memory loss, being older, having more chronic conditions, taking more prescription medications and having multiple hospitalizations. Homebound had significantly higher health care utilization and expenditures. Homebound were more likely to be noncompliant with medication adherence and care pattern rules. Ongoing screening and subsequent interventions for new enrollees classified as homebound may be warranted. PMID:26254815

  6. Perceptions and utilization of primary health care services in Iraq: findings from a national household survey

    PubMed Central

    2011-01-01

    Background After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. A network exists of public sector hospitals and clinics, as well as private clinics and a few private hospitals. Little data are available about the approximately 1400 Primary Health Care clinics (PHCCs) staffed with doctors. How do Iraqis utilize primary health care services? What are their preferences and perceptions of public primary health care clinics and private primary care services in general? How does household wealth affect choice of services? Methods A 1256 household national survey was conducted in the catchment areas of randomly selected PHCCs in Iraq. A cluster of 10 households, beginning with a randomly selected start household, were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq's 18 governorates. A questionnaire was developed using key informants. Teams of interviewers, including both males and females, were recruited and provided a week of training which included field practice. Teams then gathered data from households in the service areas of randomly selected clinics. Results Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector. Private clinics are generally the most popular source of primary care, however the PHCCs are utilized more by poorer households. In spite of free services available at PHCCs many households expressed difficulty in affording health care, especially in the purchase of medications. There is no evidence of informal payments to secure health services in the public sector. Conclusions There is widespread satisfaction reported with primary health care services, and levels did not differ appreciably between public and private sectors. The public sector PHCCs are preferentially used by poorer populations where they are important providers. PHCC

  7. A Comprehensive Assessment of Health Care Utilization Among Homeless Adults Under a System of Universal Health Insurance

    PubMed Central

    Chambers, Catharine; Chiu, Shirley; Katic, Marko; Kiss, Alex; Redelmeier, Donald A.; Levinson, Wendy

    2013-01-01

    Objectives. We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. Methods. We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and 95% confidence intervals (CIs). Results. Homeless participants had mean rates of 9.1 ambulatory care encounters (maximum = 141.1), 2.0 emergency department (ED) encounters (maximum = 104.9), 0.2 medical–surgical hospitalizations (maximum = 14.9), and 0.1 psychiatric hospitalizations per person-year (maximum = 4.8). Rate ratios for homeless participants compared with matched controls were 1.76 (95% CI = 1.58, 1.96) for ambulatory care encounters, 8.48 (95% CI = 6.72, 10.70) for ED encounters, 4.22 (95% CI = 2.99, 5.94) for medical–surgical hospitalizations, and 9.27 (95% CI = 4.42, 19.43) for psychiatric hospitalizations. Conclusions. In a universal health insurance system, homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services. PMID:24148051

  8. [The health economics of attention deficit hyperactivity disorder in Germany. Part 1: Health care utilization and cost of illness].

    PubMed

    Schlander, M; Trott, G-E; Schwarz, O

    2010-03-01

    In the German region of Nordbaden, 5% of children (aged 7-12 years) and 1.3% of adolescents (aged 13-19 years) were diagnosed with attention deficit hyperactivity disorder (ADHD) in 2003. About two thirds of these patients were not seen by a physician specialized in psychiatry. Now the National Association of Statutory Health Insurance Physicians in Germany (Kassenaerztliche Bundesvereinigung, KBV) has developed a proposal for the integrated provision of care for these patients, combining a guidelines-oriented multidisciplinary approach with a system of quality assurance. Against this background, currently available ADHD-related data are presented, covering epidemiology, comorbidity and differential diagnosis, health care utilization, and cost of illness. According to administrative data analyses from Nordbaden, direct medical costs for patients with ADHD, from the perspective of statutory health insurance (SHI), exceed those of matched controls by a factor of >2.5. On this basis, ADHD-related expenditures of the German SHI may be estimated at around EUR 260 million in 2003, and almost certainly will have continued to grow further since. In addition to this, a diagnosis of ADHD is associated with substantial indirect cost. Although the literature on the burden of ADHD is incomplete, it seems plausible that the cost of illness might be comparable to that reported for alcohol and addiction disorders. Thus we anticipate an increasing relevance of formal health economic evaluations of health care programs offered to patients with ADHD. PMID:20232510

  9. Effect of Risk Adjustment Method on Comparisons of Health Care Utilization Between Complementary and Alternative Medicine Users and Nonusers

    PubMed Central

    Gerkovich, Mary M.; Cherkin, Daniel C.; Deyo, Richard A.; Sherman, Karen J.; Lafferty, William E.

    2013-01-01

    Abstract Objectives Complementary and alternative medicine (CAM) providers are becoming more integrated into the United States health care system. Because patients self-select CAM use, risk adjustment is needed to make the groups more comparable when analyzing utilization. This study examined how the choice of risk adjustment method affects assessment of CAM use on overall health care utilization. Design and subjects Insurance claims data for 2000–2003 from Washington State, which mandates coverage of CAM providers, were analyzed. Three (3) risk adjustment methods were compared in patients with musculoskeletal conditions: Adjusted Clinical Groups (ACG), Diagnostic Cost Groups (DCG), and the Charlson Index. Relative Value Units (RVUs) were used as a proxy for expenditures. Two (2) sets of median regression models were created: prospective, which used risk adjustments from the previous year to predict RVU in the subsequent year, and concurrent, which used risk adjustment measures to predict RVU in the same year. Results The sample included 92,474 claimants. Prospective models showed little difference in the effect of CAM use on RVU among the three risk adjustment methods, and all models had low predictive power (R2 ≤0.05). In the concurrent models, coefficients were similar in direction and magnitude for all risk adjustment methods, but in some models the predicted effect of CAM use on RVU differed by as much as double between methods. Results of DCG and ACG models were similar and were stronger than Charlson models. Conclusions Choice of risk adjustment method may have a modest effect on the outcome of interest. PMID:23036140

  10. Association between body mass index and risk of total knee replacement, the Singapore Chinese Health Study

    PubMed Central

    Leung, Ying-Ying; Allen, John Carson; Noviani, Maria; Ang, Li-Wei; Wang, Renwei; Yuan, Jian-Min; Koh, Woon-Puay

    2014-01-01

    Purpose Data on the association between body mass index (BMI) and risk of knee osteoarthritis (KOA) are sparse for Asian populations who are leaner than Western populations. We evaluated the association between BMI and risk of total knee replacement (TKR) due to severe KOA among Chinese in Singapore. Methods We used data from the Singapore Chinese Health Study, a population based prospective cohort of 63,257 Chinese men and women, aged 45–74 years at enrollment from 1993 to 1998. Information on height, weight, diet and lifestyle factors were obtained via in-person interviews. TKR cases for severe KOA were identified via linkage with the nationwide hospital discharge database through 2011. Cox regression and weighted least squares regression were used in the analysis. Results The mean BMI among cohort participants was 23.1 kg/m2, and more than two-thirds had BMI below 25 kg/m2. A total of 1,649 had TKR attributable to severe KOA. Risk of TKR increased in a strong dose-dependent manner with increasing BMI throughout the 15–32 kg/m2 range and became less clear at BMI > 32 kg/m2. In the BMI range 16–27 kg/m2, there was a 27% increase in TKR risk for each unit increase in BMI (p for trend < 0.001). Compared to BMI 19–20 kg/m2, the risk estimates of TKR were all statistically significant with increasing unit of BMI ≥ 21 kg/m2. Results were similar for men and women. Conclusion Our results provided evidence for a constant mechanical mechanism underlying BMI and KOA initiation and/or progression. PMID:25450848

  11. Body Mass Index and Risk of Nonalcoholic Fatty Liver Disease: Two Electronic Health Record Prospective Studies

    PubMed Central

    Kabadi, Shaum; Preiss, David; Hyde, Craig; Bonato, Vinicius; St. Louis, Matthew; Desai, Jigar; Gill, Jason M. R.; Welsh, Paul; Waterworth, Dawn

    2016-01-01

    Context: The relationship between rising body mass index (BMI) and prospective risk of nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) is virtually absent. Objective: Determine the extent of the association between BMI and risk of future NAFLD diagnosis, stratifying by sex and diabetes. Design: Two prospective studies using Humedica and Health Improvement Network (THIN) with 1.54 and 4.96 years of follow-up, respectively. Setting: Electronic health record databases. Participants: Patients with a recorded BMI measurement between 15 and 60 kg/m2, and smoking status, and 1 year of active status before baseline BMI. Patients with a diagnosis or history of chronic diseases were excluded. Interventions: None. Main Outcome Measure: Recorded diagnosis of NAFLD/NASH during follow-up (Humedica International Classification of Diseases, Ninth Revision code 571.8, and read codes for NAFLD and NASH in THIN). Results: Hazard ratios (HRs) were calculated across BMI categories using BMI of 20–22.5 kg/m2 as the reference category, adjusting for age, sex, and smoking status. Risk of recorded NAFLD/NASH increased linearly with BMI and was approximately 5-fold higher in Humedica (HR = 4.78; 95% confidence interval, 4.17–5.47) and 9-fold higher in THIN (HR = 8.93; 7.11–11.23) at a BMI of 30–32.5 kg/m2 rising to around 10-fold higher in Humedica (HR = 9.80; 8.49–11.32) and 14-fold higher in THIN (HR = 14.32; 11.04–18.57) in the 37.5- to 40-kg/m2 BMI category. Risk of NAFLD/NASH was approximately 50% higher in men and approximately double in those with diabetes. Conclusions: These data quantify the consistent and strong relationships between BMI and prospectively recorded diagnoses of NAFLD/NASH and emphasize the importance of weight reduction strategies for prevention and management of NAFLD. PMID:26672639

  12. Use of the liver activity index and other metabolic variables in the assessment of metabolic health in dairy herds.

    PubMed

    Bertoni, Giuseppe; Trevisi, Erminio

    2013-07-01

    The usefulness of the metabolic profile in dairy cows has been questioned because of poor standardization of procedures, high cost of analysis, and perceived inefficiency of the approach. Composite indices based on multiple variables, namely the Liver Activity Index and the Liver Functionality Index, which consider the pattern of changes of some negative acute-phase proteins in the first month of lactation, appear promising in the assessment of metabolic health status and the prediction of lactational and reproductive performance. The application of such indices depends on their reliability and on making them practical and economical regarding test cost and number of sampling points required. PMID:23809898

  13. Guidelines for the Development and Utilization of Home Health Aide Services in the Community; A Supplement to A Guide for the Utilization of Personnel Supportive of Public Health Nursing Services.

    ERIC Educational Resources Information Center

    American Nurses' Association, New York, NY.

    This analysis is intended to assist public health nurses and others to apply the principles and standards of professional nursing conduct and practice to the development and utilization of home health aide services. Part I, "Development of a Home Health Aide Service" covers (1) agency organization and policies, including such topics as legal…

  14. Participation in a periodic physical examination program and group health care utilization and costs.

    PubMed

    Bernacki, E J; Tsai, S P; Malone, R D

    1988-12-01

    The authors identified 710 male employees of a multinational US corporation eligible to take periodic physical examinations for a consecutive 3-year period (1983 to 1985) and insured by one of the company's health insurers. Group health insurance claims rates and costs for the calendar year 1985 were studied among executives who did not take an examination during the study period, those who took it once or twice, and those who took it all 3 years. Health care utilization for those who did not participate in the program was significantly lower than both groups of participants. Average claim costs in 1985 among those who participated all 3 years ($1,039) was 1.77 times the cost of those who participated one or two times ($588) and 2.30 times the cost of those who did not participate ($452). We conclude that short-term health care utilization and costs are higher among participants than non-participants of a periodic physical examination program. PMID:3230446

  15. Integrating Systems Health Management with Adaptive Controls for a Utility-Scale Wind Turbine

    NASA Technical Reports Server (NTRS)

    Frost, Susan A.; Goebel, Kai; Trinh, Khanh V.; Balas, Mark J.; Frost, Alan M.

    2011-01-01

    Increasing turbine up-time and reducing maintenance costs are key technology drivers for wind turbine operators. Components within wind turbines are subject to considerable stresses due to unpredictable environmental conditions resulting from rapidly changing local dynamics. Systems health management has the aim to assess the state-of-health of components within a wind turbine, to estimate remaining life, and to aid in autonomous decision-making to minimize damage. Advanced adaptive controls can provide the mechanism to enable optimized operations that also provide the enabling technology for Systems Health Management goals. The work reported herein explores the integration of condition monitoring of wind turbine blades with contingency management and adaptive controls. Results are demonstrated using a high fidelity simulator of a utility-scale wind turbine.

  16. Understanding health-care access and utilization disparities among Latino children in the United States.

    PubMed

    Langellier, Brent A; Chen, Jie; Vargas-Bustamante, Arturo; Inkelas, Moira; Ortega, Alexander N

    2016-06-01

    It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006-2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., income) and (2) those attributable to differences in group-specific regression coefficients that measure the health-care 'return' Latino, White, and Black children receive on these characteristics. In the United States, Latino children are less likely than Whites to have a usual source of care, receive at least one preventive care visit, and visit a doctor, and are more likely to have delayed care. The return on sociodemographic characteristics explains 20-30% of the disparity between Latino and White children in the usual source of care, delayed care, and doctor visits and 40-50% of the disparity between Latinos and Blacks in emergency department use and preventive care. Much of the health-care disadvantage experienced by Latino children would persist if Latinos had the sociodemographic characteristics as Whites and Blacks. PMID:25395597

  17. Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act

    PubMed Central

    Vargas-Bustamante, Arturo; Mortensen, Karoline; Ortega, Alexander N.

    2016-01-01

    Objective: To examine racial and ethnic disparities in health care access and utilization after the Affordable Care Act (ACA) health insurance mandate was fully implemented in 2014. Research Design: Using the 2011–2014 National Health Interview Survey, we examine changes in health care access and utilization for the nonelderly US adult population. Multivariate linear probability models are estimated to adjust for demographic and sociodemographic factors. Results: The implementation of the ACA (year indicator 2014) is associated with significant reductions in the probabilities of being uninsured (coef=−0.03, P<0.001), delaying any necessary care (coef=−0.03, P<0.001), forgoing any necessary care (coef=−0.02, P<0.001), and a significant increase in the probability of having any physician visits (coef=0.02, P<0.001), compared with the reference year 2011. Interaction terms between the 2014 year indicator and race/ethnicity demonstrate that uninsured rates decreased more substantially among non-Latino African Americans (African Americans) (coef=−0.04, P<0.001) and Latinos (coef=−0.03, P<0.001) compared with non-Latino whites (whites). Latinos were less likely than whites to delay (coef=−0.02, P<0.001) or forgo (coef=−0.02, P<0.001) any necessary care and were more likely to have physician visits (coef=0.03, P<0.005) in 2014. The association between year indicator of 2014 and the probability of having any emergency department visits is not significant. Conclusions: Health care access and insurance coverage are major factors that contributed to racial and ethnic disparities before the ACA implementation. Our results demonstrate that racial and ethnic disparities in access have been reduced significantly during the initial years of the ACA implementation that expanded access and mandated that individuals obtain health insurance. PMID:26595227

  18. Stream health of Courtland Creek, Oakland, California utilizing benthic macroinvertebrates as ecological indicators

    NASA Astrophysics Data System (ADS)

    White, K.; Ahumada, A.; Lopez, C.; Phillips, A.; Varella, N.; Torres, E.; Quintero, D.; Bracho, H.

    2012-12-01

    An initial benthic macroinvertebrate and water quality survey was conducted on Courtland Creek, Oakland, California. Samples were collected from 3 sites between Brookdale avenue and 45th street at accessible sections of this largely culverted stream. To collect macroinvertebrates, brass frame kick nets with 500 micron netting were placed in the stream and substrate was disturbed for 1 minute in front of the opening of the kick net. The kick net was rinsed into a tub and invertebrates were identified and sorted on site. Organisms were ranked using a biotic index and average index was determined for each site. The biotic index of each site ranked the stream overall as poor. Dissolved oxygen and Nitrates were measured using wet chemistry procedures. Dissolved oxygen levels in the stream are sufficient for invertebrates but low for a stream at 4-5ppm. Nitrate levels were significantly high concentrations of 40 ppm for all sites. Nitrate levels recorded could reflect the presence of animal waste in the water or agricultural fertilizer from private homes and gardens that adjoin the stream. The presence of animal waste was observed at all sites in the study area and may have caused the levels of nitrates observed. Nitrate levels are not at toxic levels but at this level affect immunological functions of invertebrates. Results indicate that the habitat and water quality of Courtland Creek is in poor condition and restoration is recommended in order to increase the ecological health or this urban watershed.

  19. From health search to healthcare: explorations of intention and utilization via query logs and user surveys

    PubMed Central

    White, Ryen W; Horvitz, Eric

    2014-01-01

    Objective To better understand the relationship between online health-seeking behaviors and in-world healthcare utilization (HU) by studies of online search and access activities before and after queries that pursue medical professionals and facilities. Materials and methods We analyzed data collected from logs of online searches gathered from consenting users of a browser toolbar from Microsoft (N=9740). We employed a complementary survey (N=489) to seek a deeper understanding of information-gathering, reflection, and action on the pursuit of professional healthcare. Results We provide insights about HU through the survey, breaking out its findings by different respondent marginalizations as appropriate. Observations made from search logs may be explained by trends observed in our survey responses, even though the user populations differ. Discussion The results provide insights about how users decide if and when to utilize healthcare resources, and how online health information seeking transitions to in-world HU. The findings from both the survey and the logs reveal behavioral patterns and suggest a strong relationship between search behavior and HU. Although the diversity of our survey respondents is limited and we cannot be certain that users visited medical facilities, we demonstrate that it may be possible to infer HU from long-term search behavior by the apparent influence that health concerns and professional advice have on search activity. Conclusions Our findings highlight different phases of online activities around queries pursuing professional healthcare facilities and services. We also show that it may be possible to infer HU from logs without tracking people's physical location, based on the effect of HU on pre- and post-HU search behavior. This allows search providers and others to develop more robust models of interests and preferences by modeling utilization rather than simply the intention to utilize that is expressed in search queries. PMID

  20. [Evaluation of the reduction of the visible plaque index and of the gum bleeding index in a program of oral health promotion for children].

    PubMed

    Silveira, João Luiz Gurgel Calvet da; Oliveira, Valéria de; Padilha, Wilton Wilney Nascimento

    2002-01-01

    The purpose of this research was to evaluate the reduction of the VPI (visible plaque index) and of the GBI (gum bleeding index) in children seen at a unit of SUS, in the state of Rio de Janeiro. A comparative and statistical procedure (t-test, by means of the GMC program) was employed in order to assess the variation between initial and final mean VPI and GBI values. Initial values were registered in the beginning of the assistance program, and final values were registered after the children had participated in health promotion activities, which included weekly supervised brushing sessions, individual dietary guidance, collective instructive activities in which parents were present, adjusting of the oral environment, as well as restorative and surgical dental care, during an average period of six months. The studied sample comprised fourty-two children, with an average age of nine years, who presented an average of four teeth affected by caries. The technique of indirect documentation, by means of documental research, was employed. The following results were obtained: initial VPI = 29%; final VPI = 11%; initial GBI = 13% and final GBI = 5%. The observed variations were statistically significant at the level of 1%, which was revealed by the applied statistical test. The program proved efficient as to plaque control, reducing VPI to a more acceptable level. Although GBI presented considerable reduction, the presence of bleeding at the end of the program calls for a better approach in motivating patients as to regular oral hygiene. PMID:12131992

  1. Glucose utilization by intracranial meningiomas as an index of tumor aggressivity and probability of recurrence: a PET study

    SciTech Connect

    Di Chiro, G.; Hatazawa, J.; Katz, D.A.; Rizzoli, H.V.; De Michele, D.J.

    1987-08-01

    Seventeen patients with intracranial meningiomas were studied with positron emission tomography and fluorine-18-2-fluorodeoxyglucose (PET-FDG) to assess the glucose utilization of these tumors. Four meningiomas followed for 3-5 years after PET-FDG and surgery showed no evidence of recurrence. These tumors had significantly lower glucose utilization rates (1.9 mg/dl/min +/- 1.0) than 11 recurrent or regrowing meningiomas (4.5 mg/dl/min +/- 1.96). The glucose metabolic rates of meningiomas correlated with tumor growth, as estimated from changes in tumor size on repeated computed tomographic scans. Histopathologically, a syncytial (atypical) meningioma had the highest glucose utilization rate, followed by a papillary meningioma and an angioblastic meningioma. Individual transitional and syncytial (typical) meningiomas showed marked differences in glucose metabolism despite similar microscopic appearance. Glucose utilization rate appears to be at least as reliable as histologic classification and other proposed criteria for predicting the behavior and recurrence of intracranial meningiomas.

  2. Vagus nerve stimulation therapy for pharmacoresistant epilepsy: effect on health care utilization.

    PubMed

    Bernstein, Allan L; Hess, Terry

    2007-02-01

    We retrospectively analyzed the effects of vagus nerve stimulation (VNS) therapy on utilization of medical services by 138 patients in a large staff-model health maintenance organization. We compared average quarterly rates for 12 months before device implantation with quarterly rates during 48 months of follow-up. Wilcoxon matched-pairs signed-ranks tests comparing pre-VNS with post-VNS utilization rates showed statistically significant reductions in numbers of emergency department visits, hospitalizations, and hospital lengths of stay, beginning with the first quarter after implantation (P<0.05 for all post-implantation quarters for these three aspects). For the first two quarters after implantation, the average number of outpatient visits was significantly greater than the pre-implant quarterly average (quarter 1: P<0.0001; quarter 2: P=0.0067), but the average was 12.2% less by the fourth quarter of the first year after implantation and significantly less beginning with the first quarter of the second year (P=0.0017) and continuing through the end of the study (P<0.0001 for all subsequent quarters). A comparison of time spent on epilepsy-related tasks during the year before implantation with the year after implantation also revealed significant decreases in the average number of days on which patients could not work because of health-related concerns, from 3.67 to 1.04 days (P=0.002, paired Student's t test) and the average time spent caring for health problems, from 352.6 to 136.1 minutes per week (P<0.001). VNS therapy had a positive effect on both the utilization of health care services and the time spent on epilepsy-related tasks for these patients with pharmacoresistant epilepsy. PMID:17084676

  3. Responsiveness of health status measures and utility-based methods in patients with rheumatoid arthritis.

    PubMed

    Salaffi, F; Stancati, A; Carotti, M

    2002-11-01

    The aim of the study was to compare the responsiveness of disease-specific (Arthritis Impact Measurement Scale 2, AIMS2), generic (Medical Outcome Study Short Form Health Survey, SF-36) and preference-based instruments (rating scale, RS and time tradeoff, TTO) to changes in articular status and perceived health in patients with rheumatoid arthritis (RA). Seventy-eight consecutive patients with RA, attending the care facilities of the Department of Rheumatology of Ancona, were recruited in this longitudinal study. In order to assess the responsiveness three strategies were used: effect size (ES), standardised response mean (SRM) and receiver operating characteristic (ROC). There were 55 women and 23 men with a mean age of 56 years (range 19-78) and arthritis duration of 7.1 years (range 6 months to 24 years). Using three-category EULAR criteria as external indicators of improvement/response, 21 patients (27%) reported a significant improvement, 23 (29.5%) moderate improvement, and 34 (43.5%) no change over the 12-month period. The mean change scores in generic and specific health status instruments and utility measures were significantly related to response category. The AIMS2 subscales (physical function, pain, psychological function and social interaction) were slightly more responsive than those of SF-36. The physical and pain dimensions were most sensitive for measuring change over a 12-month period, followed by psychological and social dimensions. For the utility measurement, RS scores were found to be significantly more responsive in detecting changes in preferences than TTO scores. These results may have implications for the application of the health status and utility measures in clinical trials in patients with RA. PMID:12447631

  4. Examining inter-generational differentials in maternal health care service utilization: insights from the Indian Demographic and Health Survey.

    PubMed

    Singh, Prashant Kumar; Singh, Lucky

    2014-05-01

    This study examines the association between age cohort and utilization of maternal health care services in India, before and after adjusting for individual, household and contextual factors. Using data from the Demographic and Health Survey 2005-06, women were classified into three distinct age cohorts based on their age at childbirth: 15-24, 25-34 and 35-49 years. Binary logistic regression models were applied to assess the influence of women's age cohort on receiving full antenatal care (ANC) and skilled birth attendance (SBA). The analytical sample included the women who delivered their most recent birth at any time in the 5 years preceding the survey. Women belonging to the younger age cohort were found to be disadvantaged in receiving full ANC, whereas increasing age of women was negatively associated with receiving SBA. Low level of education, low mass media exposure, low autonomy, belonging to deprived social groups, poor economic status and residence in the central region were found to be major constraining factors in receiving full ANC and SBA for women in India. The findings support the need for 'age-sensitive' interventions that tailor programmes and incentives to women's health care needs through the reproductive life-stage. Urgent efforts are needed to ensure that women who are illiterate and those belonging to low autonomy and low socioeconomic groups receive the recommended maternal health care benefits. PMID:23866261

  5. Adult Day Care: Its Impact on the Utilization of Other Health Care Services and on Quality of Life.

    ERIC Educational Resources Information Center

    Chappell, Neena L.; Blandford, Audrey

    The Adult Day Care Program (ADC) in the Province of Manitoba is a health and social service program providing socialization and recreation in a supportive environment to those who, without this intervention, might deteriorate in physical or mental health function. To examine the impact of adult day care on the utilization of other health care…

  6. Health Behaviors, Service Utilization, and Access to Care among Older Mothers of Color Who Have Children with Developmental Disabilities

    ERIC Educational Resources Information Center

    Magana, Sandy; Smith, Matthew J.

    2008-01-01

    This study examined health behaviors, utilization, and access to care among older Latina and Black American mothers who co-reside with a child with developmental disabilities. Using data from the National Health Interview Survey National Center for Health Statistics (2005a), we compared Latina and Black American caregivers to similar women who did…

  7. Primary Health Care Utilization by the Mexican Indigenous Population: The Role of the Seguro Popular in Socially Inequitable Contexts

    PubMed Central

    Leyva-Flores, Rene; Servan-Mori, Edson; Infante-Xibille, Cesar; Pelcastre-Villafuerte, Blanca Estela; Gonzalez, Tonatiuh

    2014-01-01

    Objective To analyze the relationship between primary health care utilization and extended health insurance coverage under the Seguro Popular (SP) among Mexican indigenous people. Methodology A cross-sectional analysis was conducted using data from the Mexican National Nutrition Survey 2012 (n = 194,758). Quasi-experimental matching methods and nonlinear regression probit models were used to estimate the influence of SP on primary health care utilization. Results 25% of the Mexican population reported having no health insurance coverage, while 59% of indigenous versus 35% of non-indigenous reported having SP coverage. Health problems were reported by 13.9% of indigenous vs. 10.5% of non-indigenous; of these, 52.8% and 57.7% respectively, received primary health care (p<0.05). Economic barriers were the most frequent reasons for not using primary health care services. The probability of utilizing primary health care services was 11.5 percentage points higher (p<0.01) for indigenous SP affiliates in comparison with non-indigenous, in similar socioeconomic conditions. Conclusion Socioeconomic conditions, not ethnicity per-se, determine whether people utilize primary health care services. Therefore, SP can be conceived as a public policy strategy which acts as a social buffer by enhancing health care utilization regardless of ethnicity. Further analysis is required to explore the potential gaps as a result of SP coverage among socially vulnerable groups. PMID:25099399

  8. Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: findings from the rural lower Mississippi delta

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Although health literacy has been a public health priority area for more than a decade, the relationship between health literacy and dietary quality has not been thoroughly explored. This study, evaluates health literacy skills in relation to Healthy Eating Index (HEI) scores and sugar-sweetened bev...

  9. Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s.

    PubMed

    Basu, Sanjay; Rehkopf, David H; Siddiqi, Arjumand; Glymour, M Maria; Kawachi, Ichiro

    2016-03-15

    We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health. PMID:26946395

  10. Does the Universal Health Insurance Program Affect Urban-Rural Differences in Health Service Utilization among the Elderly? Evidence from a Longitudinal Study in Taiwan

    ERIC Educational Resources Information Center

    Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An

    2012-01-01

    Purpose: To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. Methods: A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences…

  11. Prognostic Utility of Apoptosis Index, Ki-67 and Survivin Expression in Dogs with Nasal Carcinoma Treated with Orthovoltage Radiation Therapy

    PubMed Central

    FU, Dah-Renn; KATO, Daiki; WATABE, Ai; ENDO, Yoshifumi; KADOSAWA, Tsuyoshi

    2014-01-01

    ABSTRACT Apoptosis, Ki-67 and survivin expression have been reported as prognostic values in human cancer treated with radiation therapy. The aim of this study was to evaluate the correlation between the outcome of canine nasal carcinomas treated with radiation therapy and these cancer markers. The apoptotic index (AI) was evaluated with TUNEL assays, and an immunohistochemical evaluation was performed on Ki-67 and survivin in 33 biopsy samples taken before treatment. Median survival times were estimated using Kaplan-Meier curves and the log-rank method. The AI ranged from 0 to 0.7%, and the percentage of Ki-67-positive cells defined as the proliferative index (PI) ranged from 0.8 to 77% in all samples. Neither the AI nor the PI had a significant relationship with survival time (P=0.056 and 0.211). Survivin expression was detected in 84.9% of samples of canine nasal carcinoma. Dogs with high survivin expression were associated with poorer response to treatment and had shorter survival times (P=0.017 and 0.031). Advanced-stage tumors were also significantly associated with a high level of survivin (P=0.026). Overexpression of survivin was shown to be an unfavorable prognostic factor in dogs with nasal carcinomas treated with radiation therapy. PMID:25452259

  12. US Hemophilia Treatment Center population trends 1990-2010: patient diagnoses, demographics, health services utilization.

    PubMed

    Baker, J R; Riske, B; Drake, J H; Forsberg, A D; Atwood, R; Voutsis, M; Shearer, R

    2013-01-01

    For several decades, US government agencies have partially supported regional networks of Hemophilia Treatment Centers (HTC). HTC multidisciplinary teams provide comprehensive and coordinated diagnosis, treatment, prevention, education, outreach and surveillance services to improve the health of people with genetic bleeding disorders. However, national data are scarce on HTC-patient population trends and services. The aim of the study was to examine national trends over the past 20 years in patient diagnoses, demographics and health services utilization among the Health Resources and Services Administration (HRSA) and Centers for Disease Control and Prevention (CDC)-supported HTC network. Diagnoses, demographics and health services utilization data from 1990 to 2010 were aggregated from all HTCs using the Hemophilia Data Set (HDS). From 1990 to 2010, the HTC population grew 90% from 17 177 to 32 612. HTC patients with von Willebrand's disease increased by 148%, females by 346%, Hispanic patients by 236% and African Americans by 104%. Four thousand and seventy-five deaths were reported. From 2002 to 2010, annual comprehensive evaluations grew 38%, and persons with severe haemophilia on a home intravenous therapy programme rose 37%. In 2010, 46% of patients were less than 18 years vs. 24% for the general US population. The Hemophilia Data Set documents the growth and diversity of the US Hemophilia Treatment Center Network's patient population and services. Despite disproportionate deaths due to HIV, the HTC patient base grew faster than the general US population. The HDS is a vital national public health registry for this rare-disorder population. PMID:22845803

  13. Ozone risk assessment utilities (ORAMUS) user's manual and tutorial : Volume 2, Chronic health endpoints.

    SciTech Connect

    Clemmons, M. A.; Jusko, M. J.; Whitfield, R. G.

    1998-12-16

    The primary purpose of this manual is to provide instructions on how to install and use the ORAMUS (Ozone Risk AssessMent UtilitieS) software. ORAMUS is a DOS-based software system that allows you to calculate and view risk estimates for health effects attributable to short- and long-term exposure to tropospheric ozone. The system combines exposure estimates with exposure-response relationships and then calculates and displays estimates of the overall risk in the form of probability distributions. ORAMUS allows you to select from three basic models: headcount risk, benchmark risk, and hospital admissions. It calculates a wide range of risk results for 27 air quality scenarios, 9 urban areas, 33 acute health endpoints, 4 chronic health endpoints, and 3 populations of interest. This manual is a tutorial designed to guide you through a series of steps that will familiarize you with the features of the system. The manual consists of two volumes. Volume 1 addresses acute health endpoints, and Volume 2 covers chronic health endpoints. Acute results were used during the National Ambient Air Quality Standards review process for ozone. Chronic results were not used.

  14. Ozone risk assessment utilities (ORAMUS) user's manual and tutorial : Volume 1, Acute health endpoints.

    SciTech Connect

    Clemmons, M. A.; Jusko, M. J.; Whitfield, R. G.

    1998-12-16

    The primary purpose of this manual is to provide instructions on how to install and use the ORAMUS (Ozone Risk AssessMent UtilitieS) software. ORAMUS is a DOS-based software system that allows you to calculate and view risk estimates for health effects attributable to short- and long-term exposure to tropospheric ozone. The system combines exposure estimates with exposure-response relationships and then calculates and displays estimates of the overall risk in the form of probability distributions. ORAMUS allows you to select from three basic models: headcount risk, benchmark risk, and hospital admissions. It calculates a wide range of risk results for 27 air quality scenarios, 9 urban areas, 33 acute health endpoints, 4 chronic health endpoints, and 3 populations of interest. This manual is a tutorial designed to guide you through a series of steps that will familiarize you with the features of the system. The manual consists of two volumes. Volume 1 addresses acute health endpoints, and Volume 2 covers chronic health endpoints. Acute results were used during the National Ambient Air Quality Standards review process for ozone. Chronic results were not used.

  15. Utilizing Exploratory Spatial Data Analysis to Examine Health and Environmental Disparities in Disadvantaged Neighborhoods

    PubMed Central

    Osiecki, Kristin M.; Kim, Seijeoung; Chukwudozie, Ifeanyi B.; Calhoun, Elizabeth A.

    2013-01-01

    Health disparities research has focused primarily on racial and socioeconomic differences in health outcomes. Although neighborhood characteristics and the concept of built environment have been shown to affect individual health, measuring the effects of environmental risks on health has been a less developed area of disparities research. To examine spatial associations and the distribution of geographic patterns of sociodemographic characteristics, environmental cancer risk, and cancer rates, we utilized existing data from multiple sources. The findings from our initial analysis, which concerned with proximity to environmental hazards and at-risk communities, were consistent with results of previous studies, which often reported mixed relationships between health disparity indicators and environmental burden. However, further analysis with refined models showed that several key demographic and subdomains of cancer risk measures were shown to have spatial components. With the application of exploratory spatial data analysis, we were able to identify areas with both high rates of poverty and racial minorities to further examine for possible associations to environmental cancer risk. Global spatial autocorrelation found spatial clustering with percent black, percent poverty, point and non-point cancer risks requiring further spatial analysis to determine relationship of significance based on geography. This methodology was based upon particular assumptions associated with data and applications, which needed to be met. We conclude that careful assessment of the data and applications were required to properly interpret the findings in understanding the relationship between vulnerable populations and environmental burden. PMID:26594302

  16. Impact of metabolic comorbidity on the association between body mass index and health-related quality of life: a Scotland-wide cross-sectional study of 5,608 participants

    PubMed Central

    2012-01-01

    Background The prevalence of obesity is rising in Scotland and globally. Overall, obesity is associated with increased morbidity, mortality and reduced health-related quality of life. Studies suggest that "healthy obesity" (obesity without metabolic comorbidity) may not be associated with morbidity or mortality. Its impact on health-related quality of life is unknown. Methods We extracted data from the Scottish Health Survey on self-reported health-related quality of life, body mass index (BMI), demographic information and comorbidity. SF-12 responses were converted into an overall health utility score. Linear regression analyses were used to explore the association between BMI and health utility, stratified by the presence or absence of metabolic comorbidity (diabetes, hypertension, hypercholesterolemia or cardiovascular disease), and adjusted for potential confounders (age, sex and deprivation quintile). Results Of the 5,608 individuals, 3,744 (66.8%) were either overweight or obese and 921 (16.4%) had metabolic comorbidity. There was an inverted U-shaped relationship whereby health utility was highest among overweight individuals and fell with increasing BMI. There was a significant interaction with metabolic comorbidity (p = 0.007). Individuals with metabolic comorbidty had lower utility scores and a steeper decline in utility with increasing BMI (morbidly obese, adjusted coefficient: -0.064, 95% CI -0.115, -0.012, p = 0.015 for metabolic comorbidity versus -0.042, 95% CI -0.067, -0.018, p = 0.001 for no metabolic comorbidity). Conclusions The adverse impact of obesity on health-related quality of life is greater among individuals with metabolic comorbidity. However, increased BMI is associated with reduced health-related quality of life even in the absence of metabolic comorbidity, casting doubt on the notion of "healthy obesity". PMID:22364437

  17. Systematic review of health state utility values for economic evaluation of colorectal cancer.

    PubMed

    Jeong, Kim; Cairns, John

    2016-12-01

    Cost-utility analyses undertaken to inform decision making regarding colorectal cancer (CRC) require a set of health state utility values (HSUVs) so that the time CRC patients spend in different health states can be aggregated into quality-adjusted life-years (QALY). This study reviews CRC-related HSUVs that could be used in economic evaluation and assesses their advantages and disadvantages with respect to valuation methods used and CRC clinical pathways. Fifty-seven potentially relevant studies were identified which collectively report 321 CRC-related HSUVs. HSUVs (even for similar health states) vary markedly and this adds to the uncertainty regarding estimates of cost-effectiveness. There are relatively few methodologically robust HSUVs that can be directly used in economic evaluations concerned with CRC. There is considerable scope to develop new HSUVs which improve on those currently available either by expanded collection of generic measures or by making greater use of condition-specific data, for example, using mapping algorithms. PMID:27541298

  18. Lessons for the health care industry from America's experience with public utilities.

    PubMed

    Colton, R; Frisof, K B; King, E R

    1997-01-01

    In the United States, the traditional public utilities, power and telecommunications, along with health care, are being deregulated and becoming increasingly competitive, especially on price. Regulation of the public utilities has occurred for the past century not simply because they have been monopolies, but, more importantly, because they are "industries affected with the public interest," that is industries which: 1. provide an essential service, 2. benefit from public prequisites, and 3. would cause great public harm if mismanaged. Consequently, the presence of competition in these industries does not negate the need for regulation. Regulation of these industries is best understood as being along the three sides of a "triangle of public interests"--quality, public accountability, and universal service. Examples are provided of these types of regulation in power and telecommunications, even in current "deregulatory" legislation. Health care reform activists in the United States have lately paid attention mostly to the first two legs of the triangle; they are encouraged to focus creatively on the third leg--universal health care. PMID:9519617

  19. Drug utilization in selected health facilities of South West Shoa Zone, Oromia Region, Ethiopia

    PubMed Central

    Kebede, Mengistu; Kebebe Borga, Dereje; Mulisa Bobasa, Eshetu

    2015-01-01

    Background Sustaining the availability and rational use of safe and effective drugs is a major problem in developing countries. Irrational drug use affects quality of health care more than accessibility of drugs. Objective To assess drug utilization in selected health facilities of South West Shoa Zone, Oromia Region, Ethiopia. Methods A cross-sectional study was conducted in selected health facilities of South West Shoa Zone from January 21–28, 2012 by using structured questionnaires. Results Of 50 prescribers and 30 dispensers, 58% and 83.3% were males, respectively. The result showed that majority of prescribers agreed on availability of essential drugs (72%) and had access to up-to-date drug information (76%). However, 43.3% of dispensers didn’t get access to up-to-date drug information. 86% and 88% of prescribers note cost of drugs and stick to standard treatment guidelines of Ethiopia during prescription, respectively. All drug dispensers check the name of the drug (100%), age of the patient (90%), the dosage form of drug (96.7%), the route of administration (90%), the duration of therapy (86.7%), and frequency of administration (86.7%) for prescription papers. Conclusion In general, drug utilization at the study sites was found to be good, although there are major deviations from the concept of rational drug use. PMID:26229506

  20. Development and validation of an electronic frailty index using routine primary care electronic health record data

    PubMed Central

    Clegg, Andrew; Bates, Chris; Young, John; Ryan, Ronan; Nichols, Linda; Ann Teale, Elizabeth; Mohammed, Mohammed A.; Parry, John; Marshall, Tom

    2016-01-01

    Background: frailty is an especially problematic expression of population ageing. International guidelines recommend routine identification of frailty to provide evidence-based treatment, but currently available tools require additional resource. Objectives: to develop and validate an electronic frailty index (eFI) using routinely available primary care electronic health record data. Study design and setting: retrospective cohort study. Development and internal validation cohorts were established using a randomly split sample of the ResearchOne primary care database. External validation cohort established using THIN database. Participants: patients aged 65–95, registered with a ResearchOne or THIN practice on 14 October 2008. Predictors: we constructed the eFI using the cumulative deficit frailty model as our theoretical framework. The eFI score is calculated by the presence or absence of individual deficits as a proportion of the total possible. Categories of fit, mild, moderate and severe frailty were defined using population quartiles. Outcomes: outcomes were 1-, 3- and 5-year mortality, hospitalisation and nursing home admission. Statistical analysis: hazard ratios (HRs) were estimated using bivariate and multivariate Cox regression analyses. Discrimination was assessed using receiver operating characteristic (ROC) curves. Calibration was assessed using pseudo-R2 estimates. Results: we include data from a total of 931,541 patients. The eFI incorporates 36 deficits constructed using 2,171 CTV3 codes. One-year adjusted HR for mortality was 1.92 (95% CI 1.81–2.04) for mild frailty, 3.10 (95% CI 2.91–3.31) for moderate frailty and 4.52 (95% CI 4.16–4.91) for severe frailty. Corresponding estimates for hospitalisation were 1.93 (95% CI 1.86–2.01), 3.04 (95% CI 2.90–3.19) and 4.73 (95% CI 4.43–5.06) and for nursing home admission were 1.89 (95% CI 1.63–2.15), 3.19 (95% CI 2.73–3.73) and 4.76 (95% CI 3.92–5.77), with good to moderate discrimination

  1. Micromirror-scanned dual-axis confocal microscope utilizing a gradient-index relay lens for image guidance during brain surgery

    PubMed Central

    Liu, Jonathan T.C.; Mandella, Michael J.; Loewke, Nathan O.; Haeberle, Henry; Ra, Hyejun; Piyawattanametha, Wibool; Solgaard, Olav; Kino, Gordon S.; Contag, Christopher H.

    2010-01-01

    A fluorescence confocal microscope incorporating a 1.8-mm-diam gradient-index relay lens is developed for in vivo histological guidance during resection of brain tumors. The microscope utilizes a dual-axis confocal architecture to efficiently reject out-of-focus light for high-contrast optical sectioning. A biaxial microelectromechanical system (MEMS) scanning mirror is actuated at resonance along each axis to achieve a large field of view with low-voltage waveforms. The unstable Lissajous scan, which results from actuating the orthogonal axes of the MEMS mirror at highly disparate resonance frequencies, is optimized to fully sample 500×500 pixels at two frames per second. Optically sectioned fluorescence images of brain tissues are obtained in living mice to demonstrate the utility of this microscope for image-guided resections. PMID:20459274

  2. Development of a Risk Index for Serious Prescription Opioid‐Induced Respiratory Depression or Overdose in Veterans’ Health Administration Patients

    PubMed Central

    Xie, Lin; Wang, Li; Joyce, Andrew; Vick, Catherine; Brigham, Janet; Kariburyo, Furaha; Baser, Onur; Murrelle, Lenn

    2015-01-01

    Abstract Objective Develop a risk index to estimate the likelihood of life‐threatening respiratory depression or overdose among medical users of prescription opioids. Subjects, Design, and Methods A case‐control analysis of administrative health care data from the Veterans’ Health Administration identified 1,877,841 patients with a pharmacy record for an opioid prescription between October 1, 2010 and September 30, 2012. Overdose or serious opioid‐induced respiratory depression (OSORD) occurred in 817. Ten controls were selected per case (n = 8,170). Items for an OSORD risk index (RIOSORD) were selected through logistic regression modeling, with point values assigned to each predictor. Modeling of risk index scores produced predicted probabilities of OSORD; risk classes were defined by the predicted probability distribution. Results Fifteen variables most highly associated with OSORD were retained as items, including mental health disorders and pharmacotherapy; impaired drug metabolism or excretion; pulmonary disorders; specific opioid characteristics; and recent hospital visits. The average predicted probability of experiencing OSORD ranged from 3% in the lowest risk decile to 94% in the highest, with excellent agreement between predicted and observed incidence across risk classes. The model's C‐statistic was 0.88 and Hosmer–Lemeshow goodness‐of‐fit statistic 10.8 (P > 0.05). Conclusion RIOSORD performed well in identifying medical users of prescription opioids within the Veterans’ Health Administration at elevated risk of overdose or life‐threatening respiratory depression, those most likely to benefit from preventive interventions. This novel, clinically practical, risk index is intended to provide clinical decision support for safer pain management. It should be assessed, and refined as necessary, in a more generalizable population, and prospectively evaluated. PMID:26077738

  3. Treatment patterns, health state, and health care resource utilization of patients with radioactive iodine refractory differentiated thyroid cancer

    PubMed Central

    Gianoukakis, Andrew G; Flores, Natalia M; Pelletier, Corey L; Forsythe, Anna; Wolfe, Gregory R; Taylor, Matthew H

    2016-01-01

    Background Patients with differentiated thyroid cancer (DTC) often respond well to treatment but some become refractory to radioactive iodine (RAI) treatment, and treatment options are limited. Despite the humanistic and economic burden RAI refractory disease imposes on patients, published research concerning treatment patterns and health care resource utilization is sparse. Methods Data were collected from an online retrospective chart review study in the US and five European Union (EU) countries (France, Germany, Italy, Spain, and UK) with physicians recruited from an online panel. Physicians (N=211) provided demographics, disease history, treatment information, and health care resource utilization for one to four of their patients with radioactive iodine refractory differentiated thyroid cancer (RR-DTC). Results The majority of the patients with RR-DTC (N=623) were female (56%), and their mean age was 58.2 years. In this sample, 63.2% had papillary thyroid cancer and 57.0% were in Stage IV when deemed RAI refractory. Patients with RR-DTC experienced regional recurrence in the thyroid bed/central neck area (25.3%) and had distant metastatic disease (53.6%). At the time data were collected, 50.7% were receiving systemic treatment. Of those, 78.5% were on first-line treatment and 62.7% were receiving multikinase inhibitors. Regional differences for prescribed treatments were observed; the US was more likely to have patients receiving multikinase inhibitors (79.2%) compared with UK (41.2%) and Italy (17.1%). Additional details regarding treatment patterns and resource utilization are discussed. Conclusion The current study aimed to obtain a greater understanding of RR-DTC treatment globally. These results can assist in the development and implementation of treatment guidelines and ultimately enhance the care of patients with RR-DTC. PMID:27313476

  4. Remoteness and maternal and child health service utilization in rural Liberia: A population–based survey

    PubMed Central

    Kenny, Avi; Basu, Gaurab; Ballard, Madeleine; Griffiths, Thomas; Kentoffio, Katherine; Niyonzima, Jean Bosco; Sechler, G. Andrew; Selinsky, Stephen; Panjabi, Rajesh R.; Siedner, Mark J.; Kraemer, John D.

    2015-01-01

    Background This study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa. Methods Cluster–sample survey data collected in 2012 in a very rural southeastern Liberian population were analyzed to determine associations between quartiles of GPS–measured distance from the nearest health facility and the odds of maternal (ANC, facility–based delivery, and PNC) and child (deworming and care seeking for ARI, diarrhea, and fever) service use. We estimated associations by fitting simple and multiple logistic regression models, with standard errors adjusted for clustered data. Findings Living in the farthest quartile was associated with lower odds of attending 1–or–more ANC checkup (AOR = 0.04, P < 0.001), 4–or–more ANC checkups (AOR = 0.13, P < 0.001), delivering in a facility (AOR = 0.41, P = 0.006), and postnatal care from a health care worker (AOR = 0.44, P = 0.009). Children living in all other quartiles had lower odds of seeking facility–based fever care (AOR for fourth quartile = 0.06, P < 0.001) than those in the nearest quartile. Children in the fourth quartile were less likely to receive deworming treatment (AOR = 0.16, P < 0.001) and less likely (but with only marginal statistical significance) to seek ARI care from a formal HCW (AOR = 0.05, P = 0.05). Parents in distant quartiles more often sought ARI and diarrhea care from informal providers. Conclusions Within a rural Liberian population, distance is associated with reduced health care uptake. As Liberia rebuilds its health system after Ebola, overcoming geographic disparities, including through further

  5. Brainstorming Design for Health: Helping Patients Utilize Patient-Generated Information on the Web

    PubMed Central

    Huh, Jina; Hartzler, Andrea; Munson, Sean; Anderson, Nick; Edwards, Kelly; Gore, John L.; McDonald, David; O’Leary, Jim; Parker, Andrea; Streat, Derek; Yetisgen-Yildiz, Meliha; Pratt, Wanda; Ackerman, Mark S.

    2013-01-01

    Researchers and practitioners show increasing sinterest in utilizing patient-generated information on the Web. Although the HCI and CSCW communities have provided many exciting opportunities for exploring new ideas and building broad agenda in health, few venues offer a platform for interdisciplinary and collaborative brainstorming about design challenges and opportunities in this space. The goal of this workshop is to provide participants with opportunities to interact with stakeholders from diverse backgrounds and practices—researchers, practitioners, designers, programmers, and ethnographers—and together generate tangible design outcomes that utilize patient-generated information on the Web. Through small multidisciplinary group work, we will provide participants with new collaboration opportunities, understanding of the state of the art, inspiration for future work, and ideally avenues for continuing to develop research and design ideas generated at the workshop. PMID:24499843

  6. Self-reported morbidity and health service utilization in rural Tamil Nadu, India.

    PubMed

    Dodd, Warren; King, Nia; Humphries, Sally; Little, Matthew; Dewey, Cate

    2016-07-01

    In Tamil Nadu, India, improvements have been made toward developing a high-quality, universally accessible healthcare system. However, some rural residents continue to confront significant barriers to obtaining healthcare. The primary objective of this study was to investigate self-reported morbidity, health literacy, and healthcare preferences, utilization, and experiences in order to identify priority areas for government health policies and programs. Drawing on 66 semi-structured interviews and 300 household surveys (including 1693 individuals), administered in 26 rural villages in Tamil Nadu's Krishnagiri district, we found that the prevalence of self-reported major health conditions was 22.3%. There was a large burden of non-communicable and chronic diseases, and the most common major morbidities were: connective tissue problems (7.6%), nervous system and sense organ diseases (5.0%), and circulatory and respiratory diseases (2.5%). Increased age and decreased education level were associated with higher odds of reporting most diseases. Low health literacy levels resulted in individuals seeking care only once pain interfered with daily activities. As such, individuals' health-seeking behaviour depended on which strategy was believed to result in the fastest return to work using the fewest resources. Although government facilities were the most common healthcare access point, they were mistrusted; 48.8% and 19.2% of respondents perceived inappropriate treatment protocols and corruption, respectively, at public facilities. Conversely, 93.3% of respondents reported high treatment cost as the main barrier to accessing private facilities. Our results highlight that addressing the chronic and non-communicable disease burdens amongst rural populations in this context will require health policies and village-level programs that address the low health literacy and the issues of rural healthcare accessibility and acceptability. PMID:27285663

  7. Utilizing the health belief model to assess vaccine acceptance of patients on hemodialysis.

    PubMed

    Adams, Angela; Hall, Mellisa; Fulghum, Janis

    2014-01-01

    Vaccine rates in patients on hemodialysis are substantially lower than the Healthy People 2020 targets. The purpose of this study is to utilize the perceptions and cues for action constructs of the Health Belief Model (HBM) to assess the attitudes of patients receiving outpatient hemodialysis regarding acceptance of the seasonal influenza, pneumococcal, and hepatitis B virus vaccines. Vaccine acceptance is defined as receiving the vaccine. Study findings suggest age, perceived susceptibility, and perceived severity increase the odds of getting some vaccines. Findings have implications for the development of patient education materials, interdisciplinary team assessments, and plan of care strategies to increase vaccine acceptance. PMID:25244894

  8. Utilization of open source electronic health record around the world: A systematic review

    PubMed Central

    Aminpour, Farzaneh; Sadoughi, Farahnaz; Ahamdi, Maryam

    2014-01-01

    Many projects on developing Electronic Health Record (EHR) systems have been carried out in many countries. The current study was conducted to review the published data on the utilization of open source EHR systems in different countries all over the world. Using free text and keyword search techniques, six bibliographic databases were searched for related articles. The identified papers were screened and reviewed during a string of stages for the irrelevancy and validity. The findings showed that open source EHRs have been wildly used by source limited regions in all continents, especially in Sub-Saharan Africa and South America. It would create opportunities to improve national healthcare level especially in developing countries with minimal financial resources. Open source technology is a solution to overcome the problems of high-costs and inflexibility associated with the proprietary health information systems. PMID:24672566

  9. Differences in health care utilization between parents who perceive their child as vulnerable versus overprotective parents.

    PubMed

    Thomasgard, M; Metz, W P

    1996-06-01

    While a parental perception of child vulnerability to illness/injury is often used interchangeably with parental overprotection, research suggests that they are independent constructs. We hypothesized more frequent pediatric nonwell-child visits for perceived child vulnerability, but not for parental overprotection. The parents of 300 children, ages 2-5 years, enrolled in a health maintenance organization, were sampled. For children without medical conditions, there were no differences in nonwell-child care visits between the high perceived vulnerability and high parental protection groups (Wilcoxon Rank Sum Test, WRST, P = .31). As expected, high parental protection was not significantly associated with increased nonwell-child care visits compared with the low parental protection group (WRST, P = .14). These findings suggest that markers other than health care utilization are required to identify these forms of parent-child relationship disorders. PMID:8782954

  10. Alternative dispute resolution programs in health care: a study of organizational utilization.

    PubMed

    Rotarius, T M; Liberman, A; Osterman, K C; Putnam, P

    1999-03-01

    The hyperturbulence in today's health care environment acts as a primer that escalates the frequency and severity of business conflicts. Several alternative dispute resolution (ADR) programs are described, with ADR suggested as a viable approach in assisting organizations in resolving conflicts. The data indicate that all of the health care organizations surveyed utilize some form of ADR to resolve conflict. The most common conflict resolution objective found is win/win, and respondents felt that ADR effectively met intended objectives. While the data gathered for this study are from a limited geographic region in Central Florida, the results can likely be generalized to many socially and ethnically diverse regions of the country. PMID:10351047

  11. Preventive health screening utilization in older Mexicans before and after healthcare reform

    PubMed Central

    Salinas, Jennifer J

    2016-01-01

    Objective To assess changes in preventive screening utilization in older Mexicans, pre- and post-Seguro Popular. Materials and methods Data from the Mexican Health and Aging Study (MHAS/Enasem) 2001 and 2012 were used. Logistic and ordinary least squares regression adjusted models were used to predict preventive care in 2012 by insurance status categories in 2001-2012, as the focus explanatory variable. Results Participants who were uninsured in 2001 and had Seguro Popular in 2012 were significantly more likely to be tested for diabetes, high blood pressure and receive a tetanus shot than the continually uninsured. Conclusions While disparities in preventive screening between the insured and uninsured continue to exist in Mexico, Seguro Popular seems to have provided better access to health services to prevent chronic and infectious diseases for the otherwise uninsured population. PMID:26172237

  12. Gender differences in health care utilization and outcome of respiratory tuberculosis in Alexandria.

    PubMed

    Kamel, M I; Rashed, S; Foda, N; Mohie, A; Loutfy, M

    2003-07-01

    A study of gender differences in health care utilization and outcome of respiratory tuberculosis was carried out in Alexandria, Egypt. A cohort of 334 patients was followed-up for 8 months; 69.2% of cases were males. The pattern of tuberculosis symptoms was similar for both sexes. Women started treatment earlier than men. Women had significantly lower scores in knowledge, beliefs and attitudes about tuberculosis than men. Compliance was unsatisfactory for both sexes. Men tended to be more adherent to drugs and to sputum and X-ray examinations but there were no sex differences in compliance with health education and medical examinations. No significant sex differences in treatment outcome were found: the overall cure rate was 60.5% and treatment failure was 4.8%. Multiple regression analysis showed satisfaction with medical care was the only significant predictor of treatment failure. PMID:15748071

  13. The Prevention Index '87. A Report Card on the Nation's Health. Summary Report.

    ERIC Educational Resources Information Center

    Harris (Louis) and Associates, Inc., New York, NY.

    The results of a national survey conducted by Louis Harris and Associates for "Prevention" Magazine on American health practices are presented in this report. The following topics are covered: (1) changes in health-promoting behavior 1984-1987; (2) steps people take, or fail to take, for better health; (3) exercise and weight control by adults;…

  14. Cross-Border Utilization of Health Care: Evidence from a Population-Based Study in South Texas

    PubMed Central

    Su, Dejun; Richardson, Chad; Wen, Ming; Pagán, José A

    2011-01-01

    Objective To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. Data and Methods This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Principal Findings Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. Conclusions The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.–Mexico border region. PMID:21158855

  15. Body mass index and mortality in nonsmoking older adults: the Cardiovascular Health Study.

    PubMed Central

    Diehr, P; Bild, D E; Harris, T B; Duxbury, A; Siscovick, D; Rossi, M

    1998-01-01

    OBJECTIVES: This study assesses the relationship of body mass index to 5-year mortality in a cohort of 4317 nonsmoking men and women aged 65 to 100 years. METHODS: Logistic regression analyses were conducted to predict mortality as a function of baseline body mass index, adjusting for demographic, clinical, and laboratory covariates. RESULTS: There was an inverse relationship between body mass index and mortality; death rates were higher for those who weighed the least. Inclusion of covariates had trivial effects on these results. People who had lost 10% or more of their body weight since age 50 had a relatively high death rate. When that group was excluded, there was no remaining relationship between body mass index and mortality. CONCLUSIONS: The association between higher body mass index and mortality often found in middle-aged populations was not observed in this large cohort of older adults. Over-weight does not seem to be a risk factor for 5-year mortality in this age group. Rather, the risks associated with significant weight loss should be the primary concern. PMID:9551005

  16. Validation study of the prototype of a disease-specific index measure for health-related quality of life in dementia

    PubMed Central

    2012-01-01

    Background Index measures for health-related quality of life (HRQoL) quantify the desirability (utility) of a certain health state. The commonly used generic index measure, e.g. EuroQol: EQ-5D, may underestimate relevant areas of specific diseases, resulting in lower validity. Disease-specific index measures on the other hand combine disease-specificity and quantification of perceived quality on several health domains of a certain disease into one single figure. These instruments have been developed for several diseases, but a dementia-specific HRQoL index instrument was not yet available. Facing the increasing individual and societal burden of dementia, specific HRQoL values with metric characteristics are especially useful because they will provide vital information for health outcome research and economic evaluations. Aims of the study To develop and validate the prototype of a dementia-specific HRQoL index measure: Dementia Quality of life Instrument (DQI), as the first step towards valuation of the dementia health state. Methods For development of the DQI we created a conceptual framework based on a review of the literature, qualitative interviews with people with dementia and their carers, expert opinion and team discussion. To assess validity we undertook a survey under 241 dementia professionals. Measurements consisted of ranking (1–5) and rating (1–10) of 5 dementia-specific DQI domains (memory, orientation, independence, social activities and mood) and simultaneously rating of 9 DQI-derived health states on a visual analogue scale (VAS). We also performed a cross-sectional study in a large sample of people with very mild to moderate dementia and their caregivers (N = 145) to assess feasibility and concurrent validity. In addition, caregivers valued 10 DQI and 10 EQ-5D + C derived health states of the patient simultaneously on the same VAS. Setting: outpatient clinics, nursing homes and patient residences. Results All professionals judged the

  17. Does Frailty Predict Health Care Utilization in Community-Living Older Romanians?

    PubMed Central

    Olaroiu, Marinela; Ghinescu, Minerva; Naumov, Viorica; Brinza, Ileana

    2016-01-01

    Background. The predictive value of frailty assessment is still debated. We analyzed the predictive value of frailty of independent living elderly. The outcomes variables were visits to the general practitioner, hospital admission, and occurrence of new health problems. Methods. A one-year follow-up study was executed among 215 community-living old Romanians. General practitioners reported the outcome variables of patients, whose frailty was assessed one year before, using the Groningen Frailty Indicator. The predictive validity is analyzed by descriptive and regression analysis. Results. Three-quarters of all participants visited their general practitioner three times more last year and one-third were at least once admitted to a hospital. Patients who scored frail one year before were more often admitted to a hospital. Visits to the general practitioner and occurrence of new health problems were not statistically significant related to frailty scores. The frailty items polypharmacy, social support, and activities in daily living were associated with adverse outcomes. Conclusions. The predictive value of frailty instruments as the Groningen Frailty Indicator is still limited. More research is needed to predict health outcomes, health care utilization, and quality of life of frailty self-assessment instruments. Validation research on frailty in different “environments” is recommended to answer the question to what extent contextual characteristics influence the predictive value. PMID:27493663

  18. Utility Values for Advanced Soft Tissue Sarcoma Health States from the General Public in the United Kingdom

    PubMed Central

    Guest, Julian F.; Sladkevicius, Erikas; Gough, Nicholas; Linch, Mark; Grimer, Robert

    2013-01-01

    Soft tissue sarcomas are a rare type of cancer generally treated with palliative chemotherapy when in the advanced stage. There is a lack of published health utility data for locally advanced “inoperable”/metastatic disease (ASTS), essential for calculating the cost-effectiveness of current and future treatments. This study estimated time trade-off (TTO) and standard gamble (SG) preference values associated with four ASTS health states (progressive disease, stable disease, partial response, complete response) among members of the general public in the UK (n = 207). The four health states were associated with decreases in preference values from full health. Complete response was the most preferred health state (mean utility of 0.60 using TTO). The second most preferred health state was partial response followed by stable disease (mean utilities were 0.51 and 0.43, respectively, using TTO). The least preferred health state was progressive disease (mean utility of 0.30 using TTO). The utility value for each state was significantly different from one another (P < 0.001). This study demonstrated and quantified the impact that different treatment responses may have on the health-related quality of life of patients with ASTS. PMID:23576896

  19. Body mass index, waist-to-hip ratio, and metabolic syndrome as predictors of middle-aged men's health

    PubMed Central

    Park, Jung Hyun; Cho, In-Chang; Kim, Yoo Seok; Kim, Soon Ki; Min, Seung Ki

    2015-01-01

    Purpose There is no reported evidence for an anthropometric index that might link obesity to men's sexual health. We evaluated the ability of an anthropometric index and the symptom scores of five widely used questionnaires to detect men's health problems. We determined the predictive abilities of two obesity indexes and other clinical parameters for screening for lower urinary tract symptoms and sexual dysfunction in middle-aged men. Materials and Methods A total of 1,910 middle-aged men were included in the study. Participants underwent a detailed clinical evaluation that included recording the symptom scores of five widely used questionnaires. The participants' body mass index and waist-to-hip ratio were determined. Serum prostate-specific antigen, urinalysis, testosterone, estimated glomerular filtration rate, evaluation of metabolic syndrome, and transrectal ultrasonography were assessed. Results By use of logistic regression analysis, age and total prostate volume were independent predictors of lower urinary tract symptoms. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis symptoms. Age and metabolic syndrome were independent predictive factors for erectile dysfunction. Waist-to-hip ratio had a statistically significant value for predicting erectile dysfunction. Conclusions Our data showed that total prostate volume is a significant predictor of lower urinary tract symptoms, and central obesity has predictive ability for erectile dysfunction. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis-like symptoms. The management of correctable factors such as waist-to-hip ratio and metabolic syndrome may be considered preventive modalities against the development of men's health problems. PMID:25964840

  20. Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration

    PubMed Central

    Mayhew, Susannah H.; Ploubidis, George B.; Sloggett, Andy; Church, Kathryn; Obure, Carol D.; Birdthistle, Isolde; Sweeney, Sedona; Warren, Charlotte E.; Watts, Charlotte; Vassall, Anna

    2016-01-01

    Background The body of knowledge on evaluating complex interventions for integrated healthcare lacks both common definitions of ‘integrated service delivery’ and standard measures of impact. Using multiple data sources in combination with statistical modelling the aim of this study is to develop a measure of HIV-reproductive health (HIV-RH) service integration that can be used to assess the degree of service integration, and the degree to which integration may have health benefits to clients, or reduce service costs. Methods and Findings Data were drawn from the Integra Initiative’s client flow (8,263 clients in Swaziland and 25,539 in Kenya) and costing tools implemented between 2008–2012 in 40 clinics providing RH services in Kenya and Swaziland. We used latent variable measurement models to derive dimensions of HIV-RH integration using these data, which quantified the extent and type of integration between HIV and RH services in Kenya and Swaziland. The modelling produced two clear and uncorrelated dimensions of integration at facility level leading to the development of two sub-indexes: a Structural Integration Index (integrated physical and human resource infrastructure) and a Functional Integration Index (integrated delivery of services to clients). The findings highlight the importance of multi-dimensional assessments of integration, suggesting that structural integration is not sufficient to achieve the integrated delivery of care to clients—i.e. “functional integration”. Conclusions These Indexes are an important methodological contribution for evaluating complex multi-service interventions. They help address the need to broaden traditional evaluations of integrated HIV-RH care through the incorporation of a functional integration measure, to avoid misleading conclusions on its ‘impact’ on health outcomes. This is particularly important for decision-makers seeking to promote integration in resource constrained environments. PMID:26800517

  1. Effect of pharmaceutical formulation for antihypertensive therapy on health service utilization.

    PubMed

    Skaer, T L; Sclar, D A; Robison, L M; Chin, A; Gill, M A; Okamoto, M P; Nakahiro, R K

    1993-01-01

    A significant factor in the management of hypertension is the extent to which patients comply with the treatment regimen. A retrospective analysis was undertaken to determine the relationship between antihypertensive formulation, regimen compliance, and the utilization of health care services. Data for this analysis were derived from the state of South Carolina's Medicaid computer archive. The study population consisted of 1000 randomly selected patients initially prescribed one of the following antihypertensive regimens as monotherapy: atenolol once daily, captopril BID, oral clonidine BID, transdermal clonidine once weekly, diltiazem BID, enalapril BID, metoprolol BID, prazosin BID, terazosin once daily, and sustained-release verapamil once daily. Multivariate regression analysis was used to determine the incremental influence of selected demographic characteristics, use of medical services before diagnosis of hypertension, initial antihypertensive medication, medication possession ratio for antihypertensive therapy, and number of maintenance medications for diseases other than hypertension on post-period health care expenditures. The results indicated that patients initially prescribed antihypertensive medication requiring once-daily or once-weekly administration experienced an increased utilization of antihypertensive medication, needed fewer changes in their therapeutic regimen, and far less need for concomitant therapy for blood pressure control compared with those prescribed a BID regimen. Patients in the once-daily or once-weekly groups also used significantly fewer physician, hospital, and laboratory services (P < or = 0.05). PMID:8221822

  2. Acculturation and health care utilization among Mexican heritage women in the United States.

    PubMed

    Bermúdez-Parsai, Mónica; Mullins Geiger, Jennifer L; Marsiglia, Flavio F; Coonrod, Dean V

    2012-08-01

    With the increasing Latino population in the United States, it is critical to examine the influence of the process of acculturation on health care practices and utilization. The purpose of this study was to evaluate the relationship between acculturation level and post-partum visit (PPV) compliance among Latinas participating in a larger psycho-educational intervention aimed at encouraging women to engage in positive healthcare practices. Acculturation was measured with the Bicultural Involvement Questionnaire which assigned participants to five categories: Assimilated, Separated, Moderate, Bicultural and Alienation. Logistic Regression analyses were conducted to predict post-partum visit attendance. Odds ratios and relative risk of not attending the post-partum visit are presented. Results suggest women in the Separation and Assimilation groups were less likely than bicultural group members to attend the PPV. The only other variable that was significant in this analysis is the group condition, indicating that the intervention group was more likely to attend the PPV than the control group. Women identifying as bicultural seem to participate more actively in their own healthcare as they draw on the cultural assets that have a positive influence on informal health practices, such as healthy eating and refraining from drug use. Bicultural group members can also use formal skills related to language and knowledge of the dominant culture to help effectively navigate the healthcare system. Implications for research, intervention and practice are discussed to improve healthcare practices and increase utilization among Latinas. PMID:21725624

  3. Utility of the waist-to-height ratio, waist circumference and body mass index in the screening of metabolic syndrome in adult patients with type 1 diabetes mellitus

    PubMed Central

    2014-01-01

    Background The incidence of macrovascular complications and morbidities associated to metabolic syndrome are increasing in patients with type 1 diabetes mellitus (T1DM). The combination of T1DM with features of insulin resistance similar to that of type 2 diabetes (T2DM), sometimes called “double diabetes”, has been associated with central obesity. Since the most methods to accurately detect body fat and insulin resistance are not readily available, we propose that certain indirect indexes for detecting obesity as waist-to-height ratio, waist circumference and body mass index, may be useful when screening for metabolic syndrome in patients with T1DM. Methods We performed a transversal evaluation (clinical and biochemical) in all the patients of the T1DM Clinic (n = 120). We determined the presence of metabolic syndrome according to the Joint Statement Criteria by the American Heart Association/ National Heart Lung and Blood Institute and the International Diabetes Federation and the utility of certain anthropometric indexes for predicting double diabetes was evaluated. Results Thirty seven percent of the patients were considered to have metabolic syndrome using these criteria (n = 30). These patients were significantly older (p = 0.002), have a higher glycated hemoglobin (p = 0.036), cholesterol (p < 0.012) and triglyceride concentration (p < 0.01) as well as body mass index (p = 0.004), waist circumference (p = 0.01) and waist-to-height ratio (p < 0.01) than the group without metabolic syndrome. Also their c-HDL is lower (p < 0.01). A value of 0.52 for waist-to-height ratio correctly classified the largest number of patients (68% of correctly classified) well as the waist circumference (66% of correctly classified) with an adequate specificity and sensibility. Meanwhile the most precise body mass index value only classified correctly to 61% of patients. Conclusion Our data show that waist circumference and waist

  4. DMFT index assessment, plaque pH, and microbiological analysis in children with special health care needs, India

    PubMed Central

    Katge, Farhin; Rusawat, Bhavesh; Shitoot, Abhinav; Poojari, Manohar; Pammi, Thejokrishna; Patil, Devendra

    2015-01-01

    Aim: To assess the DMFT index of children with Special Health Care Needs (SHCN) in Navi Mumbai. To correlate the DMFT index with Streptococcus mutans count in the supragingival bacterial biofilm and with plaque pH. Materials and Methods: Dental examination of 158 patients aged 5–18 years was conducted to determine the DMFT/dmft index. Supragingival plaque samples were collected from the buccal surfaces of all teeth. The samples were inoculated in mitis salivarius bacitracin agar medium and incubated at 37°C for 48 h. Supragingival plaque was collected from interproximal sites of the molar area (preferably mandibular) for conducting plaque pH test. Chi-square test and Pearson's correlation were used to find the significance of the study parameters on categorical scale between the two groups. Results: The mean DMFT recorded was 4.90 ± 4.63 and the mean dmft recorded was 1.77 ± 3.14. Mean number of S. mutans colony-forming units found was 2.961 × 104. Mean plaque pH recorded was 6.2. Conclusion: No statistically significant correlation was found between the DMFT index with the number of S. mutans and plaque pH. PMID:26539390

  5. Under-utilization of health care services for infectious diseases syndromes in rural Azerbaijan: A cross-sectional study

    PubMed Central

    2011-01-01

    Background Infectious diseases present a potentially substantial yet undefined burden on the health of the adult Azerbaijani population. Efforts to quantify this burden in Azerbaijan are currently based almost exclusively on passive disease surveillance, and therefore hinge on the health utilization practices of the population. Understanding the prevalence of infectious syndromes and health utilization practices is paramount to disease surveillance, public health planning, and health care system reform. Methods A two-stage, probability proportional to size sampling design was used to select a representative sample of three regions of northern Azerbaijan with village populations less than 500 people. Demographic, clinical, and epidemiologic parameters were assessed using prevalence odds ratios, chi-squared, and the Fisher exact test. Associations with p < 0.10 were included in the regression analysis and removed by backward elimination. Respondents included 796 adults from 39 villages. Results Self-medication with antibiotics was the predominant utilization practice reported (19.4%). Only 1.3% of respondents reported seeing a health care provider for an infection, and 3.4% missed work or stayed in bed during the day in the last 5 years. In contrast, 338 illness episodes were reported in a 5 year period. Antibiotic use was significantly associated with gender, region, history of febrile illness, sleep disturbances, and arthritis controlling for age, ethnicity, and education. Influenza-like illness was the most prevalent infectious syndrome reported (33.3%). Conclusions We observed a remarkably low utilization of health services, despite reported symptoms that would merit use. Widespread availability of antibiotics may deter health care use, and may contribute to the development of antibiotic resistance in this population. Information on utilization of health services during an infection is essential for development of effective intervention strategies, and data on

  6. The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women.

    PubMed

    Valentine, Sarah E; Elsesser, Steven; Grasso, Chris; Safren, Steven A; Bradford, Judith B; Mereish, Ethan; O'Cleirigh, Conall

    2015-12-01

    Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women. PMID:26438415

  7. Health service utilization and access to medicines among Syrian refugee children in Jordan

    PubMed Central

    Lyles, Emily; Akhu‐Zaheya, Laila; Burton, Ann; Weiss, William

    2016-01-01

    Summary Background With over one million Syrian refugee children in the region, we undertook this study to characterize care‐seeking behaviors and health service utilization for child refugees with the aim of informing humanitarian programming for non‐camp settings in Jordan. Methods A survey of Syrian refugees living outside of camps in Jordan was conducted using a 125 × 12 cluster design with probability proportional to size sampling to obtain a representative sample. The questionnaire focused on access to health services, including a module on care seeking for children. Results Care seeking was high with 90.9% of households with a child less than 18 years seeking medical care the last time it was needed. Households most often sought care for children in the public sector (54.6%), followed by private (36.5%) and charity sectors (8.9%). Among child care seekers, 88.6% were prescribed medication during the most recent visit, 90.6% of which obtained the medication. Overall, 49.4% of households reported out‐of‐pocket expenditures for either the consultation or prescribed medications at the most recent visit (mean $US21.1 and median $US0). Conclusions Syrian refugees had good access to care for their sick children at the time of the survey; however, this has likely deteriorated since the survey because of the withdrawal of free access for refugees. The number of refugees in Jordan and relative accessibility of care has resulted in a large burden on the health system; the Jordanian government will require additional support if current levels of health access are to be maintained for Syrian refugees. © 2016 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd. PMID:26799158

  8. Health Care Utilization before and after an Outpatient Emergency Department Visit in Older People

    PubMed Central

    Horney, Carolyn; Schmader, Kenneth; Sanders, Linda L.; Heflin, Mitchell; Ragsdale, Luna; McConnell, Eleanor; Hocker, Michael; Hastings, S. Nicole

    2010-01-01

    Background Older adults in the U.S. receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization has not been adequately studied in this population. Objectives The goal of this study were to examine the relationships between health care use before and after an ED visit among older adults. Methods This retrospective cohort study examined health care use among 308 patients ≥ 65 years old discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician (PCP), specialist, ED and hospital) and risk of return ED visits. Results Older ED patients in this study had visited other types of providers frequently in the previous year (median number of primary care physician (PCP) and specialist visits = 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits 7.0 vs 4.0, p<.001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (HR 2.20, 95% CI 1.15–4.21), in models adjusted for demographics and health status. Conclusion Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. PMID:21216555

  9. Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

    PubMed Central

    McCrae, Christina S.; Bramoweth, Adam D.; Williams, Jacob; Roth, Alicia; Mosti, Caterina

    2014-01-01

    Study Objectives: To examine health care utilization (HCU) and costs following brief cognitive behavioral treatment for insomnia (bCBTi). Methods: Reviewed medical records of 84 outpatients [mean age = 54.25 years (19.08); 58% women] treated in a behavioral sleep medicine clinic (2005-2010) based in an accredited sleep disorders center. Six indicators of HCU and costs were obtained: estimated total and outpatient costs, estimated primary care visits, CPT costs, number of office visits, and number of medications. All patients completed ≥ 1 session of bCBTi. Those who attended ≥ 3 sessions were considered completers (n = 37), and completers with significant sleep improvements were considered responders (n = 32). Results: For completers and responders, all HCU and cost variables, except number of medications, significantly decreased (ps < 0.05) or trended towards decrease at post-treatment. Completers had average decreases in CPT costs of $200 and estimated total costs of $75. Responders had average decreases in CPT costs of $210. No significant decreases occurred for non-completers. Conclusions: bCBTi can reduce HCU and costs. Response to bCBTi resulted in greater reduction of HCU and costs. While limited by small sample size and non-normal data distribution, the findings highlight the need for greater dissemination of bCBTi for several reasons: a high percentage of completers responded to treatment, as few as 3 sessions can result in significant improvements in insomnia severity, bCBTi can be delivered by novice clinicians, and health care costs can reduce following treatment. Insomnia remains an undertreated disorder, and brief behavioral treatments can help to increase access to care and reduce the burden of insomnia. Citation: McCrae CS; Bramoweth AD; Williams J; Roth A; Mosti C. Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs. J Clin Sleep Med 2014;10(2):127-135. PMID:24532995

  10. Care utilization in a pediatric diabetes clinic: cancellations, parental attendance, and mental health appointments

    PubMed Central

    Markowitz, Jessica T.; Volkening, Lisa K.; Laffel, Lori M.B.

    2014-01-01

    Objective To examine care utilization, family attendance, and A1c in a multi-disciplinary pediatric diabetes clinic. Study design Retrospective electronic record review of de-identified data included patients (99% type 1 diabetes) with established diabetes care, aged <30 years (mean 15±5.2) and diabetes duration >1 year (mean 8.5±5.1) at first visit during a two-year period. Outcomes included care utilization, family attendance, and glycemic control (A1c). Analyses included t-tests, ANOVAs, chi-square analyses, odds ratios (95% CI), and multivariate analyses. Results Among 1771 patients, there were 5.8±2.8 visits/patient; 15% of scheduled appointments resulted in cancellation or no-show; 61% of patients missed ≥1 visit. Patients with ≥2 missed appointments had higher A1c and were older than those with <2 missed visits. Almost half of visits were attended by mothers alone; fathers attended 22% of visits. Patients whose fathers attended ≥1 visit had lower A1c than patients whose fathers never attended. Eighteen percent of patients had on-site mental health visits. Patients with ≥1 mental health visit(s) had higher mean A1c, shorter diabetes duration, and were younger than those with no mental health visits. Conclusions Our observations suggest a need to encourage attendance at diabetes visits and include fathers to improve A1c. The high rate of missed visits, especially in patients with poor glycemic control, identifies wasted provider effort when late cancellations/no-shows yield vacant clinic time. It is important to explore reasons for missed visits and to find approaches to maximize attendance, e.g., extended evening/weekend clinic hours or virtual visits. PMID:24612905

  11. Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services

    PubMed Central

    Eichler, Tilly; Hoffmann, Wolfgang; Hertel, Johannes; Richter, Steffen; Wucherer, Diana; Michalowsky, Bernhard; Dreier, Adina; Thyrian, Jochen René

    2016-01-01

    Background: Little is known about the proportion and the characteristics of community-dwelling people with dementia (PWD) living alone in Germany. Objectives: To analyze the prevalence of PWD living alone (with and without the support of an informal caregiver) and socio-demographical and clinical characteristics as well as health and nursing care utilization associated with living alone. Methods: DelpHi-MV (Dementia: Life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, randomized controlled intervention trial. The present analyses are based on baseline data of 511 patients (≥70 years, community-dwelling) who had screened positive for dementia (DemTect <9). Results: N = 251 (51%) of the patients lived alone. PWD living alone were statistically significantly more often female, older, and more often widowed than those not living alone. About 9% of the patients (n = 24) were not supported by any informal caregiver. Regarding the clinical variables (cognitive and functional impairment, depression, falls, number of drug-related problems, malnutrition, quality of life), there were no statistically significant group differences. Patients living alone utilized professional services such as home care, help with medication, home-delivered meals, or housekeeping assistance significantly more often. Multivariate analyses confirmed these findings. Conclusion:Our results reveal the high proportion of PWD living alone in Germany. PWD living alone did not seem to be at an increased health risk. Our findings indicate that living alone with dementia is possible. In order to ensure the sufficient provision of health and nursing care services for PWD living alone, providers should consider the present results for future planning. PMID:27031480

  12. Does Access to Care Still Affect Health Care Utilization by Immigrants? Testing of an Empirical Explanatory Model of Health Care Utilization by Korean American Immigrants with High Blood Pressure

    PubMed Central

    Han, Hae-Ra; Lee, Jong-Eun; Kim, Ji-Yun; Kim, Kim B.; Ryu, Jai Poong; Kim, Miyong

    2015-01-01

    Despite well-known benefits of health care utilization for the effective management of chronic diseases, the underlying mechanism of understanding health care utilization in ethnic minority population has not been systematically explored. The purpose of this paper is to examine the predictive ability of a health care utilization model by analyzing the interplay between predisposing, enabling, and need factors. The sample consisted of hypertensive Korean American immigrants (KAIs) 40–64 years of age who participated in a self-help intervention for high blood pressure care (SHIP-HBP). Using structured questionnaires, data were collected from 445 KAIs at baseline and analyzed with path analysis. Insurance status and relevant medical history were not just strong direct effects but also carried the most total effect on the health care utilization of these patients. Life priorities, years of residence in the US and perceived income level exerted indirect effects through the participants’ insurance status. Our statistical analysis indicated a good fit for the proposed model (x2 = 28.4, P = 0.29; NFI = 0.91; CFI = 0.99; RMSEA = 0.02). Overall, the model explained 18% of the variance in health care utilization of hypertensive KAIs. These findings strongly support a need to improve access to health care for KAIs by introducing a variety of community resources and building sustainable community infrastructures. PMID:19649709

  13. Determinants and patterns of service utilization and recourse to professionals for mental health reasons

    PubMed Central

    2014-01-01

    Background This study has a dual purpose: 1) identify determinants of healthcare service utilization for mental health reasons (MHR) in a Canadian (Montreal) catchment area; 2) determine the patterns of recourse to healthcare professionals in terms of frequency of visits and type of professionals consulted, and as it relates to the most prevalent mental disorders (MD) and psychological distress. Methods Data was collected from a random sample of 1,823 individuals interviewed after a two-year follow-up period. A regression analysis was performed to identify variables associated with service utilization and complementary analyses were carried out to better understand participants’ patterns of healthcare service utilization in relation to the most prevalent MD. Results Among 243 individuals diagnosed with a MD in the 12 months preceding an interview, 113 (46.5%) reported having used healthcare services for MHR. Determinants of service utilization were emotional and legal problems, number of MD, higher personal income, lower quality of life, inability of individuals to influence events occurring in their neighborhood, female gender and, marginally, lack of alcohol dependence in the past 12 months. Emotional problems were the most significant determinant of healthcare service utilization. Frequent visits with healthcare professionals were more likely associated with major depression and number of MD with or without dependence to alcohol or drugs. People suffering from major depression, psychological distress and social phobia were more likely to consult different professionals, while individuals with panic disorders relied on their family physician only. Concerning social phobia, panic disorders and psychological distress, more frequent visits with professionals did not translate into involvement of a higher number of professionals or vice-versa. Conclusions This study demonstrates the impact of emotional problems, neighborhood characteristics and legal problems in

  14. Knowledge and Utilization of Computers Among Health Professionals in a Developing Country: A Cross-Sectional Study

    PubMed Central

    2015-01-01

    Background Incorporation of information communication technology in health care has gained wide acceptance in the last two decades. Developing countries are also incorporating information communication technology into the health system including the implementation of electronic medical records in major hospitals and the use of mobile health in rural community-based health interventions. However, the literature on the level of knowledge and utilization of information communication technology by health professionals in those settings is scarce for proper implementation planning. Objective The objective of this study is to assess knowledge, computer utilization, and associated factors among health professionals in hospitals and health institutions in Ethiopia. Methods A quantitative cross-sectional study was conducted on 554 health professionals working in 7 hospitals, 19 primary health centers, and 10 private clinics in the Harari region of Ethiopia. Data were collected using a semi-structured, self-administered, and pre-tested questionnaire. Descriptive and logistic regression techniques using SPSS version 16.0 (IBM Corporation) were applied to determine the level of knowledge and identify determinants of utilization of information communication technology. Results Out of 554 participants, 482 (87.0%) of them responded to the questionnaire. Among them, 90 (18.7%) demonstrated good knowledge of computers while 142 (29.5%) demonstrated good utilization habits. Health professionals who work in the primary health centers were found to have lower knowledge (3.4%) and utilization (18.4%). Age (adjusted odds ratio [AOR]=3.06, 95% CI 0.57-5.37), field of study (AOR=3.08, 95% CI 1.65-5.73), level of education (AOR=2.78, 95% CI 1.43-5.40), and previous computer training participation (AOR=3.65, 95% CI 1.62-8.21) were found to be significantly associated with computer utilization habits of health professionals. Conclusions Computer knowledge and utilization habits of health

  15. Mental ill-health across the continuum of body mass index

    PubMed Central

    2011-01-01

    Background Several studies have found a non-linear relationship between mental ill-health and BMI with higher rates in both the underweight and the obese. This study evaluated the shape of the relationship between BMI and distress, suicidal ideation and self-reported mental ill-health conditions in a large population sample. Methods Data were drawn from the South Australian Monitoring and Surveillance System (SAMSS) for the years 2002 to 2009 (n = 46,704). SAMSS monitors population trends in state and national risk factors and chronic diseases. Samples are drawn from all households with a functioning number in the Australian White Pages. Computer assisted telephone interviews collected information on self-reported height and weight, demographic and health behaviours. Respondents completed the Kessler Distress and suicidal ideation scales and reported specific mental ill-health conditions. BMI was categorized into deciles to allow for assessment of the shape of any associations with other variables. Logistic regression was used to examine associations between each mental ill-health condition and BMI-decile controlling for age in the base model. This was followed by a full model that added SES and the health-adverse coping behaviours of smoking, alcohol and physical activity to test for changes from the base model. Results Non-linear associations were observed between BMI-decile and mental ill-health but statistically significantly greater odds of mental ill-health were observed only in the obese and not in the underweight after controlling for age, health-adverse behaviours and socioeconomic status. The association between BMI and mental ill-health might best be described as 'threshold'. Elevated odds were apparent for middle-aged persons, whereas younger and older individuals had a significantly lower odds of having a mental ill-health condition. Conclusions In conclusion, this study has provided no support for the hypothesis of increased mental ill-health problems

  16. Health Care Utilization and Attitudes Survey: Understanding Diarrheal Disease in Rural Gambia

    PubMed Central

    Saha, Debasish; Akinsola, Adebayo; Sharples, Katrina; Adeyemi, Mitchell O.; Antonio, Martin; Imran, Sayeed; Jasseh, Momodou; Hossain, Mohammad J.; Nasrin, Dilruba; Kotloff, Karen L.; Levine, Myron M.; Hill, Philip C.

    2013-01-01

    Diarrheal disease causes ∼1.34 million deaths per year among children under 5 years of age globally. We conducted a Health Care Utilization and Attitudes Survey of 1,012 primary caregivers of children aged 0–11, 12–23, and 24–59 months randomly selected from a Demographic Surveillance population in rural Gambia. Point prevalence of diarrhea was 7.7% (95% confidence interval [CI] = 6.1–9.8); 23.3% had diarrhea within the previous 2 weeks. Caregivers of 81.5% of children with diarrhea sought healthcare outside their home, but only 48.4% of them visited a health center. Only 17.0% (95% CI = 12.1–23.2) of children with diarrhea received oral rehydration solution (ORS) at home. Abbreviated surveys conducted on six occasions over the subsequent 2 years showed no change in prevalence or treatment-seeking behavior. Diarrhea remains a significant problem in rural young Gambian children. Encouraging care-seeking behavior at health centers and promoting ORS use can reduce mortality and morbidity in this population. PMID:23629926

  17. Inmate attitudes toward treatment: mental health service utilization and treatment effects.

    PubMed

    Shaw, Lucas B; Morgan, Robert D

    2011-08-01

    This study examined inmate attitudes toward treatment, mental health treatment utilization, and treatment effects that maximize treatment effectiveness. Participants consisted of 278 incarcerated male adult offenders from the Kansas Department of Corrections. Multiple linear regression analysis indicated that inmate attitudes toward treatment were predictive of the number of mental health treatment sessions (dosage) inmates received. Hierarchical linear regression analyses indicated positive help-seeking attitudes were associated with institutional behavior (decreased number and severity of disciplinary infractions) and scores on a measure assessing risk for future criminal behavior; however, the amount of mental health treatment an inmate received (treatment dosage) was associated with problematic institutional behavior (i.e., increased severity and number of disciplinary infractions). These results indicated that treatment dosage and behavioral outcomes were impacted by inmate attitudes toward treatment. As a result, correctional psychologists may be better able to predict which inmates will receive the most benefit from services. Implications of these findings for practitioners and policy makers are discussed. PMID:20499269

  18. Characteristics and VA Health Care Utilization of U.S. Veterans Who Completed Suicide in Oregon between 2000 and 2005

    ERIC Educational Resources Information Center

    Basham, Chandra; Denneson, Lauren M.; Millet, Lisa; Shen, Xun; Duckart, Jonathan; Dobscha, Steven K.

    2011-01-01

    Oregon Violent Death Reporting System data were linked with Veterans Affairs (VA) administrative data to identify and describe veterans who completed suicide in Oregon from 2000 to 2005 (n = 968), and to describe their VA health care utilization in the year prior to death. Twenty-two percent had received health care in the VA system. Of these, 57%…

  19. Utility of the International Classification of Functioning, Disability and Health (ICF) for Educational Psychologists' Work

    ERIC Educational Resources Information Center

    Aljunied, Mariam; Frederickson, Norah

    2014-01-01

    Despite embracing a bio-psycho-social perspective, the World Health Organization's International Classification of Functioning, Disability and Health (ICF) assessment framework has had limited application to date with children who have special educational needs (SEN). This study examines its utility for educational psychologists' work…

  20. Utilization and Expenditure of Hospital Admission in Patients with Autism Spectrum Disorder: National Health Insurance Claims Database Analysis

    ERIC Educational Resources Information Center

    Lin, Jin-Ding; Hung, Wen-Jiu; Lin, Lan-Ping; Lai, Chia-Im

    2011-01-01

    There were not many studies to provide information on health access and health utilization of people with autism spectrum disorders (ASD). The present study describes a general profile of hospital admission and the medical cost among people with ASD, and to analyze the determinants of medical cost. A retrospective study was employed to analyze…

  1. Health Care of Latino Children with Autism and Other Developmental Disabilities: Quality of Provider Interaction Mediates Utilization

    ERIC Educational Resources Information Center

    Parish, Susan; Magana, Sandra; Rose, Roderick; Timberlake, Maria; Swaine, Jamie G.

    2012-01-01

    This study examines access to, utilization of, and quality of health care for Latino children with autism and other developmental disabilities. We analyze data from the National Survey of Children with Special Health Care Needs (N = 4,414 children with autism and other developmental disabilities). Compared with White children, Latino children with…

  2. Short- and longer-term health-care resource utilization and costs associated with acute ischemic stroke

    PubMed Central

    Johnson, Barbara H; Bonafede, Machaon M; Watson, Crystal

    2016-01-01

    Objectives The mean lifetime cost of ischemic stroke is approximately $140,048 in the United States, placing stroke among the top 10 most costly conditions among Medicare beneficiaries. The objective of this study was to describe the health-care resource utilization and costs in the year following hospitalization for acute ischemic stroke (AIS). Methods This retrospective claims analysis quantifies utilization and costs following inpatient admission for AIS among the commercially insured and Medicare beneficiaries in the Truven Health databases. Patients who were 18 years or older and continuously enrolled for 12 months before and after an AIS event occurring (index) between January 2009 and December 2012 were identified. Patients with AIS in the year preindex were excluded. Demographic and clinical characteristics were evaluated at admission and in the preindex, respectively. Direct costs, readmissions, and inpatient length of stay (LOS) were described in the year postindex. Results The eligible populations comprised 20,314 commercially insured patients and 31,037 Medicare beneficiaries. Average all-cause costs were $61,354 and $44,929 (commercial and Medicare, respectively) in the first year after the AIS. Approximately 50%–55% of total 12-month costs were incurred between day 31 and day 365 following the incident AIS. One quarter (24.6%) of commercially insured patients and 38.8% of Medicare beneficiaries were readmitted within 30 days with 16.6% and 71.7% (commercial and Medicare, respectively) of those having a principal diagnosis of AIS. The average AIS-related readmission length of stay was nearly three times that of the initial hospitalization for both commercially insured patients (3.8 vs 10.8 days) and Medicare beneficiaries (4.0 vs 10.8 days). Conclusion In addition to the substantial costs of the initial hospitalization of an AIS, these costs double within the year following this event. Given the high cost associated with AIS, new interventions

  3. A Comparison of Health Care Utilization and Costs of Children with and without Autism Spectrum Disorders in a Large Group-Model Health Plan

    ERIC Educational Resources Information Center

    Croen, Lisa A.; Najjar, Daniel V.; Ray, G. Thomas; Lotspeich, Linda; Bernal, Pilar

    2007-01-01

    Objective: Data on the current costs of medical services for children with autism spectrum disorders are lacking. Our purpose for this study was to compare health care utilization and costs of children with and without autism spectrum disorders in the same health plan. Patients and Methods: Participants included all 2- to 18-year-old children with…

  4. Influencing Self-Reported Health among Rural Low-Income Women through Health Care and Social Service Utilization: A Structural Equation Model

    ERIC Educational Resources Information Center

    Bice-Wigington, Tiffany; Huddleston-Casas, Catherine

    2012-01-01

    Using structural equation modeling, this study examined the mesosystemic processes among rural low-income women, and how these processes subsequently influenced self-reported health. Acknowledging the behavioral processes inherent in utilization of health care and formal social support services, this study moved beyond a behavioral focus by…

  5. A Multi-Worksite Analysis of the Relationships among Body Mass Index, Medical Utilization and Worker Productivity

    PubMed Central

    2010-01-01

    Background The relationships between worker health and productivity are becoming clearer. However, few large scale studies have measured the direct and indirect cost burden of overweight and obesity among employees using actual biometric values. Objective To quantify the direct medical and indirect (absence and productivity) cost burden of overweight and obesity in workers. Subjects A cross-sectional study of 10,026 employees in multiple professions and worksites across the U.S. Measures The main outcomes were five self-reported measures of workers’ annual healthcare use and productivity: doctor visits, emergency room visits, hospitalizations, absenteeism (days absent from work), and presenteeism (percent on-the-job productivity losses). Multivariate count and continuous data models (Poisson, negative binomial and zero-inflated Poisson) were estimated. Results After adjusting for covariates, obese employees had 20% higher doctor visits than normal weight employees (CI 16%, 24%, p < 0.01) and 26% higher emergency room visits (CI 11%, 42%, p < 0.01). Rates of doctor and emergency room visits for overweight employees were no different than those of normal weight employees. Compared to normal weight employees, presenteeism rates were 10% and 12% higher for overweight and obese employees, respectively (CI 5%, 15% and 5%, 19%, all p < 0.01). Taken together, compared to normal weight employees, obese and overweight workers were estimated to cost employers $644 and $201 more per employee per year, respectively. Conclusions This study provides evidence that employers face a financial burden imposed by obesity. Implementation of effective workplace programs for the prevention and management of excess weight will benefit employers and their workers. PMID:20061888

  6. Analysing the primacy of distance in the utilization of health services in the Ahafo-Ano South district, Ghana.

    PubMed

    Buor, Daniel

    2003-01-01

    Although the distance factor has been identified as key in the utilization of health services in rural areas of developing countries, it has been analysed without recourse to related factors of travel time and transport cost. Also, the influence of distance on vulnerable groups in utilization has not been an object of survey by researchers. This paper addresses the impact of distance on utilization, and how distance compares with travel time and transport cost that are related to it in the utilization of health services in the Ahafo-Ano South (rural) district in Ghana. The study, a cross-sectional survey, also identifies the position of distance among other important factors of utilization. A sample of 400, drawn through systematic random technique, was used for the survey. Data were analysed using the regression model and some graphic techniques. The main instruments used in data collection were formal (face-by-face) interview and a questionnaire. The survey finds that distance is the most important factor that influences the utilization of health services in the Ahafo-Ano South district. Other key factors are income, service cost and education. The effect of travel time on utilization reflects that of distance and utilization. Recommendations to reduce distance coverage, improve formal education and reduce poverty have been made. PMID:14727709

  7. A systematic review of Demographic and Health Surveys: data availability and utilization for research

    PubMed Central

    Choi, YoonJoung; Bird, Sandra

    2012-01-01

    Abstract Objective To systematically review the public health literature to assess trends in the use of Demographic and Health Survey (DHS) data for research from 1984 to 2010 and to describe the relationship between data availability and data utilization. Methods The MEASURE DHS web site was searched for information on all population-based surveys completed under the DHS project between 1984 and 2010. The information collected included the country, type of survey, survey design, fieldwork period and certain special features, such as inclusion of biomarkers. A search of PubMed was also conducted to identify peer-reviewed articles published during 2010 that analysed DHS data and included an English-language abstract. Trends in data availability and in the use of DHS data for research were assessed through descriptive, graphical and bivariate linear regression analyses. Findings In total, 236 household surveys under the DHS project were completed across 84 countries during 2010. The number of surveys per year has remained constant, although the scope of the survey questions has expanded. The inclusion criteria were met by 1117 peer-reviewed publications. The number of publications has increased progressively over the last quarter century, with an average annual increment of 4.3 (95% confidence interval, CI: 3.2–5.3) publications. Trends in the number of peer-reviewed publications based on the use of DHS data were highly correlated with trends in funding for health by the Government of the United States of America and globally. Conclusion Published peer-reviewed articles analysing DHS data, which have increased progressively in number over the last quarter century, have made a substantial contribution to the public health evidence base in developing countries. PMID:22893744

  8. Development of an Environmental Quality Index to assess environmental public health disparities - What data are available?

    EPA Science Inventory

    Assessing exposure to environmental insults and human health outcomes is complex. Environmental exposures tend to cluster spatially, with disamenities (e.g., landfills, industrial plants) often located in high-minority and largely poor neighborhoods, while wealthier neighborhoods...

  9. Exploring data availability for the Environmental Quality Index to assess environmental health disparities

    EPA Science Inventory

    The interaction between environmental insults and human health is complex. Environmental exposures tend to cluster, with disamenities (e.g., landfills, industrial plants) often located in high-minority and largely poor neighborhoods, while wealthier neighborhoods contain amenitie...

  10. Air Quality Index (AQI) -- A Guide to Air Quality and Your Health

    MedlinePlus

    ... the AQI value, the greater the level of air pollution and the greater the health concern. For example, ... to 50. Air quality is considered satisfactory, and air pollution poses little or no risk. "Moderate" AQI is ...

  11. Family Culture in Mental Health Help-Seeking and Utilization in a Nationally Representative Sample of Latinos in the United States: The NLAAS

    PubMed Central

    Villatoro, Alice P.; Morales, Eduardo S.; Mays, Vickie M.

    2014-01-01

    Considering the central role of familismo in Latino culture, it is important to assess the extent to which familismo affects mental health help-seeking. This study examined the role of behavioral familismo, the level of perceived family support, in the use of mental health services of Latinos in the United States. Data come from the National Latino and Asian American Study (NLAAS), a representative household survey examining the prevalence of mental disorders and services utilization among Latinos and Asian Americans. Analyses were limited to Latino adults with a clinical need for mental health services, indexed by meeting DSM–IV diagnostic criteria for any mood, anxiety, or substance use disorder during the past 12 months (N = 527). One-third of Latinos with a clinical need used any type of service in the past year, including specialty mental health, general medical, and informal or religious services. High behavioral familismo was significantly associated with increased odds of using informal or religious services, but not specialty or medical services. Self-perceived need and social perceptions of need for care within close networks (i.e., told by family/friends to seek professional help) also were significant predictors of service use. These results carry important implications toward expansions of the mental health workforce in the informal and religious services settings. PMID:24999521

  12. A brotherhood perspective: how African American male relationships may improve trust and utilization of health care.

    PubMed

    Grande, Stuart W; Sherman, Ledric; Shaw-Ridley, Mary

    2013-11-01

    The objective of this research was to explore interview data to understand and characterize the nature of brotherhood in a sample of African American men at two historically Black colleges and universities. The authors used thematic analysis on semistructured interview data, collected by an ethnically diverse research team. Recruitment and interviews were conducted at two historically Black colleges and universities in Texas. Twenty African American men, 18 to 35 years old, were randomly selected from 62 recruited participants. Five categories framed brotherhood and health care utilization: (a) trust lessens individual barriers to action, (b) identity unites men through a process of authentication, (c) generations lead by example, (d) approaching life as a shared learning experience, and (e) social pressure and ridicule uphold collective action. Findings suggest that participants trust a group view, identify with the collective, and respond to social pressure to conform; therefore, brotherhood acts as a support mechanism, and its validation influences individual-level engagement and nonengagement. PMID:23620540

  13. Online Prediction of Health Care Utilization in the Next Six Months Based on Electronic Health Record Information: A Cohort and Validation Study

    PubMed Central

    Hu, Zhongkai; Hao, Shiying; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Wang, Yue; Zheng, Le; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank

    2015-01-01

    Background The increasing rate of health care expenditures in the United States has placed a significant burden on the nation’s economy. Predicting future health care utilization of patients can provide useful information to better understand and manage overall health care deliveries and clinical resource allocation. Objective This study developed an electronic medical record (EMR)-based online risk model predictive of resource utilization for patients in Maine in the next 6 months across all payers, all diseases, and all demographic groups. Methods In the HealthInfoNet, Maine’s health information exchange (HIE), a retrospective cohort of 1,273,114 patients was constructed with the preceding 12-month EMR. Each patient’s next 6-month (between January 1, 2013 and June 30, 2013) health care resource utilization was retrospectively scored ranging from 0 to 100 and a decision tree–based predictive model was developed. Our model was later integrated in the Maine HIE population exploration system to allow a prospective validation analysis of 1,358,153 patients by forecasting their next 6-month risk of resource utilization between July 1, 2013 and December 31, 2013. Results Prospectively predicted risks, on either an individual level or a population (per 1000 patients) level, were consistent with the next 6-month resource utilization distributions and the clinical patterns at the population level. Results demonstrated the strong correlation between its care resource utilization and our risk scores, supporting the effectiveness of our model. With the online population risk monitoring enterprise dashboards, the effectiveness of the predictive algorithm has been validated by clinicians and caregivers in the State of Maine. Conclusions The model and associated online applications were designed for tracking the evolving nature of total population risk, in a longitudinal manner, for health care resource utilization. It will enable more effective care management

  14. Patterns of analgesic adherence predict health care utilization among outpatients with cancer pain

    PubMed Central

    Meghani, Salimah H; Knafl, George J

    2016-01-01

    Background Studies in chronic noncancer pain settings have found that opioid use increases health care utilization. Despite the key role of analgesics, specifically opioids, in the setting of cancer pain, there is no literature to our knowledge about the relationship between adherence to prescribed around-the-clock (ATC) analgesics and acute health care utilization (hospitalization) among patients with cancer pain. Purpose To identify adherence patterns over time for cancer patients taking ATC analgesics for pain, cluster these patterns into adherence types, combine the types into an adherence risk factor for hospitalization, identify other risk factors for hospitalization, and identify risk factors for inconsistent analgesic adherence. Materials and methods Data from a 3-month prospective observational study of patients diagnosed with solid tumors or multiple myeloma, having cancer-related pain, and having at least one prescription of oral ATC analgesics were collected. Adherence data were collected electronically using the medication event-monitoring system. Analyses were conducted using adaptive modeling methods based on heuristic search through alternative models controlled by likelihood cross-validation scores. Results Six adherence types were identified and combined into the risk factor for hospitalization of inconsistent versus consistent adherence over time. Twenty other individually significant risk factors for hospitalization were identified, but inconsistent analgesic adherence was the strongest of these predictors (ie, generating the largest likelihood cross-validation score). These risk factors were adaptively combined into a model for hospitalization based on six pairwise interaction risk factors with exceptional discrimination (ie, area under the receiver-operating-characteristic curve of 0.91). Patients had from zero to five of these risk factors, with an odds ratio of 5.44 (95% confidence interval 3.09–9.58) for hospitalization, with a unit

  15. Usefulness of the construct of social network to explain mental health service utilization by the maori population in new zealand.

    PubMed

    Kumar, Shailesh; Oakley Browne, Mark A

    2008-09-01

    This article briefly reviews the literature on the relationship between social network and mental health, and presents a theoretical framework outlining the role social networks may play in explaining the differential mental health service utilization rates between Maori and European people of New Zealand. By buffering individuals from the ill effects of stressful events, social networks may have a protective effect on people's mental health. In addition, social networks influence the way people with mental illnesses use mental health services. An inverse relationship between the size of an individual's social network and the rate of utilization of in-patient services has been reported. Despite having a larger and presumably more supportive social networks, Maori are over-represented in mental health service utilization statistics. Using the Maori example, we demonstrate that ethnic differences exist in the structure of social networks and the provision of social support to their members. Such differences may be based on the degree of emphasis placed on kinship or on individualism by cultures and on the receptivity or prejudice of the host community. We examine the sources of stress on Maori social networks that may adversely affect the network's ability to support its members experiencing mental illnesses. Caution must be exercised in using service utilization rates as measures of the mental health needs of different ethnic groups because of problems with help seeking and the detection of mental health issues in different ethnic groups. PMID:18799642

  16. Relationship between buprenorphine adherence and health service utilization and costs among opioid dependent patients.

    PubMed

    Tkacz, Joseph; Volpicelli, Joseph; Un, Hyong; Ruetsch, Charles

    2014-04-01

    Buprenorphine-medication assisted therapy (B-MAT) is an effective treatment for opioid dependence, but may be considered cost-prohibitive based on ingredient cost alone. The purpose of this study was to use medical and pharmacy claims data to estimate the healthcare service utilization and costs associated with B-MAT adherence among a sample of opioid dependent members. Members were placed into two adherence groups based on 1-year medication possession ratio (≥ 0.80 vs. <0.80). The B-MAT adherent group incurred significantly higher pharmacy charges (adjusted means; $6,156 vs. $3,581), but lower outpatient ($9,288 vs. $14,570), inpatient ($10,982 vs. $26,470), ER ($1,891 vs. $4,439), and total healthcare charges ($28,458 vs. $49,051; p<0.01) compared to non-adherent members. Adherence effects were confirmed in general linear models. Though B-MAT adherence requires increased pharmacy utilization, adherent individuals were shown to use fewer expensive health care services, resulting in overall reduced healthcare expenditure compared to non-adherent patients. PMID:24332511

  17. Adoption and utilization of electronic health record systems by long-term care facilities in Texas.

    PubMed

    Wang, Tiankai; Biedermann, Sue

    2012-01-01

    Long-term care (LTC) is an important sector in the healthcare industry; however, the adoption of electronic health record (EHR) systems in LTC facilities lags behind that in other sectors of healthcare. This study examines the adoption and utilization of EHRs in LTC facilities in Texas and identifies the barriers preventing implementation of EHRs. A survey instrument was mailed to all Texas LTC facilities between October 2010 and March 2011. The survey found that in Texas, 39.5 percent of LTC facilities have fully or partially implemented EHR systems and 15 percent of LTC facilities have no plans to adopt EHRs yet. There is significant variation in the use of EHR functionalities across the LTC facilities in Texas. In the LTC facilities, the administrative functions of EHRs have been more widely adopted and are more widely utilized than the clinical functions of EHRs. Among the clinical functions adopted, the resident assessment, physician orders, care management plan, and census management are the leading functions used by the LTC facilities in Texas. Lack of capital resources is still the greatest barrier to EHR adoption and implementation. Policy makers, vendors, LTC administrators, educators, and researchers should make more effort to improve EHR adoption in LTC facilities. PMID:22737099

  18. Health utilities of type 2 diabetes-related complications: a cross-sectional study in Sweden.

    PubMed

    Kiadaliri, Aliasghar A; Gerdtham, Ulf-G; Eliasson, Björn; Gudbjörnsdottir, Soffia; Svensson, Ann-Marie; Carlsson, Katarina Steen

    2014-05-01

    This study estimates health utilities (HU) in Sweden for a range of type 2 diabetes-related complications using EQ-5D and two alternative tariffs (UK and Swedish) from 1757 patients with type 2 diabetes from the Swedish National Diabetes Register (NDR). Ordinary least squares were used for statistical analysis. Lower HU was found for female gender, younger age at diagnosis, higher BMI, and history of complications. Microvascular and macrovascular complications had the most negative effect on HU among women and men, respectively. The greatest decline in HU was associated with kidney disorders (-0.114) using the UK tariff and stroke (-0.059) using the Swedish tariff. Multiple stroke and non-acute ischaemic heart disease had higher negative effect than a single event. With the UK tariff, each year elapsed since the last microvascular/macrovascular complication was associated with 0.013 and 0.007 units higher HU, respectively. We found important heterogeneities in effects of complications on HU in terms of gender, multiple event, and time. The Swedish tariff gave smaller estimates and so may result in less cost-effective interventions than the UK tariff. These results suggest that incorporating subgroup-specific HU in cost-utility analyses might provide more insight for informed decision-making. PMID:24810579

  19. Heterogeneity of mental health service utilization and high mental health service use among women eight years after initiating substance use disorder treatment

    PubMed Central

    Evans, Elizabeth; Padwa, Howard; Li, Libo; Lin, Veronique; Hser, Yih-Ing

    2015-01-01

    Objective To determine mental health service utilization patterns among women treated for substance use disorders (SUD) and identify factors associated with patterns of high mental health service use. Methods Data were provided by 4,447 women treated for SUD in California during 2000–2002 for whom mental health services utilization records were acquired. A latent class model was fitted to women’s high use of services (≥6 services/year over 8 years). Multinomial logistic regression was used to identify predisposing, enabling, and need factors associated with utilization patterns. Results In 8 years after initiating SUD treatment, 50% of women utilized mental health services. High use probability was consistently low for most women (76.9%); for others, however, it decreased immediately following SUD treatment and then increased over time (9.3%), increased immediately following SUD treatment and then decreased (8.7%), or remained consistently high (5.1%). Consistently high services use was negatively associated with marriage (OR 0.60, p<0.05) and employment (OR 0.53, p<0.05) and positively associated with older age (OR 1.04, p<0.001), homelessness (OR 1.68, p<0.05), public assistance (OR 1.76, p<0.01), outpatient SUD treatment (OR 3.