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  1. Health Insurance Status May Affect Cancer Patients' Survival

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_160304.html Health Insurance Status May Affect Cancer Patients' Survival 2 studies ... certain cancers in America could depend on your health insurance status. Despite improvements in cancer diagnosis and treatment, ...

  2. Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?

    PubMed

    Clemens, Jeffrey; Gottlieb, Joshua D

    2014-04-01

    We investigate whether physicians' financial incentives influence health care supply, technology diffusion, and resulting patient outcomes. In 1997, Medicare consolidated the geographic regions across which it adjusts physician payments, generating area-specific price shocks. Areas with higher payment shocks experience significant increases in health care supply. On average, a 2 percent increase in payment rates leads to a 3 percent increase in care provision. Elective procedures such as cataract surgery respond much more strongly than less discretionary services. Non-radiologists expand their provision of MRIs, suggesting effects on technology adoption. We estimate economically small health impacts, albeit with limited precision. PMID:25170174

  3. Factors Affecting the Downward Mobility of Psychiatric Patients: A Korean Study of National Health Insurance Beneficiaries

    PubMed Central

    2016-01-01

    Objectives: The purpose of this study is to examine the magnitude of and the factors associated with the downward mobility of first-episode psychiatric patients. Methods: This study used the claims data from the Korean Health Insurance Review and Assessment Service. The study population included 19 293 first-episode psychiatric inpatients diagnosed with alcohol use disorder (International Classification of Diseases, 10th revision [ICD-10] code F10), schizophrenia and related disorders (ICD-10 codes F20-F29), and mood disorders (ICD-10 codes F30-F33) in the first half of 2005. This study included only National Health Insurance beneficiaries in 2005. The dependent variable was the occurrence of downward mobility, which was defined as a health insurance status change from National Health Insurance to Medical Aid. Logistic regression analysis was used to assess factors associated with downward drift of first-episode psychiatric patients. Results: About 10% of the study population who were National Health Insurance beneficiaries in 2005 became Medical Aid recipients in 2007. The logistic regression analysis showed that age, gender, primary diagnosis, type of hospital at first admission, regular use of outpatient clinic, and long-term hospitalization are significant predictors in determining downward drift in newly diagnosed psychiatric patients. Conclusions: This research showed that the downward mobility of psychiatric patients is affected by long-term hospitalization and medical care utilization. The findings suggest that early intensive intervention might reduce long-term hospitalization and the downward mobility of psychiatric patients. PMID:26841885

  4. Does Time Affect Patient Satisfaction and Health-Related Quality of Life After Reduction Mammoplasty?

    PubMed Central

    Cohen, Wess A.; Homel, Peter

    2016-01-01

    Objective: A total of 62,611 patients with breast hypertrophy underwent breast reduction surgery in 2013 in the United States to improve their symptoms and health-related quality of life. While multiple studies utilizing various outcome instruments demonstrate the efficacy of reductive surgery, it is presently unknown how the postoperative course affects patient satisfaction and health-related quality of life as measured by the BREAST-Q. Our objective was to determine the temporal relationship of patient satisfaction and health-related quality of life after reduction mammoplasty. Methods: Patients prospectively completed the BREAST-Q reduction mammoplasty module at 3 time points during their treatment: preoperatively, at less than 3 months postoperatively, and at more than 3 months (<12 months) postoperatively. A single surgeon (N.P.P.) performed all of the breast reduction procedures. Results: Each time point contained 20 questionnaires. Mean preoperative BREAST-Q scores were significantly lower than scores at the less than 3-month postoperative time point for the scales Satisfaction With Breasts, Psychosocial Well-being, Sexual Well-being, and Physical Well-being (P < .001). There was no significant difference in BREAST-Q scores between the postoperative time points in these measures. Conclusion: Breast reduction surgery offers a vast improvement in patients’ satisfaction and health-related quality of life that is maintained throughout the postoperative period. These findings can assist surgeons in managing patient expectations after reduction mammoplasty and help improve the probability of obtaining prior authorization for insurance coverage. PMID:26819650

  5. Do health literacy and patient empowerment affect self-care behaviour? A survey study among Turkish patients with diabetes

    PubMed Central

    Eyüboğlu, Ezgi; Schulz, Peter J

    2016-01-01

    Objective This study aimed to assess the impact of health literacy and patient empowerment on diabetes self-care behaviour in patients in metropolitan Turkish diabetes centres. The conceptual background is provided by the psychological health empowerment model, which holds that health literacy without patient empowerment comes down to wasting health resources, while empowerment without health literacy can lead to dangerous or suboptimal health behaviour. Design, setting and participants A cross-sectional study was conducted with 167 patients over the age of 18 from one of two diabetes clinics in a major Turkish City. Self-administered questionnaires were distributed to eligible outpatients who had an appointment in one of the clinics. Health literacy was measured by a newly translated Turkish version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Chew self-report scale. Patient empowerment was measured by a 12-item scale based on Spreitzer's conceptualisation of psychological empowerment in the workplace. Self-care behaviour was measured by the Self-care behaviours were measured by the Summary of Diabetes Self-Care Activities Measure (SDSCA). Level of diabetes knowledge was measured by Diabetes Knowledge Test. Results Two subscales of empowerment, impact and self-determination, predicted self-reported frequency of self-care behaviours. Neither health literacy nor diabetes knowledge had an effect on self-care behaviours. Conclusions Health literacy might be more effective in clinical decisions while empowerment might exert a stronger influence on habitual health behaviours. PMID:26975936

  6. Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?†

    PubMed Central

    Clemens, Jeffrey; Gottlieb, Joshua D.

    2014-01-01

    We investigate whether physicians' financial incentives influence health care supply, technology diffusion, and resulting patient outcomes. In 1997, Medicare consolidated the geographic regions across which it adjusts physician payments, generating area-specific price shocks. Areas with higher payment shocks experience significant increases in health care supply. On average, a 2 percent increase in payment rates leads to a 3 percent increase in care provision. Elective procedures such as cataract surgery respond much more strongly than less discretionary services. Non-radiologists expand their provision of MRIs, suggesting effects on technology adoption. We estimate economically small health impacts, albeit with limited precision. PMID:25170174

  7. Does Commuting Affect Health?

    PubMed

    Künn-Nelen, Annemarie

    2016-08-01

    This paper analyzes the relation between commuting time and health in the UK. I focus on four different types of health outcomes: subjective health measures, objective health measures, health behavior, and healthcare utilization. Fixed effect models are estimated with British Household Panel Survey data. I find that whereas objective health and health behavior are barely affected by commuting time, subjective health measures are clearly lower for people who commute longer. A longer commuting time is, moreover, related to more visits to the general practitioner. Effects turn out to be more pronounced for women and for commuters driving a car. For women, commuting time is also negatively related to regular exercise and positively to calling in sick. Copyright © 2015 John Wiley & Sons, Ltd. PMID:26010157

  8. Autoimmunity affects health-related quality of life in patients with Hashimoto's thyroiditis.

    PubMed

    Bektas Uysal, Hilal; Ayhan, Mediha

    2016-08-01

    Hashimoto's thyroiditis (HT) is the most common endocrine disorder leading to hypothyroidism. HT is characterized by the presence of elevated circulating antibodies, especially anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg). In our study, we aimed to reveal the effects of autoimmunity on health-related quality of life of euthyroid HT patients. Patients who were admitted to the Adnan Menderes University Outpatient Clinic were enrolled. The medical records of the patients were surveyed and their demographical data were collected. By using communication data, the patients were invited to our clinic, to inform them about our study and to fill out the health-related quality of life questionnaire. A total of 84 euthyroid HT patients older than 18 years who completed the short form-36 questionnaire, were enrolled. As all patients were euthyroid, there was a significant negative correlation between each domain score and the antibody levels, individually. Patients who had higher anti-TPO and anti-Tg levels had significantly lower quality of life domain scores (p < 0.001). There was statistically no significant correlation between the antibody levels and thyroid function tests (p > 0.05). Additionally, all dimension scores were significantly higher both in the anti-Tg and anti-TPO negative groups, indicating a better quality of life than that in the antibody positive groups. Our study revealed that higher thyroid antibody levels were negatively correlated with life quality scores. Thus, patients who had higher anti-TPO and anti-Tg levels had significantly lower quality of life domain scores. We believe that apart from hypothyroidism, a high antibody level was one of the contributing factors for the development of HT-associated symptoms, leading to a lower quality of life. Other probable contributing factors such as selenium deficiency, thyroid hormone fluctuation, and disease awareness should keep in mind. PMID:27523457

  9. Periodontal Health and Caries Prevalence Evaluation in Patients Affected by Parkinson's Disease

    PubMed Central

    Cicciù, Marco; Risitano, Giacomo; Lo Giudice, Giuseppe; Bramanti, Ennio

    2012-01-01

    Parkinson's disease (PD) is a progressive neurodegenerative disorder related to the loss or absence of dopaminergic neurons in the brain. These deficits result in slowness of movement, tremor, rigidity, and dysfunction of behaviour. These symptoms negatively influence the patient's capability to carry out the daily oral hygiene manoeuvres. The aim of this work is to record the oral health condition of PD patients evaluated at the IRCSS Bonino-Puleio in Messina. The oral health of 45 consecutive PD patients (study group) with neurologic diagnosis based on United Kingdom Brain Bank Criteria has been compared with that of another 45 no PD patients of the same age (control group). The evaluation of the general oral condition was recorded underlining tooth loss, active periodontal disease, and presence of untreated caries. The frequency of untreated caries, periodontal diseases, and missing teeth of the study group was significantly higher than in control group. Based on the data results, clinicians should direct high attention to the oral hygiene of patients with PD, above all at the early stages of the caries or periodontal disease, in order to prevent serious evolution of those pathologic dental conditions that may finally result in the tooth extraction event. PMID:23320249

  10. Health care reform: will quality remodeling affect obstetrician-gynecologists in addition to patients?

    PubMed

    von Gruenigen, Vivian E; Deveny, T Clifford

    2011-05-01

    The Patient Protection and Affordable Care Act is a federal statute that attempts to address many fundamental problems with the current health care system including the uninsured, rising health care costs, and quality care. Quality metrics have been in development for years (by private and governmental sectors), and momentum is growing. The purpose of this commentary is to explore quality changes in the way practicing obstetricians and gynecologists will be held accountable for quality service. Two new options being explored for health care, both focusing on improving quality and physician metrics, include value-based purchasing and accountable-care organizations. Both will likely consist of universal clinical algorithms and cost monitoring as measures. For obstetrics this will probably include physician's rates of cesarean deliveries and elective inductions. For gynecology this may comprise of indications for hysterectomy with documented failed medical management, minor surgical management, or both medical and minor surgical management. It is anticipated patients will no longer be able to request obstetric testing, pregnancy induction, or hysterectomy. It is imperative we, as obstetrician-gynecologists, are involved in health care reform that inevitably involves the care of women. The expectation is that the American Congress of Obstetricians and Gynecologists (ACOG) will further develop evidenced-based opinions and guidelines, as medical communities embrace ACOG documents and reference these in hospital policies and peer review. PMID:21508757

  11. [Affection, proximity, frequency and hesitant clinical practice: basis of the "bond" between Down syndrome patients and primary health care?].

    PubMed

    Fontanella, Bruno José Barcellos; Setoue, Cesar Seiji; Melo, Débora Gusmão

    2013-07-01

    The national policy of comprehensive care in clinical genetics propounds that families and individuals with genetic disorders should receive ongoing assistance at primary health care (PHC) level. In this study, the social representation of professionals working in family health care units (FHCU) is investigated based on their "bond" with Down syndrome patients, bearing in mind that this expression currently contains relevant meanings in the clinical practice and service management routine. Sixteen practitioners were interviewed, and the sample was defined by theoretical saturation. The statements given by the participants expressed knowledge based mainly on affective skills, physical proximity and patients' frequency of attendance at the family health care unit (FHCU). Clinical skills of other kinds, especially cognitive skills, do not appear to justify the notion of "bond." The results indicate the need of continuous professional education and definition of guidelines and approaches in care to the most common syndromes in the context of primary health care (PHC). PMID:23827892

  12. Spinocerebellar Ataxia: Patient and Health Professional Perspectives on Whether and How Patents Affect Access to Clinical Genetic Testing

    PubMed Central

    Powell, Ashton; Chandrasekharan, Subhashini; Cook-Deegan, Robert

    2011-01-01

    Genetic testing for spinocerebellar ataxia (SCA) is used in diagnosis of rare movement disorders. Such testing generally does not affect treatment, but confirmation of mutations in a known gene can confirm diagnosis and end an often years-long quest for the cause of distressing and disabling symptoms. Through interviews and a web forum hosted by the National Ataxia Foundation, patients and health professionals related their experiences with patents’ impact on access to genetic testing for SCA. In the United States, Athena Diagnostics holds either a patent or an exclusive license to a patent in the case of 6 SCA variants (SCA1-3 & 6-8) and two other hereditary ataxias (Friedreich’s Ataxia and Early Onset Ataxia). Athena has enforced its exclusive rights to SCA-related patents by sending cease and desist letters to multiple laboratories offering genetic testing for inherited neurological conditions, including SCA. Roughly half of web forum respondents had decided not to get genetic tests. Price, coverage and reimbursement by insurers and health plans, and fear of genetic discrimination were the main reasons cited for deciding not to get tested. Price was cited as an access concern by the physicians, and as sole US provider, coverage and reimbursement depend on having payment agreements between Athena and payers. In cases where payers do not reimburse, the patient is responsible for payment, although some patients can apply to the voluntary Athena Access and Patient Protection Programs offered by the company. PMID:20393313

  13. Spinocerebellar ataxia: patient and health professional perspectives on whether and how patents affect access to clinical genetic testing.

    PubMed

    Powell, Ashton; Chandrasekharan, Subhashini; Cook-Deegan, Robert

    2010-04-01

    Genetic testing for spinocerebellar ataxia is used in diagnosis of rare movement disorders. Such testing generally does not affect treatment, but confirmation of mutations in a known gene can confirm diagnosis and end an often years-long quest for the cause of distressing and disabling symptoms. Through interviews and a web forum hosted by the National Ataxia Foundation, patients and health professionals related their experiences with the effect of patents on access to genetic testing for spinocerebellar ataxia. In the United States, Athena Diagnostics holds either a patent or an exclusive license to a patent in the case of six spinocerebellar ataxia variants (spinocerebellar ataxia 1-3 and 6-8) and two other hereditary ataxias (Friedreich's Ataxia and Early Onset Ataxia). Athena has enforced its exclusive rights to spinocerebellar ataxia-related patents by sending notification letters to multiple laboratories offering genetic testing for inherited neurological conditions, including spinocerebellar ataxia. Roughly half of web forum respondents had decided not to get genetic tests. Price, coverage and reimbursement by insurers and health plans, and fear of genetic discrimination were the main reasons cited for deciding not to get tested. Price was cited as an access concern by the physicians, and as sole US provider, coverage and reimbursement depend on having payment agreements between Athena and payers. In cases in which payers do not reimburse, the patient is responsible for payment, although some patients can apply to the voluntary Athena Access and Patient Protection Plan offered by the company. PMID:20393313

  14. Influence of oral health condition on swallowing and oral intake level for patients affected by chronic stroke

    PubMed Central

    Mituuti, Cláudia T; Bianco, Vinicius C; Bentim, Cláudia G; de Andrade, Eduardo C; Rubo, José H; Berretin-Felix, Giédre

    2015-01-01

    Background According to the literature, the occurrence of dysphagia is high in cases of stroke, and its severity can be enhanced by loss of teeth and the use of poorly fitting prostheses. Objective To verify that the status of oral health influences the level of oral intake and the degree of swallowing dysfunction in elderly patients with stroke in chronic phase. Methods Thirty elderly individuals affected by stroke in chronic phase participated. All subjects underwent assessment of their oral condition, with classification from the Functional Oral Intake Scale (FOIS) and nasoendoscopic swallowing assessment to classify the degree of dysphagia. The statistical analysis examined a heterogeneous group (HG, n=30) and two groups designated by the affected body part, right (RHG, n=8) and left (LHG, n=11), excluding totally dentate or edentulous individuals without rehabilitation with more than one episode of stroke. Results There was a negative correlation between the need for replacement prostheses and the FOIS scale for the HG (P=0.02) and RHG (P=0.01). Differences in FOIS between types of prostheses of the upper dental arch in the LHG (P=0.01) and lower dental arch in the RHG (P=0.04). A negative correlation was found between the number of teeth present and the degree of dysfunction in swallowing liquid in the LHG (P=0.05). There were differences in the performance in swallowing solids between individuals without prosthesis and those with partial prosthesis in the inferior dental arch (P=0.04) for the HG. Conclusion The need for replacement prostheses, type of prostheses, and the number of teeth of elderly patients poststroke in chronic phase showed an association with the level of oral intake and the degree of oropharyngeal dysphagia. PMID:25565784

  15. Attitudes of Hungarian asthmatic and COPD patients affecting disease control: empirical research based on Health Belief Model

    PubMed Central

    Simon, Judit

    2013-01-01

    Introduction: Patient non-adherence to treatment is a major problem across most chronic diseases. In COPD and asthma treatments it is a complex issue because people need to make behavioral and lifestyle changes while taking medications. Poor adherence results in increased rates of morbidity and mortality, more frequent hospitalizations, and ultimately higher healthcare expenditures. Materials and methods: The objective of the study was to assess asthmatic and COPD patient's attitudes toward adherence in Hungary. Health Belief Model was used to help explain reasons of non-adherence. The results of the study should provide additional support to understanding health-related behaviors and to developing health related programs enhancing adherence of asthmatic and COPD patients. 145 diagnosed COPD patients and 161 diagnosed asthmatic patients were involved in 6 pulmonary centers. The questions were designed to measure Health Belief Model dimensions A 1–5 point verbal Likert scale was used. As a second stage, the answers were compared with the registered patient's personal health data available in pulmonary center's documentation. The data was analyzed using SPSS software. Results: More than 32% of patients are very interested in new asthma or COPD research results, but their main information source is physician. The trust toward the physician is very high. Patients accept treatments and rarely ask questions. Respondents are cooperative but sometimes fail to follow therapeutic recommendations. There is no willingness to join self-help groups or associations. Discussion: The paternalistic approach was generally accepted, moreover expected by the patients from the physicians. It is important to train patients, increase their self-efficacy, responsibility and involve them into self-management programs. Both physicians and patients should be trained how to communicate—this approach can lead to increased understanding and better adherence. PMID:24312052

  16. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures

    PubMed Central

    2013-01-01

    Background Two of the current methodological barriers to implementation science efforts are the lack of agreement regarding constructs hypothesized to affect implementation success and identifiable measures of these constructs. In order to address these gaps, the main goals of this paper were to identify a multi-level framework that captures the predominant factors that impact implementation outcomes, conduct a systematic review of available measures assessing constructs subsumed within these primary factors, and determine the criterion validity of these measures in the search articles. Method We conducted a systematic literature review to identify articles reporting the use or development of measures designed to assess constructs that predict the implementation of evidence-based health innovations. Articles published through 12 August 2012 were identified through MEDLINE, CINAHL, PsycINFO and the journal Implementation Science. We then utilized a modified five-factor framework in order to code whether each measure contained items that assess constructs representing structural, organizational, provider, patient, and innovation level factors. Further, we coded the criterion validity of each measure within the search articles obtained. Results Our review identified 62 measures. Results indicate that organization, provider, and innovation-level constructs have the greatest number of measures available for use, whereas structural and patient-level constructs have the least. Additionally, relatively few measures demonstrated criterion validity, or reliable association with an implementation outcome (e.g., fidelity). Discussion In light of these findings, our discussion centers on strategies that researchers can utilize in order to identify, adapt, and improve extant measures for use in their own implementation research. In total, our literature review and resulting measures compendium increases the capacity of researchers to conceptualize and measure implementation

  17. Does health affect portfolio choice?

    PubMed

    Love, David A; Smith, Paul A

    2010-12-01

    A number of recent studies find that poor health is empirically associated with a safer portfolio allocation. It is difficult to say, however, whether this relationship is truly causal. Both health status and portfolio choice are influenced by unobserved characteristics such as risk attitudes, impatience, information, and motivation, and these unobserved factors, if not adequately controlled for, can induce significant bias in the estimates of asset demand equations. Using the 1992-2006 waves of the Health and Retirement Study, we investigate how much of the connection between health and portfolio choice is causal and how much is due to the effects of unobserved heterogeneity. Accounting for unobserved heterogeneity with fixed effects and correlated random effects models, we find that health does not appear to significantly affect portfolio choice among single households. For married households, we find a small effect (about 2-3 percentage points) from being in the lowest of five self-reported health categories. PMID:19937612

  18. Online Activity and Participation in Treatment Affects the Perceived Efficacy of Social Health Networks Among Patients With Chronic Illness

    PubMed Central

    Bergman, Yoav S; Grosberg, Dafna

    2014-01-01

    Background The use of online health-related social networks for support, peer-to-peer connections, and obtaining health information has increased dramatically. Participation in an online health-related social network can enhance patients’ self-efficacy and empowerment, as they are given knowledge and tools to manage their chronic health condition more effectively. Thus, we can deduce that patient activation, the extent to which individuals are able to manage their own health care, also increases. However, little is known about the effects of participation in online health-related social networks and patient activation on the perceived usefulness of a website across disease groups. Objective The intent of the study was to evaluate the effects and benefits of participation in an online health-related social network and to determine which variables predict perceived site usefulness, while examining patient activation. Methods Data were collected from “Camoni”, the first health-related social network in the Hebrew language. It offers medical advice, including blogs, forums, support groups, internal mail, chats, and an opportunity to consult with experts. This study focused on the site’s five largest and most active communities: diabetes, heart disease, kidney disease, spinal injury, and depression/anxiety. Recruitment was conducted during a three-month period in which a link to the study questionnaire was displayed on the Camoni home page. Three questionnaires were used: a 13-item measure of perceived usefulness (Cronbach alpha=.93) to estimate the extent to which an individual found the website helpful and informative, a 9-item measure of active involvement in the website (Cronbach alpha=.84), and The Patient Activation Measure (PAM-13, Cronbach alpha=.86), which assesses a patient’s level of active participation in his or her health care. Results There were 296 participants. Men 30-39 years of age scored higher in active involvement than those 40-49 years

  19. Does Positive Affect Influence Health?

    ERIC Educational Resources Information Center

    Pressman, Sarah D.; Cohen, Sheldon

    2005-01-01

    This review highlights consistent patterns in the literature associating positive affect (PA) and physical health. However, it also raises serious conceptual and methodological reservations. Evidence suggests an association of trait PA and lower morbidity and of state and trait PA and decreased symptoms and pain. Trait PA is also associated with…

  20. Nutritional Factors Affecting Mental Health.

    PubMed

    Lim, So Young; Kim, Eun Jin; Kim, Arang; Lee, Hee Jae; Choi, Hyun Jin; Yang, Soo Jin

    2016-07-01

    Dietary intake and nutritional status of individuals are important factors affecting mental health and the development of psychiatric disorders. Majority of scientific evidence relating to mental health focuses on depression, cognitive function, and dementia, and limited evidence is available about other psychiatric disorders including schizophrenia. As life span of human being is increasing, the more the prevalence of mental disorders is, the more attention rises. Lists of suggested nutritional components that may be beneficial for mental health are omega-3 fatty acids, phospholipids, cholesterol, niacin, folate, vitamin B6, and vitamin B12. Saturated fat and simple sugar are considered detrimental to cognitive function. Evidence on the effect of cholesterol is conflicting; however, in general, blood cholesterol levels are negatively associated with the risk of depression. Collectively, the aims of this review are to introduce known nutritional factors for mental health, and to discuss recent issues of the nutritional impact on cognitive function and healthy brain aging. PMID:27482518

  1. Nutritional Factors Affecting Mental Health

    PubMed Central

    Lim, So Young; Kim, Eun Jin; Kim, Arang; Lee, Hee Jae; Choi, Hyun Jin

    2016-01-01

    Dietary intake and nutritional status of individuals are important factors affecting mental health and the development of psychiatric disorders. Majority of scientific evidence relating to mental health focuses on depression, cognitive function, and dementia, and limited evidence is available about other psychiatric disorders including schizophrenia. As life span of human being is increasing, the more the prevalence of mental disorders is, the more attention rises. Lists of suggested nutritional components that may be beneficial for mental health are omega-3 fatty acids, phospholipids, cholesterol, niacin, folate, vitamin B6, and vitamin B12. Saturated fat and simple sugar are considered detrimental to cognitive function. Evidence on the effect of cholesterol is conflicting; however, in general, blood cholesterol levels are negatively associated with the risk of depression. Collectively, the aims of this review are to introduce known nutritional factors for mental health, and to discuss recent issues of the nutritional impact on cognitive function and healthy brain aging. PMID:27482518

  2. Factors affecting the presence of depression, anxiety disorders, and suicidal ideation in patients attending primary health care service in Lithuania

    PubMed Central

    Bunevicius, Robertas; Peceliuniene, Jurate; Raskauskiene, Nijole; Bunevicius, Adomas; Mickuviene, Narseta

    2014-01-01

    Abstract Objective. The aim of this study was to establish prevalence, recognition, and risk factors for mental disorders and suicidal ideation in PC patients. Design. A cross-sectional survey based on standard mental health evaluation. Setting. Lithuanian primary care. Subjects. 998 patients from four urban PC clinics. Main outcome measures. Current mental disorders and suicidal ideation assessed using the Mini International Neuropsychiatric Interview (MINI). Results. According to the MINI, 27% of patients were diagnosed with at least one current mental disorder. The most common mental disorders were generalized anxiety disorder (18%) and major depressive episode (MDE) (15%), followed by social phobia (3%), panic disorder (3%), and post-traumatic stress disorder (2%). Some 6% of patients reported suicidal ideation. About 70% of patients with current mental disorder had no documented psychiatric diagnosis and about 60% received no psychiatric treatment. Greater adjusted odds for current MDE were associated with being widowed or divorced patients (odds ratio, OR = 1.8, 95% CI 1.2–2.8) and with lower education (OR = 1.6, 95% CI 1.1–2.3), while greater adjusted odds for any current anxiety disorder were found for women (OR = 1.9, 95% CI 1.3–2.8) and for patients with documented insomnia (OR = 2.2, 95% CI 1.2–4.2). Suicidal ideation was independently associated with use of antidepressants (OR = 5.4, 95% CI 1.7–16.9), with current MDE (OR = 2.9, 95% CI 1.5–5.8), and with excessive alcohol consumption (OR = 2.0, 95% CI 1.1–3.8). Conclusions. Depression, anxiety disorders, and suicidal ideation are prevalent but poorly recognized among PC patients. The presence of current MDE is independently associated with marital status and with lower education, while current anxiety disorder is associated with female gender and insomnia. Suicidal ideation is associated with current MDE, and with antidepressants and alcohol use. PMID:24533847

  3. Does trade affect child health?

    PubMed

    Levine, David I; Rothman, Dov

    2006-05-01

    Frankel and Romer [Frankel, J., Romer, D., 1999. Does trade cause growth? American Economic Review 89 (3), 379-399] documented positive effects of geographically determined trade openness on economic growth. At the same time, critics fear that openness can lead to a "race to the bottom" that increases pollution and reduces government resources for investments in health and education. We use Frankel and Romer's gravity model of trade to examine how openness to trade affects children. Overall, we find little harm from trade, and potential benefits largely through slightly faster GDP growth. PMID:16303196

  4. Undergoing Diagnostic Evaluation for Possible Cancer Affects the Health-Related Quality of Life in Patients Presenting with Non-Specific Symptoms

    PubMed Central

    Moseholm, Ellen; Rydahl-Hansen, Susan; Lindhardt, Bjarne Ørskov

    2016-01-01

    Aim Undergoing diagnostic evaluation for possible cancer can affect health-related quality of life (HRQoL). The aims of this study were to examine the HRQoL in patients undergoing a diagnostic evaluation for possible cancer due to non-specific symptoms and further to investigate the impact of socio-demographic and medical factors associated with HRQoL at the time of diagnosis. Methods This was a prospective, multicenter survey study that included patients who were referred for a diagnostic evaluation due to non-specific cancer symptoms. Participants completed the EORTC-QLQ-C30 quality of life scale before and after completing the diagnostic evaluation. The baseline and follow-up EORTC-QLQ-C30 scores were compared with reference populations. The impact of socio-demographic and medical factors on HRQoL at follow-up was explored by bootstrapped multivariate linear regression. Results A total of 838 patients participated in the study; 680 (81%) also completed follow-up. Twenty-two percent of the patients received a cancer diagnosis at the end of follow-up. Patients presented initially with a high burden of symptoms, less role and emotional functioning and a lower global health/QoL. Most domains improved after diagnosis and no clinically important difference between baseline and follow-up scores was found. Patients reported effects on HRQoL both at baseline and at follow-up compared with the Danish reference population and had similar scores as a cancer reference population. Co-morbidity, being unemployed and receiving a cancer diagnosis had the greatest effect on HRQoL around the time of diagnosis. Conclusions Patients with non-specific symptoms reported an affected HRQoL while undergoing a diagnostic evaluation for possible cancer. Morbidity, being unemployed and receiving a cancer diagnosis had the greatest effect on HRQoL around the time of diagnosis. PMID:26840866

  5. Air Pollution Affects Community Health

    ERIC Educational Resources Information Center

    Shy, Carl M.; Finklea, John F.

    1973-01-01

    Community Health and Environmental Surveillance System (CHESS), a nationwide program relating community health to environmental quality, is designed to evaluate existing environmental standards, obtain health intelligence for new standards, and document health benefits of air pollution control. (BL)

  6. Demographics, Affect, and Adolescents' Health Behaviors.

    ERIC Educational Resources Information Center

    Terre, Lisa; And Others

    1992-01-01

    Examined relationship between affect, demographics, and health-related lifestyle among 139 public high school students. Data analyses revealed distinctive demographic and affective correlates of different health behaviors. No one variable uniformly predicted adolescents' health behaviors. Demographics and affect showed differential relationships…

  7. Influence of negative affectivity and self-esteem on the oral health related quality of life in patients receiving oral rehabilitation

    PubMed Central

    2013-01-01

    Background The aim of this study was to investigate if and how the personality traits Negative Affectivity (NA) and self-esteem influenced the Oral Health Related Quality of Life (OHRQoL) in patients receiving oral rehabilitation. Methods OHRQoL was measured by the Oral Health Impact Profile 49 (OHIP-49), NA with a short form of the Eysenck Personality Inventory Questionnaire (EPI-Q), and self-esteem with Rosenbergs Self-Esteem Scale (RSES) in 66 patients treated with removable dental prosthesis (RDP). The minimally important difference (MID), effect size (ES), and standard error of the measurement (SEM) were used to clinically interpret the patient-reported effect. Results The OHIP-49 score was significantly higher and exceeded the MID pre- and post-treatment in participants with high EPI-Q and low RSES score compared to participants with low EPI-Q and high RSES score. The improvement in OHIP-49 score was significant and not limited by high EPI-Q and low RSES score. High EPI-Q score was associated high improvement in OHIP-49 score and the ES of the improvement in participants with high EPI-Q was large and exceeded the MID and SEM. Conclusion Treatment with RDP improves the OHRQoL regardless of level of NA and self-esteem. High NA is associated with a large effect, but both high NA and low self-esteem is associated with poorer OHRQoL both before and after treatment. PMID:24156271

  8. [Harmful practices affecting women's health].

    PubMed

    1990-07-01

    The harmful practices discussed in this article are based on case histories form the Central Maternity in Niamey, yet these practices universally affect women throughout Africa. Nutritional taboos are aimed at certain diseases such as measles, diarrhea, dysentery, malnutrition and anemia and consumption of foods rich in proteins and lipids are forbidden. Children are forbidden from eating eggs; pregnant women are forbidden from eating fruits and vegetables because of the fear of hemorrhaging from the sugar content in the fruit; camel meat is forbidden for fear of extending the pregnancy. Female circumcision, a dangerous practice, especially during childbirth, causes many medical problems that remain permanent. Adolescent pregnancy and marriages are practiced to avoid delinquency among children; yet such practices take place because of arranged marriages for a dowry to young men or to older rich men and these forced marriages to adolescents are the causes of increases in divorce, prostitution and desertion. These young marriages have serious consequences on the health status of the mother and the infant, often leading to maternal and infant death. The high level of fertility in Niger is a response to the social structure of the family. It is a patrilineal system that encourages women to have many children, especially sons. In Niger, pregnancy is surrounded by supernatural and mysterious forces, where a child is the intervention for ancestral spirits. In Islam a child is considered a "Gift of God". A woman is expected to work until the delivery of her baby otherwise she is jeered by her neighbors. During delivery women are not expected to cry or show any pain for fear of dishonoring her family irregardless of any medical compilations she faces. Women in Africa are exploited as free labor, deteriorate and age rapidly, are generally illiterate and are not protected under any laws. PMID:12342832

  9. Health-related quality of life and affective status in liver transplant recipients and patients on the waiting list with low MELD scores

    PubMed Central

    Benzing, Christian; Krezdorn, Nicco; Förster, Julia; Hinz, Andreas; Krenzien, Felix; Atanasov, Georgi; Schmelzle, Moritz; Hau, Hans-Michael; Bartels, Michael

    2016-01-01

    Background This study seeks to examine the impact of orthotopic liver transplantation (OLT) on Health-Related Quality of Life (HRQoL) and mental health in patients with different MELD scores. Methods Patients who has undergone orthotopic liver transplant (OLT) or were on the waiting list for OLT were submitted to HRQoL and depression/anxiety assessment by questionnaire: Short-Form 36 (SF-36), Questions on Life Satisfaction (FLZ-M), Patient Health Questionnaire-4 (PHQ-4). Data were analysed following division of patients into three groups: pretransplant patients with a MELD score <10, ≥10, and OLT recipients. Results The surveys were sent to 940 consecutive patients within one week in June 2013. Of these 940 patients, 869 (92.4%) met the inclusion criteria. In total, 291 (33.5%) eligible questionnaires (OLT group: 235, MELD <10: 25; MELD _10: 31) were suitable for analysis. General health (GH), vitality (VIT), and mental health (MH) were lower in both pretransplant groups compared to the OLT group (all p < 0.05). Anxiety and depression were higher in the MELD <10 group than in the OLT group (anxiety: p < 0.05; depression: p < 0.01). Discussion Patients with low MELD scores seem to benefit from OLT with regards to HRQoL and mental health. PMID:27154809

  10. Affective Evaluation Techniques in School Health Education.

    ERIC Educational Resources Information Center

    Sutherland, Mary S.

    1981-01-01

    Ways in which affective measurement and evaluation techniques could be used for health instruction include: (1) determining student behavioral information and assisting in the removal of barriers to smooth classroom functioning; (2) attitude measurement; and (3) evaluation of classroom learning. Several types of affective measurement techniques…

  11. Monitoring fluid intake in mental health patients.

    PubMed

    Taylor, Daniel

    2016-08-17

    During my second year of nurse training, I had a clinical placement on an acute male psychiatric ward with around 20 male patients. They had a variety of mental health conditions, including depression, bipolar affective disorder and schizophrenia. PMID:27533410

  12. 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

  13. Health literacy and patient portals.

    PubMed

    Gu, Yulong; Orr, Martin; Warren, Jim

    2015-06-01

    Health literacy has been described as the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Improving health literacy may serve to promote concordance with therapy, engage patients in their own health care, and improve health outcomes. Patient portal technology aims at enabling patients and families to have easy access to key information in their own medical records and to communicate with their health care providers electronically. However, there is a gap in our understanding of how portals will improve patient outcome. The authors believe patient portal technology presents an opportunity to improve patient concordance with prescribed therapy, if adequate support is provided to equip patients (and family/carers) with the knowledge needed to utilise the health information available via the portals. Research is needed to understand what a health consumer will use patient portals for and how to support a user to realise the technology's potential. PMID:26125067

  14. Remote sensing of environmental factors affecting health

    NASA Astrophysics Data System (ADS)

    Jovanovic, Petar

    The purpose of this paper is to present the results of research to identify, by satellite imagery, parameters of the environment affecting health on Earth. Thus, we suggest expanding the application of space technology to preventive medicine, as a new field in the peaceful uses of outer space. The scope of the study includes all parts of the environment, natural and man-made, and all kinds of protection of life: human, animal and vegetation health. The general objective is to consider and classify those factors, detectable from space, that affect or are relevant to health and may be found in the air, water, sea, soil, land, vegetation, as well as those linked to climate, industry, energy production, development works, irrigation systems, and human settlements. The special objective is the classification of environmental factors detectable from space, that are linked to communicable or chronic endemic diseases or health problems. The method of identifying the factors affecting health was the parallel study of environmental epidemiological and biological parameters. The role of environmental factors common to both human and animal populations is discussed. Conclusive findings are formulated and possible applications, both scientific and practical, in other sectors are also discussed.

  15. Patient education: a component of health education.

    PubMed

    De Haes, W F

    1982-01-01

    Because health education is aimed at influencing behavior capable of affecting health and disease, patient education is a important constituent of health education. Patient education should demonstrably lead to increased self-assurance, reduced anxiety, better insight into one's ailments, more knowledge about the effects of medicines administered, greater self-acceptance after surgery, and improved social contacts among the chronically ill. It well deserves a place in primary health care. Patient education is not widely practiced in the Netherlands. Small-scale experiments are needed to establish effective modes of intervention. PMID:10258423

  16. Affects of Anxiety and Depression on Health-Related Quality of Life among Patients with Benign Breast Lumps Diagnosed via Ultrasonography in China

    PubMed Central

    Lou, Zhe; Li, Yinyan; Yang, Yilong; Wang, Lie; Yang, Jun

    2015-01-01

    There is a high incidence of benign breast lumps among women, and these lumps may lead to physical and psychological problems. This study aims to evaluate anxiety and depressive symptoms among patients with benign breast lumps diagnosed via ultrasonography and investigate their impacts on health-related quality of life (HRQOL). A cross-sectional survey was conducted in Shenyang, China, from January to November 2013. Data were collected with self-administered questionnaires, including the Zung Self-Rating Anxiety Scale (SAS), the Center for Epidemiologic Studies Depression Scale (CES-D), and the 36-item Short-Form Health Survey (SF-36), together with demographic characteristics, from patients of the Department of Breast Surgery of the First Affiliated Hospital of China Medical University. Hierarchical multiple regression analysis (HMR) was performed to explore the effects of anxiety and depression on HRQOL. The overall prevalences of anxiety (SAS score ≥ 40) and depression (CES-D scores ≥ 16) were 40.2% and 62.0%, respectively, and 37.5% of the participants had both of these psychological symptoms. The means and standard deviations of PCS and MCS were 75.42 (15.22) and 68.70 (17.71), respectively. Anxiety and depressive symptoms were significantly negatively associated with the HRQOL of patients with benign breast lumps diagnosed via ultrasonography. Women with benign breast lumps diagnosed via ultrasonography in China experienced relatively high levels of anxiety and depressive symptoms. Anxiety and depressive symptoms had significant negative impacts on both the mental and physical quality of life (QOL) of women with benign breast lumps. Beyond the necessary clinical treatment procedures, psychological guidance and detailed explanations of the disease should be offered to alleviate the anxiety and depressive symptoms and enhance the HRQOL of patients with benign breast lumps. PMID:26343700

  17. Soil Resources Area Affects Herbivore Health

    PubMed Central

    Garner, James A.; Ahmad, H. Anwar; Dacus, Chad M.

    2011-01-01

    Soil productivity effects nutritive quality of food plants, growth of humans and animals, and reproductive health of domestic animals. Game-range surveys sometimes poorly explained variations in wildlife populations, but classification of survey data by major soil types improved effectiveness. Our study evaluates possible health effects of lower condition and reproductive rates for wild populations of Odocoileus virginianus Zimmerman (white-tailed deer) in some physiographic regions of Mississippi. We analyzed condition and reproductive data for 2400 female deer from the Mississippi Department of Wildlife, Fisheries, and Parks herd health evaluations from 1991–1998. We evaluated age, body mass (Mass), kidney mass, kidney fat mass, number of corpora lutea (CL) and fetuses, as well as fetal ages. Region affected kidney fat index (KFI), which is a body condition index, and numbers of fetuses of adults (P ≤ 0.001). Region affected numbers of CL of adults (P ≤ 0.002). Mass and conception date (CD) were affected (P ≤ 0.001) by region which interacted significantly with age for Mass (P ≤ 0.001) and CD (P < 0.04). Soil region appears to be a major factor influencing physical characteristics of female deer. PMID:21776246

  18. Addressing health literacy in patient decision aids

    PubMed Central

    2013-01-01

    Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and 2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations. Methods We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews. Results Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies

  19. National Institutes of Health (NIH) Chronic GVHD Staging in Severely Affected Patients: Organ and Global Scoring Correlate with Established Indicators of Disease Severity and Prognosis

    PubMed Central

    Baird, K.; Steinberg, S.M.; Grkovic, L.; Pulanic, D.; Cowen, E.W.; Mitchell, S.A.; Williams, K.M.; Datiles, M.B.; Bishop, R.; Bassim, C.W.; Mays, J.W.; Edwards, D.; Cole, K.; Avila, D.N.; Taylor, T.; Urban, A.; Joe, G.O.; Comis, L.E.; Berger, A.; Stratton, P.; Zhang, D.; Shelhamer, J.H.; Gea-Banacloche, J.C.; Sportes, C.; Fowler, D.H.; Gress, R.E.; Pavletic, S.Z.

    2013-01-01

    Between 2004 and 2010, 189 adult patients were enrolled on the National Cancer Institute (NCI) cross-sectional chronic Graft-versus-Host disease (cGVHD) natural history study. Patients were evaluated by multiple disease scales and outcome measures including the 2005 NIH Consensus Project cGVHD severity score. The purpose of this study is to assess the validity of the NIH scoring variables as determinants of disease severity in severely affected patients in order to standardize clinician evaluation and staging of cGVHD. 125 of 189 patients met criteria for severe cGVHD on the NIH global score and 62 had moderate disease, with a median of 4 (range 1–8) involved organs. Clinician average NIH organ score and the corresponding organ scores performed by subspecialists were highly correlated (r=0.64). NIH global severity scores showed significant associations with nearly all functional and quality of life outcome measures including Lee Scale, SF-36 Physical Component Scale (PCS), 2 minutes walk, grip strength, range of motion and Human Activity Profile (HAP). Joints/fascia, skin, and lung involvement impacted function and quality of life most significantly and showed highest number of correlations with outcome measures. The final Cox model showing factors jointly predictive for survival contained the time from cGVHD diagnosis (>49 vs. ≤49 months, HR=0.23; p=0.0011), absolute eosinophil count of (0–0.5 vs. >0.5 cells/µL, HR=3.95; p=0.0006) at the time of NIH evaluation, and NIH lung score (3 vs. 0–2, HR=11.02; p <0.0001). These results demonstrate that NIH organs and global severity scores are reliable measures of cGVHD disease burden. Strong association with subspecialist evaluation suggests that NIH organs and global severity scores are appropriate for clinical and research assessments, and may serve as a surrogate for more complex sub-specialist exams. In this population of severely affected patients, NIH lung score is the strongest predictor of poor overall

  20. Dispositional Affect in Unique Subgroups of Patients with Rheumatoid Arthritis

    PubMed Central

    Rice, Danielle B.; Mehta, Swati; Pope, Janet E.; Harth, Manfred; Shapiro, Allan; Teasell, Robert W.

    2016-01-01

    Background. Patients with rheumatoid arthritis may experience increased negative outcomes if they exhibit specific patterns of dispositional affect. Objective. To identify subgroups of patients with rheumatoid arthritis based on dispositional affect. The secondary objective was to compare mood, pain catastrophizing, fear of pain, disability, and quality of life between subgroups. Methods. Outpatients from a rheumatology clinic were categorized into subgroups by a cluster analysis based on dispositional affect. Differences in outcomes were compared between clusters through multivariate analysis of covariance. Results. 227 patients were divided into two subgroups. Cluster 1 (n = 85) included patients reporting significantly higher scores on all dispositional variables (experiential avoidance, anxiety sensitivity, worry, fear of pain, and perfectionism; all p < 0.001) compared to patients in Cluster 2 (n = 142). Patients in Cluster 1 also reported significantly greater mood impairment, pain anxiety sensitivity, and pain catastrophizing (all p < 0.001). Clusters did not differ on quality of life or disability. Conclusions. The present study identifies a subgroup of rheumatoid arthritis patients who score significantly higher on dispositional affect and report increased mood impairment, pain anxiety sensitivity, and pain catastrophizing. Considering dispositional affect within subgroups of patients with RA may help health professionals tailor interventions for the specific stressors that these patients experience. PMID:27445594

  1. [Affect processing in psychosomatic patients. I].

    PubMed

    Ahrens, S

    1984-01-01

    The present article reports the results of an empirical investigation concerned with specific characteristics of psychosomatic patients. Subjects suffering from ulcus duodeni or from colitis ulcerosa designated as psychosomatic patients. Controls were chosen from among neurotic patients and from among patients with only somatic illness. Against the background of the criticism with regard to the scientific approaches so far, our own approach was conceived as an experiment. Film episodes of two contrating (friendly versus unfriendly) interactions between physician and patient were offered to the test subjects as triggering situations. The contents of these film segments were organized in a manner calculated to produce an affective embarrassment in the psychosomatic patients. The reactions of the test subjects were inventoried on two levels. One of the levels of investigation was geared to cognitive processes by the application of Hofstätter's list of polarities (1955, 1973). In this case the psychosomatic patients distinguished themselves from the two control groups in that they misinterpreted the differences in the affective contents of both film sequences. On the other level of investigation subconscious processes were recorded by the application of Gottschalk's analysis of verbal contents. In this context all three groups in the investigation reacted in a similar manner to friendly connotations in the behaviour of the physician, namely with hidden aggressions. The results infer an affective resonance of the investigated psychosomatic patients on a subconscious level which, however, does not become evident on the conscious cognitive level. PMID:6485587

  2. Affective instability in patients with chronic pain: a diary approach.

    PubMed

    Rost, Silke; Van Ryckeghem, Dimitri M L; Koval, Peter; Sütterlin, Stefan; Vögele, Claus; Crombez, Geert

    2016-08-01

    Affective instability, conceptualized as fluctuations in mood over time, has been related to ill-health and psychopathology. In this study, we examined the role of affective instability on daily pain outcomes in 70 patients with chronic pain (Mage = 49.7 years; 46 females) using an end-of-day diary. During a baseline phase, patients completed self-reported questionnaires of pain severity, pain duration, disability, depression, and anxiety. During a subsequent diary phase, patients filled out an electronic end-of-day diary over 14 consecutive days assessing daily levels of pain severity, disability, cognitive complaints, negative affect (NA) and positive affect. Affective instability was operationalized as the mean square of successive differences in daily mood (separately for NA and positive affect), which takes into account the size of affective changes over consecutive days. Results indicated that NA instability was positively associated with daily disability, beyond the effects of daily pain severity. Furthermore, NA instability moderated the relationship between daily pain severity and daily disability and the relationship between daily pain severity and daily cognitive complaints. Positive affect instability, however, showed to be unrelated to all outcomes. Current findings extend previous results and reveal the putative role of affective instability on pain-related outcomes and may yield important clinical implications. Indeed, they suggest that targeting NA instability by improving emotion regulation skills may be a strategy to diminish disability and cognitive complaints in patients with chronic pain. PMID:27075427

  3. Are physicians' ratings of pain affected by patients' physical attractiveness?

    PubMed

    Hadjistavropoulos, H D; Ross, M A; von Baeyer, C L

    1990-01-01

    The degree to which physical attractiveness and nonverbal expressions of pain influence physicians' perceptions of pain was investigated. Photographs of eight female university students were represented in four experimental conditions created by the manipulation of cosmetics, hairstyles, and facial expressions: (a) attractive-no pain, (b) attractive-pain, (c) unattractive-no pain, and (d) unattractive-pain. Each photograph was accompanied by a brief description of the patient's pain problem that was standard across conditions. Medical residents (N = 60) viewed the photographs and rated each patient's pain, distress, negative affective experience, health, personality, blame for the situation, and the physician's own solicitude for the patient. The results showed that physicians' ratings of pain were influenced both by attractiveness of patients and by nonverbal expressions of pain. Unattractive patients, and patients who were expressing pain, were perceived as experiencing more pain, distress, and negative affective experiences than attractive patients and patients who were not expressing pain. Unattractive patients also received higher ratings of solicitude on the doctor's part and lower ratings of health than attractive patients. Physician's assessments of pain appear to be influenced by the physical attractiveness of the patient. PMID:2367884

  4. Factors affecting choice of health care plans.

    PubMed

    Grazier, K L; Richardson, W C; Martin, D P; Diehr, P

    1986-02-01

    The research reported here examined the factors which affected the decision to remain with either Blue Cross of Washington and Alaska or Group Health Cooperative of Puget Sound, or to change to an independent practice association (IPA) in which the primary care physicians control all care. The natural setting allowed examination of the characteristics of families with experience in structurally different plans; a decision not influenced by premium differentials; the importance of the role of usual provider; and a family-based decision using multivariate techniques. An expected utility model implied that factors affecting preferences included future need for medical care; access to care; financial resources to meet the need for care; and previous level of experience with plan and provider. Analysis of interview and medical record abstract data from 1,497 families revealed the importance of maintaining a satisfactory relationship with the usual sources of care in the decision to change plans. Adverse selection into the new IPA as measured by health status and previous utilization of medical services was not noted. PMID:3949539

  5. Factors affecting choice of health care plans.

    PubMed Central

    Grazier, K L; Richardson, W C; Martin, D P; Diehr, P

    1986-01-01

    The research reported here examined the factors which affected the decision to remain with either Blue Cross of Washington and Alaska or Group Health Cooperative of Puget Sound, or to change to an independent practice association (IPA) in which the primary care physicians control all care. The natural setting allowed examination of the characteristics of families with experience in structurally different plans; a decision not influenced by premium differentials; the importance of the role of usual provider; and a family-based decision using multivariate techniques. An expected utility model implied that factors affecting preferences included future need for medical care; access to care; financial resources to meet the need for care; and previous level of experience with plan and provider. Analysis of interview and medical record abstract data from 1,497 families revealed the importance of maintaining a satisfactory relationship with the usual sources of care in the decision to change plans. Adverse selection into the new IPA as measured by health status and previous utilization of medical services was not noted. PMID:3949539

  6. Do waiting times affect health outcomes? Evidence from coronary bypass.

    PubMed

    Moscelli, Giuseppe; Siciliani, Luigi; Tonei, Valentina

    2016-07-01

    Long waiting times for non-emergency services are a feature of several publicly-funded health systems. A key policy concern is that long waiting times may worsen health outcomes: when patients receive treatment, their health condition may have deteriorated and health gains reduced. This study investigates whether patients in need of coronary bypass with longer waiting times are associated with poorer health outcomes in the English National Health Service over 2000-2010. Exploiting information from the Hospital Episode Statistics (HES), we measure health outcomes with in-hospital mortality and 28-day emergency readmission following discharge. Our results, obtained combining hospital fixed effects and instrumental variable methods, find no evidence of waiting times being associated with higher in-hospital mortality and weak association between waiting times and emergency readmission following a surgery. The results inform the debate on the relative merits of different types of rationing in healthcare systems. They are to some extent supportive of waiting times as an acceptable rationing mechanism, although further research is required to explore whether long waiting times affect other aspects of individuals' life. PMID:27299977

  7. Roundtable on public policy affecting patient safety.

    PubMed

    Crane, Robert M; Raymond, Brian

    2011-03-01

    On April 15, 2010, patient safety experts were assembled to discuss the adequacy of the public policy response to the Institute of Medicine report "To Err is Human" 10 years after its publication. The experts concluded that additional government actions should be considered. Actions that deserve consideration include the development of an educational campaign to improve public and provider understanding of the issue as a means to support change similar to successful public health campaigns, support the evolution of payment reform away from fee for service, create a clearer aim or goal for patient safety activities, support the development and use of better safety measures to judge status and improvement, and support for additional learning of what works particularly on implementation issues. Participants included: Moderator Robert Crane, senior advisor, Kaiser Permanente Participants Doug Bonacum, vice president, Safety Management, Kaiser Permanente Janet Corrigan, PhD, president and CEO, National Quality Forum Helen Darling, MA, president and CEO, National Business Group on Health Susan Edgman-Levitan, PA, executive director, John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital David M. Lawrence, MD, MPH, chairman and CEO (Retired), Kaiser Foundation Health Plan and Hospitals, Inc Lucian Leape, MD, adjunct professor of Health Policy, Harvard School of Public Health Diane C. Pinakiewicz, president, National Patient Safety Foundation Robert M. Wachter, MD, professor and associate chairman, Department of Medicine, University of California, San Francisco. PMID:22026014

  8. PSEUDOBULBAR AFFECT IN MULTIPLE SCLEROSIS PATIENTS.

    PubMed

    Vidović, Viktor; Rovazdi, Merisanda Časar; Kraml, Oto; Kes, Vanja Bašić

    2015-06-01

    The aim of the study was to determine the prevalence of pseudobulbar affect (PBA) in patients with multiple sclerosis (MS) and to analyze the link between PBA and patient age, sex, clinical course of MS, disease duration and degree of disability. The study was conducted on 79 MS patients that underwent inpatient rehabilitation at the Lipik Special Hospital for Medical Rehabilitation in the period from August 15, 2014 to February 15, 2015. PBA is a term used for an emotional disinhibition syndrome characterized by sudden and involuntary episodes of crying or laughing which are not in proportion to the stimulus applied or occur without stimulus. The condition can be present in patients with various neurological disorders, such as amyotrophic lateral sclerosis, Alzheimer's disease, Parkinson's disease, patients having recovered from stroke, or following traumatic brain injury. The estimated prevalence in patients with MS ranges from 10% to 46.2%. As a measuring instrument in the study, we used the Center for Neurologic Study-Lability Scale (CNS-LS), where a sum 17 denoted positive finding. The total number of respondents was 79, of which 33 (41.8%) met the CNS-LS criteria for the diagnosis of PBA. There was no statistically significant correlation between PBA, age and degree of disability, although PBA was more common in women and in patients with a secondary progressive form of the disease. We found that 42.4% of respondents with positive CNS-LS criteria for PBA did not inform their neurologist on the presence of sudden mood changes. The high frequency of PBA and the fact that a significant proportion of patients did not inform the neurologist on their affective disturbances call for an active approach to diagnosis and treatment. PMID:26415311

  9. How the stigma of low literacy can impair patient-professional spoken interactions and affect health: insights from a qualitative investigation

    PubMed Central

    2013-01-01

    Background Low literacy is a significant problem across the developed world. A considerable body of research has reported associations between low literacy and less appropriate access to healthcare services, lower likelihood of self-managing health conditions well, and poorer health outcomes. There is a need to explore the previously neglected perspectives of people with low literacy to help explain how low literacy can lead to poor health, and to consider how to improve the ability of health services to meet their needs. Methods Two stage qualitative study. In-depth individual interviews followed by focus groups to confirm analysis and develop suggestions for service improvements. A purposive sample of 29 adults with English as their first language who had sought help with literacy was recruited from an Adult Learning Centre in the UK. Results Over and above the well-documented difficulties that people with low literacy can have with the written information and complex explanations and instructions they encounter as they use health services, the stigma of low literacy had significant negative implications for participants’ spoken interactions with healthcare professionals. Participants described various difficulties in consultations, some of which had impacted negatively on their broader healthcare experiences and abilities to self-manage health conditions. Some communication difficulties were apparently perpetuated or exacerbated because participants limited their conversational engagement and used a variety of strategies to cover up their low literacy that could send misleading signals to health professionals. Participants’ biographical narratives revealed that the ways in which they managed their low literacy in healthcare settings, as in other social contexts, stemmed from highly negative experiences with literacy-related stigma, usually from their schooldays onwards. They also suggest that literacy-related stigma can significantly undermine mental

  10. Structural Factors Affecting Health Examination Behavioral Intention.

    PubMed

    Huang, Hui-Ting; Kuo, Yu-Ming; Wang, Shiang-Ru; Wang, Chia-Fen; Tsai, Chung-Hung

    2016-04-01

    Disease screening instruments used for secondary prevention can facilitate early determination and treatment of pathogenic factors, effectively reducing disease incidence, mortality rates, and health complications. Therefore, people should be encouraged to receive health examinations for discovering potential pathogenic factors before symptoms occur. Here, we used the health belief model as a foundation and integrated social psychological factors and investigated the factors influencing health examination behavioral intention among the public in Taiwan. In total, 388 effective questionnaires were analyzed through structural model analysis. Consequently, this study yielded four crucial findings: (1) The established extended health belief model could effectively predict health examination behavioral intention; (2) Self-efficacy was the factor that most strongly influenced health examination behavioral intention, followed by health knowledge; (3) Self-efficacy substantially influenced perceived benefits and perceived barriers; (4) Health knowledge and social support indirectly influenced health examination behavioral intention. The preceding results can effectively increase the acceptance and use of health examination services among the public, thereby facilitating early diagnosis and treatment and ultimately reducing disease and mortality rates. PMID:27043606

  11. Structural Factors Affecting Health Examination Behavioral Intention

    PubMed Central

    Huang, Hui-Ting; Kuo, Yu-Ming; Wang, Shiang-Ru; Wang, Chia-Fen; Tsai, Chung-Hung

    2016-01-01

    Disease screening instruments used for secondary prevention can facilitate early determination and treatment of pathogenic factors, effectively reducing disease incidence, mortality rates, and health complications. Therefore, people should be encouraged to receive health examinations for discovering potential pathogenic factors before symptoms occur. Here, we used the health belief model as a foundation and integrated social psychological factors and investigated the factors influencing health examination behavioral intention among the public in Taiwan. In total, 388 effective questionnaires were analyzed through structural model analysis. Consequently, this study yielded four crucial findings: (1) The established extended health belief model could effectively predict health examination behavioral intention; (2) Self-efficacy was the factor that most strongly influenced health examination behavioral intention, followed by health knowledge; (3) Self-efficacy substantially influenced perceived benefits and perceived barriers; (4) Health knowledge and social support indirectly influenced health examination behavioral intention. The preceding results can effectively increase the acceptance and use of health examination services among the public, thereby facilitating early diagnosis and treatment and ultimately reducing disease and mortality rates. PMID:27043606

  12. What Affects Clinicians’ Usage of Health Information Exchange?

    PubMed Central

    Rudin, R.; Volk, L.; Simon, S.; Bates, D.

    2011-01-01

    Background The ability to electronically exchange health information among healthcare providers holds enormous promise to improve care coordination and reduce costs. Provider-to-provider data exchange is an explicit goal of the American Recovery and Reinvestment Act of 2009 and may be essential for the long-term success of the Affordable Care Act of 2010. However, little is known about what factors affect clinicians’ usage of health information exchange (HIE) functionality. Objective To identify factors that affect clinicians’ HIE usage - in terms of frequency of contributing data to and accessing data from aggregate patient records - and suggest policies for fostering its usage. Methods We performed a qualitative study using grounded theory by interviewing clinician-users and HIE staff of one operational HIE which supported aggregate patient record functionality. Fifteen clinicians were interviewed for one hour each about what factors affect their HIE usage. Five HIE staff were asked about technology and training issues to provide context. Interviews were recorded, transcribed and analyzed. Recruitment excluded clinicians with little or no familiarity with the HIE and was restricted to one community and a small number of specialties. Results Clinicians were motivated to access the HIE by perceived improvements in care quality and time savings, but their motivation was moderated by an extensive list of factors including gaps in data, workflow issues and usability issues. HIE access intensities varied widely by clinician. Data contribution intensities to the HIE also varied widely and were affected by billing concerns and time constraints. Conclusions Clinicians, EHR and HIE product vendors and trainers should work toward integrating HIE into clinical workflows. Policies should create incentives for HIE organizations to assist clinicians in using HIE, develop measures of HIE contributions and accesses, and create incentives for clinicians to contribute data to

  13. Resveratrol Does Not Affect Health, Longevity in Population Study

    MedlinePlus

    ... You are here Home Resveratrol does not affect health, longevity in population study May 16, 2014 Resveratrol, ... disease. Researchers have found it to improve the health (and in some cases, longevity) of animals, including ...

  14. Nurse Overestimation of Patients' Health Literacy

    PubMed Central

    Dickens, Carolyn; Lambert, Bruce L.; Cromwell, Terese; Piano, Mariann R.

    2013-01-01

    Patient education and effective communication are core elements of the nursing profession; therefore, awareness of a patient's health literacy is integral to patient care, safety, education, and counseling. Several past studies have suggested that health care providers overestimate their patient's health literacy. In this study, the authors compare inpatient nurses' estimate of their patient's health literacy to the patient's health literacy using Newest Vital Sign as the health literacy measurement. A total of 65 patients and 30 nurses were enrolled in this trial. The results demonstrate that nurses incorrectly identify patients with low health literacy. In addition, overestimates outnumber underestimates 6 to 1. The results reinforce previous evidence that health care providers overestimate a patient's health literacy. The overestimation of a patient's health literacy by nursing personnel may contribute to the widespread problem of poor health outcomes and hospital readmission rates. PMID:24093346

  15. How health care complexity leads to cooperation and affects the autonomy of health care professionals.

    PubMed

    Molleman, Eric; Broekhuis, Manda; Stoffels, Renee; Jaspers, Frans

    2008-12-01

    Health professionals increasingly face patients with complex health problems and this pressurizes them to cooperate. The authors have analyzed how the complexity of health care problems relates to two types of cooperation: consultation and multidisciplinary teamwork (MTW). Moreover, they have analyzed the impact of these two types of cooperation on perceived professional autonomy. Two teams were studied, one team dealing with geriatric patients and another treating oncology patients. The authors conducted semi-structured interviews, studied written documents, held informal discussions and observed the teams at work. Consultation was most likely to take place when a patient had multiple problems. However, if these problems were interrelated, i.e. the solution for one problem interfered with solving another, then MTW was favored. The same was true when the available information was equivocal such that there were conflicting interpretations of a problem. How the professionals perceived the relationship between complexity and the need to cooperate depended on their expertise, their occupational background, and their work orientation. Consultation did not affect the professional autonomy of the health care professionals. MTW however did decrease the perceived level of professional autonomy. The extent to which this occurred seemed to depend on the quality of the interpersonal relations within the team. The findings can help in selecting the most appropriate and efficient type of cooperation based on the complexity of a patient's problems. They can also help team leaders to stimulate reflection and feedback processes, and medical trainers to develop competencies among students related to such teamwork behaviors. PMID:18193356

  16. How Can Spirituality Affect Your Family's Health?

    MedlinePlus

    ... some take a second look. Studies show that religion and faith can help to promote good health ... surgery who received strength and comfort from their religion were three times more likely to survive than ...

  17. Arsenic in drinking water in bangladesh: factors affecting child health.

    PubMed

    Aziz, Sonia N; Aziz, Khwaja M S; Boyle, Kevin J

    2014-01-01

    The focus of this paper is to present an empirical model of factors affecting child health by observing actions households take to avoid exposure to arsenic in drinking water. Millions of Bangladeshis face multiple health hazards from high levels of arsenic in drinking water. Safe water sources are either expensive or difficult to access, affecting people's individuals' time available for work and ultimately affecting the health of household members. Since children are particularly susceptible and live with parents who are primary decision makers for sustenance, parental actions linking child health outcomes is used in the empirical model. Empirical results suggest that child health is significantly affected by the age and gender of the household water procurer. Adults with a high degree of concern for children's health risk from arsenic contamination, and who actively mitigate their arsenic contaminated water have a positive effect on child health. PMID:24982854

  18. Arsenic in Drinking Water in Bangladesh: Factors Affecting Child Health

    PubMed Central

    Aziz, Sonia N.; Aziz, Khwaja M. S.; Boyle, Kevin J.

    2014-01-01

    The focus of this paper is to present an empirical model of factors affecting child health by observing actions households take to avoid exposure to arsenic in drinking water. Millions of Bangladeshis face multiple health hazards from high levels of arsenic in drinking water. Safe water sources are either expensive or difficult to access, affecting people’s individuals’ time available for work and ultimately affecting the health of household members. Since children are particularly susceptible and live with parents who are primary decision makers for sustenance, parental actions linking child health outcomes is used in the empirical model. Empirical results suggest that child health is significantly affected by the age and gender of the household water procurer. Adults with a high degree of concern for children’s health risk from arsenic contamination, and who actively mitigate their arsenic contaminated water have a positive effect on child health. PMID:24982854

  19. Health and Retirement: Do Changes in Health Affect Retirement Expectations?

    ERIC Educational Resources Information Center

    McGarry, Kathleen

    2004-01-01

    Health plays a vital role in the decision making process of retirement for an employee. The changes in retirement expectations are driven to a much greater degree by change in health rather than change in income or wealth.

  20. [Burnout : concepts and implications affecting public health].

    PubMed

    Segura, Omar

    2014-01-01

    Burnout was originally described as a mental condition characterized by reduced work performance, impotence, frustration and lack of capability to reach objectives or goals while performing a job. For some authors, burnout is a poorly defined mixture of symptoms and signs, while other professionals think of it as a disease and a potential threat to public health. Worldwide, it has been observed that the most afflicted professionals and technicians are those who work providing services or assistance to other people, especially those dedicated to health care. This paper focuses on the idea that burnout should be considered a disease more than a syndrome. On the other hand, definitions of health and disease have changed with time, as well as theoretical and methodological references about burnout. In addition, burnout remains a condition that is being discussed in various scientific areas, with radically opposing positions; these approaches are discussed in this article. After presenting different conceptions regarding burnout, the essay concludes with an exploration of its implications and the identification of possible treatments, especially for health workers, among whom it is more common depending on their predisposing conditions and environments. PMID:25504242

  1. Factors Affecting Hemodialysis Patients' Satisfaction with Their Dialysis Therapy

    PubMed Central

    Al Eissa, M.; Al Sulaiman, M.; Jondeby, M.; Karkar, A.; Barahmein, M.; Shaheen, F. A. M.; Al Sayyari, A.

    2010-01-01

    Aim. To assess the degree of satisfaction among hemodialysis patients and the factors influencing this satisfaction. Methods. Patients were recruited from 3 Saudi dialysis centers. Demographic data was collected. Using 1 to 10 Likert scale, the patients were asked to rate the overall satisfaction with, and the overall impact of, their dialysis therapy on their lives and to rate the effect of the dialysis therapy on 15 qualities of life domains. Results. 322 patients were recruited (72.6% of the total eligible patients). The mean age was 51.7 years (±15.4); 58% have been on dialysis for >3 years. The mean Charlson Comorbidity Index was 3.2 (±2), and Kt/V was 1.3 (±0.44). The mean satisfaction score was (7.41 ± 2.75) and the mean score of the impact of the dialysis on the patients' lives was 5.32 ± 2.55. Male patients reported worse effect of dialysis on family life, social life, energy, and appetite. Longer period since the commencement of dialysis was associated with adverse effect on finances and energy. Lower level of education was associated with worse dialysis effect on stress, overall health, sexual life, hobbies, and exercise ability. Conclusion. The level of satisfaction is affected by gender, duration on dialysis, educational level, and standard of care given. PMID:21152200

  2. Promoting Health Literacy in the Nonsurgical Cosmetic Patient.

    PubMed

    Warren, Hermine

    2016-01-01

    Significant numbers of adults, when presented with basic health care information, have been shown to struggle with their abilities to comprehend and integrate materials presented to them. This lack of perception underscores the essence of health literacy. Even though health literacy is a newer concept, its impact is gathering momentum, as politicians, health care providers, researchers, and the media become more aware of the extent this disparity is seen within the health care system and how it affects patient care. This article explores how nursing philosophy and knowledge development have the capacity to provide a solid infrastructure that may promote increased health literacy among patients within the nonsurgical cosmetic arena. PMID:27254238

  3. How energy policies affect public health.

    PubMed Central

    Romm, J J; Ervin, C A

    1996-01-01

    The connection between energy policy and increased levels of respiratory and cardiopulmonary disease has become clearer in the past few years. People living in cities with high levels of pollution have a higher risk of mortality than those living in less polluted cities. The pollutants most directly linked to increased morbidity and mortality include ozone, particulates, carbon monoxide, sulfur dioxide, volatile organic compounds, and oxides of nitrogen. Energy-related emissions generate the vast majority of these polluting chemicals. Technologies to prevent pollution in the transportation, manufacturing, building, and utility sectors can significantly reduce these emissions while reducing the energy bills of consumers and businesses. In short, clean energy technologies represent a very cost-effective investment in public health. Some 72% of the Federal government's investment in the research, development, and demonstration of pollution prevention technologies is made by the Department of Energy, with the largest share provided by the Office of Energy Efficiency and Renewable Energy. This article will examine the connections between air pollution and health problems and will discuss what the Department of Energy is doing to prevent air pollution now and in the future. Images p390-a p391-a p392-a p393-a p394-a p395-a p396-a p397-a PMID:8837627

  4. Discussing Health Care Costs with Patients

    PubMed Central

    Hardee, James T; Platt, Frederic W; Kasper, Ilene K

    2005-01-01

    Escalating health care costs are affecting patients across the country. As employers and insurance companies face higher expenses, they may move to a cost-sharing strategy, which potentially increases financial burdens on patients. In this situation, physicians may find themselves serving as both medical and financial advisors for their patients. Clinical encounters in which patients experience financial hardship can be awkward and frustrating for both parties. Physicians must learn to discuss issues of affordability in a manner that builds, rather than detracts, from a therapeutic alliance. This article describes our experiences using several communication skills that can help in the discussion of health care costs with patients. The primary skill, empathic communication, which includes “we” statements and “I wish …” statements, serves to create a platform for shared decision-making, negotiation, and a search for alternatives. In addition, it is helpful if physician offices have resource materials available and strategies identified to assist patients facing financial hardship. PMID:16050867

  5. Health innovation for patient safety improvement.

    PubMed

    Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

    2013-01-01

    Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare. PMID:23423150

  6. Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities.

    PubMed

    Chen, Jie; Mullins, C Daniel; Novak, Priscilla; Thomas, Stephen B

    2016-02-01

    Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making. PMID:25845376

  7. How Does Bullying Affect Health and Well-Being?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How does bullying affect health & well-being? Skip sharing on social media links Share this: Page Content Bullying can lead to physical injury, social problems, emotional ...

  8. [Patient-Proposed Health Services].

    PubMed

    Fujiwara, Yasuhiro

    2016-06-01

    The Patient-Proposed Health Services(PPHS)was launched in April 2016. PPHS was proposed by the Council for Regulatory Reform, which was established in January 2013 under the Second Abe Administration. After discussion within the council, PPHS was published in the Japan Revitalization Strategy(2014 revised edition), which was endorsed by the Cabinet on June 24, 2014. PPHS was proposed therein as a new mechanism within the mixed billing system to apply for a combination of treatment not covered by the public health insurance with treatment covered by the insurance. Subsequently, PPHS was submitted for diet deliberations in April and May 2015 and inserted into article 63 of the health insurance act in accordance with "a law for making partial amendments to the National Health Insurance Act, etc., in order to create a sustainable medical insurance system", which was promulgated on May 29, 2015. In this paper I will review the background of the birth of PPHS and discuss its overview. PMID:27306801

  9. Patient Matching within a Health Information Exchange.

    PubMed

    Godlove, Tim; Ball, Adrian W

    2015-01-01

    The purpose of this article is to describe the patient matching problems resulting from the Nationwide Health Information Network's automated patient discovery specification and propose a more effective and secure approach for patient matching between health information organizations participating in a health information exchange. This proposed approach would allow the patient to match his or her identity between a health information organization's electronic health records (EHRs) at the same time the patient identifies which EHR data he or she consents to share between organizations. The patient's EHR username/password combination would be the credential used to establish and maintain health information exchange identity and consent data. The software developed to support this approach (e.g., an EHR health information exchange module) could also allow a patient to see what health information was shared when and with whom. PMID:26755901

  10. Patient Matching within a Health Information Exchange

    PubMed Central

    Godlove, Tim; Ball, Adrian W.

    2015-01-01

    The purpose of this article is to describe the patient matching problems resulting from the Nationwide Health Information Network's automated patient discovery specification and propose a more effective and secure approach for patient matching between health information organizations participating in a health information exchange. This proposed approach would allow the patient to match his or her identity between a health information organization's electronic health records (EHRs) at the same time the patient identifies which EHR data he or she consents to share between organizations. The patient's EHR username/password combination would be the credential used to establish and maintain health information exchange identity and consent data. The software developed to support this approach (e.g., an EHR health information exchange module) could also allow a patient to see what health information was shared when and with whom. PMID:26755901

  11. Patient Moderator Interaction in Online Health Communities

    PubMed Central

    Huh, Jina; McDonald, David W.; Hartzler, Andrea; Pratt, Wanda

    2013-01-01

    An increasing number of people visit online health communities to share experiences and seek health information. Although studies have enumerated reasons for patients’ visits to online communities for health information from peers, we know little about how patients gain health information from the moderators in these communities. We qualitatively analyze 480 patient and moderator posts from six communities to understand how moderators fulfill patients’ information needs. Our findings show that patients use the community as an integral part of their health management practices. Based on our results, we suggest enhancements to moderated online health communities for their unique role to support patient care. PMID:24551364

  12. Patient Experience in Health Center Medical Homes.

    PubMed

    Cook, Nicole; Hollar, Lucas; Isaac, Emmanuel; Paul, Ludmilla; Amofah, Anthony; Shi, Leiyu

    2015-12-01

    The Human Resource and Services Administration, Bureau of Primary Health Care Health Center program was developed to provide comprehensive, community-based quality primary care services, with an emphasis on meeting the needs of medically underserved populations. Health Centers have been leaders in adopting innovative approaches to improve quality care delivery, including the patient centered medical home (PCMH) model. Engaging patients through patient experience assessment is an important component of PCMH evaluation and a vital activity that can help drive patient-centered quality improvement initiatives. A total of 488 patients from five Health Center PCMHs in south Florida were surveyed in order to improve understanding of patient experience in Health Center PCMHs and to identify quality improvement opportunities. Overall patients reported very positive experience with patient-centeredness including being treated with courtesy and respect (85 % responded "always") and communication with their provider in a way that was easy to understand (87.7 % responded "always"). Opportunities for improvement included patient goal setting, referrals for patients with health conditions to workshops or educational programs, contact with the Health Center via phone and appointment availability. After adjusting for patient characteristics, results suggest that some patient experience components may be modified by educational attainment, years of care and race/ethnicity of patients. Findings are useful for informing quality improvement initiatives that, in conjunction with other patient engagement strategies, support Health Centers' ongoing transformation as PCMHs. PMID:26026275

  13. Factors Affecting Exercise Test Performance in Patients After Liver Transplantation

    PubMed Central

    Kotarska, Katarzyna; Wunsch, Ewa; Jodko, Lukasz; Raszeja-Wyszomirska, Joanna; Bania, Izabela; Lawniczak, Malgorzata; Bogdanos, Dimitrios; Kornacewicz-Jach, Zdzislawa; Milkiewicz, Piotr

    2016-01-01

    Background Cardiovascular diseases are a leading cause of morbidity and mortality in solid organ transplant recipients. In addition, low physical activity is a risk factor for cardiac and cerebrovascular complications. Objectives This study examined potential relationships between physical activity, health-related quality of life (HRQoL), risk factors for cardiovascular disease, and an exercise test in liver-graft recipients. Patients and Methods A total of 107 participants (62 men/45 women) who had received a liver transplantation (LT) at least 6 months previously were evaluated. Physical activity was assessed using three different questionnaires, while HRQoL was assessed using the medical outcomes study short form (SF)-36 questionnaire, and health behaviors were evaluated using the health behavior inventory (HBI). The exercise test was performed in a standard manner. Results Seven participants (6.5%) had a positive exercise test, and these individuals were older than those who had a negative exercise test (P = 0.04). A significant association between a negative exercise test and a higher level of physical activity was shown by the Seven-day physical activity recall questionnaire. In addition, HRQoL was improved in various domains of the SF-36 in participants who had a negative exercise test. No correlations between physical activity, the exercise test and healthy behaviors, as assessed via the HBI were observed. Conclusions Exercise test performance was affected by lower quality of life and lower physical activity after LT. With the exception of hypertension, well known factors that affect the risk of coronary artery disease had no effect on the exercise test results. PMID:27226801

  14. Creating the Exceptional Patient Experience in One Academic Health System.

    PubMed

    Lee, Vivian S; Miller, Thomas; Daniels, Chrissy; Paine, Marilynn; Gresh, Brian; Betz, A Lorris

    2016-03-01

    Whether patient satisfaction scores can act as a catalyst for improving health care is highly debated. Some argue that pursuing patient satisfaction is overemphasized and potentially at odds with providing good care because it leads providers to overtest and overtreat patients and to bend to unreasonable patient demands, all to improve their ratings. Others cite studies showing that high patient satisfaction scores correlate with improved health outcomes. Ideally, assessing patient satisfaction metrics will encourage empathy, communication, trust, and shared decision making in the health care delivery process. From the patient's perspective, sharing such metrics motivates physicians to provide patient-centered care and meets their need for easily accessible information about their providers. In this article, the authors describe a seven-year initiative, which began in 2008, to change the culture of the University of Utah Health Care system to deliver a consistently exceptional patient experience. Five factors affected the health system's ability to provide such care: (1) a lack of good decision-making processes, (2) a lack of accountability, (3) the wrong attitude, (4) a lack of patient focus, and (5) mission conflict. Working groups designed initiatives at all levels of the health system to address these issues. What began as a patient satisfaction initiative evolved into a model for physician engagement, values-based employment practices, enhanced professionalism and communication, reduced variability in performance, and improved alignment of the mission and vision across hospital and faculty group practice teams. PMID:26606723

  15. Applying Health Literacy Principles: Strategies and Tools to Develop Easy-to-Read Patient Education Resources.

    PubMed

    Foster, Jackie; Idossa, Lensa; Mau, Lih-Wen; Murphy, Elizabeth

    2016-08-01

    Health literacy is an important construct in health care that affects patient outcomes and overall health. The impact of limited health literacy in cancer care is wide, and it can affect patients' ability to make treatment decisions, follow directions on a prescription label, or adhere to neutropenic precautions. This article describes strategies and tools for nurses to use when developing written patient education resources in their daily practice. PMID:27441517

  16. Creating the Exceptional Patient Experience in One Academic Health System

    PubMed Central

    Miller, Thomas; Daniels, Chrissy; Paine, Marilynn; Gresh, Brian; Betz, A. Lorris

    2016-01-01

    Whether patient satisfaction scores can act as a catalyst for improving health care is highly debated. Some argue that pursuing patient satisfaction is overemphasized and potentially at odds with providing good care because it leads providers to overtest and overtreat patients and to bend to unreasonable patient demands, all to improve their ratings. Others cite studies showing that high patient satisfaction scores correlate with improved health outcomes. Ideally, assessing patient satisfaction metrics will encourage empathy, communication, trust, and shared decision making in the health care delivery process. From the patient’s perspective, sharing such metrics motivates physicians to provide patient-centered care and meets their need for easily accessible information about their providers. In this article, the authors describe a seven-year initiative, which began in 2008, to change the culture of the University of Utah Health Care system to deliver a consistently exceptional patient experience. Five factors affected the health system’s ability to provide such care: (1) a lack of good decision-making processes, (2) a lack of accountability, (3) the wrong attitude, (4) a lack of patient focus, and (5) mission conflict. Working groups designed initiatives at all levels of the health system to address these issues. What began as a patient satisfaction initiative evolved into a model for physician engagement, values-based employment practices, enhanced professionalism and communication, reduced variability in performance, and improved alignment of the mission and vision across hospital and faculty group practice teams. PMID:26606723

  17. Desperation and Other Affective States in Suicidal Patients

    ERIC Educational Resources Information Center

    Hendin, Herbert; Maltsberger, John T.; Haas, Ann Pollinger; Szanto, Katalin; Rabinowicz, Heather

    2004-01-01

    Data collected from 26 therapists who were treating patients when they died by suicide were used to identify intense affective states in such patients preceding the suicide. Eleven therapists provided comparable data on 26 patients they had treated who were seriously depressed but not suicidal. Although the two groups had similar numbers diagnosed…

  18. Does Sex Education Affect Adolescent Sexual Behaviors and Health?

    ERIC Educational Resources Information Center

    Sabia, Joseph J.

    2006-01-01

    This study examines whether offering sex education to young teenagers affects several measures of adolescent sexual behavior and health: virginity status, contraceptive use, frequency of intercourse, likelihood of pregnancy, and probability of contracting a sexually transmitted disease. Using data from the National Longitudinal Study of Adolescent…

  19. Factors Affecting the Technology Readiness of Health Professionals

    ERIC Educational Resources Information Center

    Myers, Stephanie E.

    2010-01-01

    Federal government policies are promoting diffusion of technologies into the healthcare system. If health professionals reject the new technologies planned for the healthcare system, it could result in costly failures, delays, and workforce problems. There is a lack of knowledge about factors that affect technology readiness (TR), defined as the…

  20. Bees brought to their knees: Microbes affecting honey bee health

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The biology and health of the honey bee, Apis mellifera, has been of interest to human societies since the advent of beekeeping. Descriptive scientific research on pathogens affecting honey bees have been published for nearly a century, but it wasn’t until the recent outbreak of heavy colony losses...

  1. Trends Affecting the U.S. Health Care System. Health Planning Information Series.

    ERIC Educational Resources Information Center

    Cerf, Carol

    This integrated review of national trends affecting the health care system is primarily intended to facilitate the planning efforts of health care providers and consumers, Government agencies, medical school administrators, health insurers, and companies in the medical market. It may also be useful to educators as a textbook to give their students…

  2. Infertility Patients' Mental Health Problems Often Unaddressed

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_160382.html Infertility Patients' Mental Health Problems Often Unaddressed 'We're ... California, San Francisco. Many studies have found that infertility patients often feel distressed. And, Pasch said, professional ...

  3. [The phenomenology and psychodynamics of affects in borderline patients].

    PubMed

    Leichsenring, Falk

    2004-01-01

    This paper presents a review of the phenomenology and psychodynamics of affects in borderline patients. The first part demonstrates that in most current conceptions of the borderline disorder affective disturbances are regarded as to be characteristic. In this context, the strong overlap between borderline disorders and affective disorders found in many empirical studies is described and different hypotheses are presented to explain this phenomenon. The second part of this review is concerned with the psychodynamics of affects in borderline patients. The role of affects in thinking, behaviour, self perception and the regulation of object relations is discussed. Borderline and other severe personality disorders are assessed from the perspective of affective disturbances. The psychodynamic functions of particularly characteristic affects such as anger, anxiety, depression and boredom are discussed. The close connection between affective and cognitive functioning in borderline patients is described and evaluated with regard to modern theories of affect and cognition. Finally, the role of affects in the treatment of borderline patients is discussed. PMID:15510348

  4. Promoting health literacy with orofacial myofunctional patients.

    PubMed

    Reed, Hope C

    2007-11-01

    The definition of health literacy is provided along with information substantiating its importance. Focused initiatives, the consequences of poor health literacy, and at-risk populations are briefly discussed. The focus of this article is the application of health literacy principles to the discipline of orofacial myology and how the promotion of health literacy facilitates positive growth for patients, orfacial myologists, and the professions. The article concludes with a vision for a health literate society. PMID:18942479

  5. Factors Affecting Healthful Eating Among Touring Popular Musicians and Singers.

    PubMed

    Cizek, Erin; Kelly, Patrick; Kress, Kathleen; Mattfeldt-Beman, Mildred

    2016-06-01

    Maintaining good health is essential for touring musicians and singers. The stressful demands of touring may impact food choices, leading to detrimental effects on health and performance. This exploratory pilot study aimed to assess factors affecting healthful eating of touring musicians and singers. A 46-item survey was used to assess food- and nutrition-related attitudes, knowledge and behaviors, and environmental factors, as well as lifestyle, musical background, and demographic data. Participants (n=35) were recruited from a musicians' assistance foundation as well as touring musical theater productions and a music festival. Results indicate that touring musicians and singers had positive attitudes regarding healthful foods. Of 35 respondents, 80.0% indicated eating healthful food was important to them. Respondents reported feeling confident selecting (76.5%) and preparing (82.4%) healthful foods; however, they showed uncertainty when determining if carbohydrate-containing foods should be consumed or avoided. Respondents indicated environmental factors including availability and cost of healthy food options and tour schedules limited access to healthful foods. Venues (73.5%), fast food restaurants (67.6%), and airports (64.7%) were the most frequently identified locations in need of offering more healthful food choices. Respondents (52.9%) indicated more support from others while touring would help them make healthier food choices. More research is needed to develop mobile wellness programs as well as performance-based nutrition guidelines for musicians and singers that address the unique demands associated with touring. PMID:27281376

  6. Factors Affecting Patients Undergoing Cosmetic Surgery in Bushehr, Southern Iran

    PubMed Central

    Salehahmadi, Zeinab; Rafie, Seyyed Reza

    2012-01-01

    BACKGROUND Although, there have been extensive research on the motivations driving patient to undergo cosmetic procedures, there is still a big question mark on the persuasive factors which may lead individuals to undergo cosmetic surgery. The present study evaluated various factors affecting patients undergoing cosmetic surgery in Bushehr, Southern Iran. METHODS From 24th March 2011 to 24th March 2012, eighty-one women and 20 men who wished to be operated in Fatemeh Zahra Hospital in Bushehr, Southern Iran and Pars Clinic, Iran were enrolled by a simple random sampling method. They all completed a questionnaire to consider reasons for cosmetic procedures. The collected data were statistically analyzed. RESULTS Demographical, sociological and psychological factors such as age, gender, educational level, marital status, media, perceived risks, output quality, depression and self-improvement were determined as factors affecting tendency of individuals to undergo cosmetic surgery in this region. Trend to undergo cosmetic surgery was more prevalent in educational below bachelor degree, married subjects, women population of 30-45 years age group. Education level, age, marital status and gender were respectively the influential factors in deciding to undergo cosmetic surgery. Among the socio-psychological factors, self-improvement, finding a better job opportunity, rivalry, media, health status as well as depression were the most persuasive factors to encourage people to undergo cosmetic surgery too. Cost risk was not important for our samples in decision making to undergo cosmetic surgery. CONCLUSION We need to fully understand the way in which the combination of demographic, social and psychological factors influence decision-making to undergo cosmetic surgery. PMID:25734051

  7. Factors Affecting Indigenous West Australians' Health Behavior: Indigenous Perspectives.

    PubMed

    Waterworth, Pippa; Dimmock, James; Pescud, Melanie; Braham, Rebecca; Rosenberg, Michael

    2016-01-01

    The factors driving the disparity in health outcomes between Indigenous and non-Indigenous Australians include socio-economic factors, racism, and history. The current study focused on exploring Indigenous participants' perspectives of the factors that affect the health behavior of their community members. Participatory action research methodology and a grounded theory approach were utilized. In total, 120 members of two urban West Australian Indigenous communities participated in focus group discussions. There was substantial similarity between the themes that emerged within the discussions held in the two communities. Factors relating to culture, social connections, racism, communication, and personal aspects were particularly salient to health behavior of the participants. Several of the themes including culture, racism, communication, and distrust highlight the tension caused by being a member of a minority cultural group that has been marginalized by the practices and attitudes of the dominant cultural group. Personal choice was sometimes prioritized over health. PMID:25847855

  8. Alterations in psychosocial health of people affected by asbestos poisoning

    PubMed Central

    Clemente, Miguel; Reig-Botella, Adela; Prados, Juan Carlos

    2015-01-01

    OBJECTIVE To analyze the state of psychosocial and mental health of professionals affected by asbestos. METHODS A cross-sectional study was conducted with 110 professionals working in the Ferrolterra region of Spain, who were affected by asbestos poisoning. This group was compared with a group of 70 shipyard workers with no manifestation of work-related diseases. All the participants were male with a mean age of 67 years. This study was conducted in 2013, between January and June, and used the SCL-90 questionnaire by Derogatis as its primary measure for research. This questionnaire consists of 9 variables that measure psychosomatic symptoms. In addition, an overall index of psychosomatic gravity was calculated. The participants were also asked two questions concerning their overall perception of feeling good. Data were analyzed by ANOVA and logistic regression. RESULTS Participants affected by asbestos poisoning showed high occurrence rates of psychological health variables such as somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and global severity index. CONCLUSIONS Social interaction as a differentiating factor between workers affected by work-related chronic syndromes as compared to healthy participants will possibly aid in the development of intervention programs by improving the social network of affected individuals. PMID:25902564

  9. Moving towards health oriented patient education (HOPE).

    PubMed

    Glanville, I K

    2000-01-01

    The economics of prevention supports reimbursement of nurse practitioners for patient education. The role has undergone historical change, shifting from imparting disease-oriented health education (DOPE) toward empowering patients to use their own resources to the fullest to attain health. Nurse practitioners are well suited to provide care that facilitates behavior change and health-oriented patient education (HOPE). Essentials for effective patient education include use of an open communication style, written instructions, and the address of barriers. Adult literacy and reader-friendliness must be considered when assembling written materials. PMID:12119971

  10. Contraceptive choice and patient compliance. The health care provider's challenge.

    PubMed

    Branden, P S

    1998-01-01

    Contraceptive compliance is a multifaceted issue that is influenced by many factors. These factors can directly affect the level of patient compliance, thereby affecting contraceptive method efficacy rates. A review of the literature reveals many studies about contraceptive compliance but a dearth of studies addressing how to change noncompliant behaviors. This article describes the contraceptive methods currently available and their efficacy rates. Patient characteristics and the components of compliance are described as they affect contraceptive efficacy and patient care. Suggestions are made for the use of alternative terminology to include adherence to or continuance of a contraceptive method. Health care providers should realize the impact they can have on a patient's education, decision-making process, and ultimate compliance with a contraceptive method. It is the patient, however, who ultimately makes the decision, either actively or passively, to comply or not and whether to have an unplanned pregnancy. PMID:9871380

  11. Parental health literacy and its impact on patient care.

    PubMed

    Scotten, Mitzi

    2015-03-01

    The process of navigating through the modern American health care system is becoming progressively challenging. The range of tasks being asked of patients in the digital age is vast and complex and includes completing intricate insurance applications, signing complex consent forms, and translating medical data and prescription medication directions. Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely offered by medical providers. Mounting evidence now supports a growing awareness that general health literacy is the greatest individual factor affecting a person's health status. PMID:25634701

  12. [WHO AFFECTS THE PATIENT, DR. GOOGLE OR THE DOCTOR?].

    PubMed

    Mishali, Moshe; Avrech, Tova

    2015-09-01

    In the last decade the World Wide Web has become one of the prime sources for medical data searches. The abundance of information and emphasis on consumer communication, which are the main characteristics of the new generation of the web named "Web 2.0", enable users to engage and educate others by sharing and collaborating knowledge. It also enables them to receive medical information based on the experience of other patients, while the duration of the traditional physician's visit has shortened. However, using Web 2.0 for health collaboration has drawbacks as well: When alternative ways of "knowing" replace objective medical facts, there is danger of misinformation and truth "flattening". This article examines the distribution of medical misinformation online: Its characteristics, the nature of the messages presented online and the means that might help protect users and patients from it. The authors hold positions in the Israeli Dairy Board (IDB): Dr. Averch manages the health field on the IDB, and the findings in this article are based on research that she is leading as part of this position, and Dr. Mishali is a trained psychologist, and acts as a strategic consultant for IDB in the field of coping with the opposition to milk and its products. In this article it is initially shown how the characteristics of information distribution in general help spreading medical misinformation online: The decline of doctors' authority as sole providers of medical information, disillusionment and suspicion towards science and the notion of expertise, and the emergence of new ways to evaluate information, based on community ties. The nature of this pseudo-medical information will then be discussed, including the range of the phenomenon and the probability of users to be affected by it. Furthermore, we will raise specific tactics in which anti-establishment messages are portrayed; examples will be given of the use of emotion evoking content in the anti-establishment messages

  13. New aspects on patients affected by dysferlin deficient muscular dystrophy

    PubMed Central

    Klinge, Lars; Aboumousa, Ahmed; Eagle, Michelle; Hudson, Judith; Sarkozy, Anna; Vita, Gianluca; Charlton, Richard; Roberts, Mark; Straub, Volker; Barresi, Rita; Lochmüller, Hanns

    2009-01-01

    Mutations in the dysferlin gene lead to limb girdle muscular dystrophy 2B, Miyoshi myopathy and distal anterior compartment myopathy. A cohort of 36 patients affected by dysferlinopathy is described, in the first UK study of clinical, genetic, pathological and biochemical data. The diagnosis was established by reduction of dysferlin in the muscle biopsy and subsequent mutational analysis of the dysferlin gene. Seventeen mutations were novel; the majority of mutations were small deletions/insertions, and no mutational hotspots were identified. Sixty-one per cent of patients (22 patients) initially presented with limb girdle muscular dystrophy 2B, 31% (11 patients) with a Miyoshi phenotype, one patient with proximodistal mode of onset, one patient with muscle stiffness after exercise and one patient as a symptomatic carrier. A wider range of age of onset was noted than previously reported, with 25% of patients having first symptoms before the age of 13 years. Independent of the initial mode of presentation, in our cohort of patients the gastrocnemius muscle was the most severely affected muscle leading to an inability to stand on tiptoes, and lower limbs were affected more severely than upper limbs. As previous anecdotal evidence on patients affected by dysferlinopathy suggests good muscle prowess before onset of symptoms, we also investigated pre-symptomatic fitness levels of the patients. Fifty-three per cent of the patients were very active and sporty before the onset of symptoms which makes the clinical course of dysferlinopathy unusual within the different forms of muscular dystrophy and provides a challenge to understanding the underlying pathomechanisms in this disease. PMID:19528035

  14. Urban sprawl and you: how sprawl adversely affects worker health.

    PubMed

    Pohanka, Mary; Fitzgerald, Sheila

    2004-06-01

    Urban sprawl, once thought of as just an environmental issue, is currently gaining momentum as an emerging public health issue worthy of research and political attention. Characteristics seen in sprawling communities include increasing traffic volumes; inadequate public transportation; pedestrian unfriendly streets; and the division of businesses, shops, and homes. These characteristics can affect health in many ways. Greater air pollution contributes to higher asthma and other lung disorder rates. An increased dependence on the automobile encourages a more sedentary lifestyle and can potentially contribute to obesity. The increased danger and stress of long commutes can lead to more accidents, anxiety, and social isolation. Occupational health nurses can become involved by promoting physical activity in the workplace, creating programs for injury prevention and stress management, becoming involved in political smart growth measures, and educating and encouraging colleagues to become active in addressing this issue. PMID:15219110

  15. Patient Perceptions of Electronic Health Records

    ERIC Educational Resources Information Center

    Lulejian, Armine

    2011-01-01

    Research objective. Electronic Health Records (EHR) are expected to transform the way medicine is delivered with patients/consumers being the intended beneficiaries. However, little is known regarding patient knowledge and attitudes about EHRs. This study examined patient perceptions about EHR. Study design. Surveys were administered following…

  16. Health and Illness in a Connected World: How Might Sharing Experiences on the Internet Affect People's Health?

    PubMed Central

    Ziebland, Sue; Wyke, Sally

    2012-01-01

    Context The use of the Internet for peer-to-peer connection has been one of its most dramatic and transformational features. Yet this is a new field with no agreement on a theoretical and methodological basis. The scientific base underpinning this activity needs strengthening, especially given the explosion of web resources that feature experiences posted by patients themselves. This review informs a National Institute for Health Research (NIHR) (UK) research program on the impact of online patients’ accounts of their experiences with health and health care, which includes the development and validation of a new e-health impact questionnaire. Methods We drew on realist review methods to conduct a conceptual review of literature in the social and health sciences. We developed a matrix to summarize the results, which we then distilled from a wide and diverse reading of the literature. We continued reading until we reached data saturation and then further refined the results after testing them with expert colleagues and a public user panel. Findings We identified seven domains through which online patients’ experiences could affect health. Each has the potential for positive and negative impacts. Five of the identified domains (finding information, feeling supported, maintaining relationships with others, affecting behavior, and experiencing health services) are relatively well rehearsed, while two (learning to tell the story and visualizing disease) are less acknowledged but important features of online resources. Conclusions The value of first-person accounts, the appeal and memorability of stories, and the need to make contact with peers all strongly suggest that reading and hearing others’ accounts of their own experiences of health and illnesss will remain a key feature of e-health. The act of participating in the creation of health information (e.g., through blogging and contributing to social networking on health topics) also influences patients

  17. Obesity Adversely Affects Survival in Pancreatic Cancer Patients

    PubMed Central

    McWilliams, Robert R.; Matsumoto, Martha E.; Burch, Patrick A.; Kim, George P.; Halfdanarson, Thorvardur R.; de Andrade, Mariza; Reid-Lombardo, Kaye; Bamlet, William R.

    2010-01-01

    Purpose Higher body-mass index (BMI) has been implicated as a risk factor for developing pancreatic cancer, but its effect on survival has not been thoroughly investigated. We assessed the association of BMI with survival in a sample of pancreatic cancer patients and utilized epidemiologic and clinical information to understand the contribution of diabetes and hyperglycemia. Methods A survival analysis using Cox proportional hazards by usual adult BMI was performed on 1,861 unselected patients with pancreatic adenocarcinoma; analyses were adjusted for covariates that included clinical stage, age, and sex. Secondary analyses incorporated self reported diabetes and fasting blood glucose in the survival model. Results BMI as a continuous variable was inversely associated with survival from pancreatic adenocarcinoma [hazard ratio 1.019 for each increased unit of BMI (kg/m2), p < 0.001] after adjustment for age, stage, and sex. In analysis by National Institutes of Health BMI category, BMI of 30–34.99 kg/m2 (HR 1.14, 95% confidence interval 0.98–1.33), 35–39.99 kg/m2 (HR 1.32, 95% CI 1.08–1.62), and ≥40 (HR 1.60, 95% CI 1.26–2.04) were associated with decreased survival compared to normal BMI of 18,5–24.99 kg/m2 (overall trend test p<0.001). Fasting blood glucose and diabetes did not affect the results. Conclusions Higher BMI is associated with decreased survival in pancreatic cancer. Although the mechanism of this association remains undetermined, diabetes and hyperglycemia do not appear to account for the observed association. PMID:20665496

  18. Hearing the patient's voice? Factors affecting the use of patient survey data in quality improvement

    PubMed Central

    Davies, E; Cleary, P

    2005-01-01

    Objective: To develop a framework for understanding factors affecting the use of patient survey data in quality improvement. Design: Qualitative interviews with senior health professionals and managers and a review of the literature. Setting: A quality improvement collaborative in Minnesota, USA involving teams from eight medical groups, focusing on how to use patient survey data to improve patient centred care. Participants: Eight team leaders (medical, clinical improvement or service quality directors) and six team members (clinical improvement coordinators and managers). Results: Respondents reported three types of barriers before the collaborative: organisational, professional and data related. Organisational barriers included lack of supporting values for patient centred care, competing priorities, and lack of an effective quality improvement infrastructure. Professional barriers included clinicians and staff not being used to focusing on patient interaction as a quality issue, individuals not necessarily having been selected, trained or supported to provide patient centred care, and scepticism, defensiveness or resistance to change following feedback. Data related barriers included lack of expertise with survey data, lack of timely and specific results, uncertainty over the effective interventions or time frames for improvement, and consequent risk of perceived low cost effectiveness of data collection. Factors that appeared to have promoted data use included board led strategies to change culture and create quality improvement forums, leadership from senior physicians and managers, and the persistence of quality improvement staff over several years in demonstrating change in other areas. Conclusion: Using patient survey data may require a more concerted effort than for other clinical data. Organisations may need to develop cultures that support patient centred care, quality improvement capacity, and to align professional receptiveness and leadership with

  19. Attitudes of patients toward smoking by health professionals.

    PubMed Central

    Olive, K E; Ballard, J A

    1992-01-01

    Do the smoking behaviors of physicians and nurses affect patients' perceptions of the trust and effectiveness of these health professionals? In this exploratory study, a 40-item questionnaire was given to patients discharged from an Air Force hospital during a 4-week period. The survey resulted in 116 usable questionnaires from 40 patients who had never smoked, 44 who no longer smoked, and 32 who still smoked. Analyses of variance in the replies to the questionnaire indicated that nonsmokers felt strongly about health professionals not modeling unhealthy behaviors, while smokers indicated they had no opinion. Regarding the relationship between the smoking habits of physicians and nurses and patients' perceptions of trust and effectiveness, smokers felt strongly there was no relationship, whereas nonsmokers indicated no opinion. A review of the literature suggested that, on the average, health professionals who smoke may not be as effective in counseling patients to quit smoking as health professionals who do not smoke. Health professionals who smoke have the potential to affect unintentionally the smoking behaviors of others through modeling. PMID:1594744

  20. Legal issues affecting confidentiality and informed consent in reproductive health.

    PubMed

    Rockett, L R

    2000-01-01

    The law governing confidentiality and informed consent has acquired unique characteristics in the area of reproductive health, as a consequence of both the establishment of a constitutional right to privacy in reproductive health matters and the reaction of those politically and morally opposed to the exercise of that right. The primary issues have involved: 1) the right of minors to receive reproductive health services without parental consent, which remains a political battleground; 2) laws requiring physicians to provide information to pregnant patients that is intended, not to inform them of the risks and benefits of the procedure, but to discourage them from obtaining abortions; 3) coerced and prohibited sterilizations; 4) court-ordered contraception and procedures to protect the fetus; and 5) restrictions on counseling about abortion, contraception, sterilization, and other reproductive health services authorized by state conscience or noncompliance clauses that shield such restrictions from the usual ethical, medical, and legal rules governing informed consent. The last area is of profound significance to the ability of women to make informed decisions about their reproductive health options. In the current economic environment, which fuels mergers and acquisitions involving sectarian and nonsectarian institutions, women are increasingly being put at risk as a result of such restrictions. PMID:11070641

  1. Designing online health services for patients.

    PubMed

    Crotty, Bradley H; Slack, Warner V

    2016-01-01

    Patients are increasingly interacting with their healthcare system through online health services, such as patient portals and telehealth programs. Recently, Shabrabani and Mizrachi provided data outlining factors that are most important for users or potential users of these online services. The authors conclude convincingly that while online health services have great potential to be helpful to their users, they could be better designed. As patients and their families play an increasingly active role in their health care, online health services should be made easier for them to use and better suited to their health-related needs. Further, the online services should be more welcoming to people of all literacy levels and from all socioeconomic backgrounds. PMID:27307985

  2. Does debt affect health? Cross country evidence on the debt-health nexus.

    PubMed

    Clayton, Maya; Liñares-Zegarra, José; Wilson, John O S

    2015-04-01

    We investigate the relationship between aggregate household debt and aggregate health outcomes across 17 European countries over the period 1995 to 2012. Using a dataset of country-level standardized and objective measures of household debt, health outcomes and a rich set of control variables, we estimate an instrumental variable (GMM) model to address possible reverse causality concerns. We find that aggregate household debt affects health outcomes, and that this varies by the maturity of debt. Both short and medium-term debt has a positive effect on health outcomes. Long-term unsecured debt and mortgage debt are associated with poorer health outcomes. These findings are robust after controlling for alternative measures of health and debt. Overall, the results suggest that aggregate household debt is an important determinant of aggregate health outcomes across countries. PMID:25681714

  3. Heart Health Tests for Diabetes Patients

    MedlinePlus

    ... Tools & Resources Stroke More Heart Health Tests for Diabetes Patients Updated:Dec 3,2015 If you have ... angiograms . This content was last reviewed August 2015. Diabetes • Home • About Diabetes • Why Diabetes Matters • Understand Your ...

  4. Improving Health Outcomes for Low Health Literacy Heart Failure Patients.

    PubMed

    Friel, Catherine J

    2016-09-01

    According to the National Assessment of Adult Literacy (2003), only 12% of U.S. adults have a proficient level of health literacy, with adults 65 years and older more likely to have a below basic or a basic health literacy level. An estimated 5.8 million individuals in the United States have heart failure (HF) and it is one of the most common reasons for those aged 65 and over to be hospitalized. Many patients with HF are at risk for poor health outcomes due to low health literacy. This article reviews the literature with regard to the effectiveness of methods used to address low health literacy among HF patients and describes a pilot study implemented by a home care agency in the northeast to address high HF readmission rates. PMID:27580282

  5. Unmet Needs of Patients Feeling Severely Affected by Multiple Sclerosis in Germany: A Qualitative Study

    PubMed Central

    Golla, Heidrun; Strupp, Julia; Karbach, Ute; Kaiser, Claudia; Ernstmann, Nicole; Pfaff, Holger; Ostgathe, Christoph; Voltz, Raymond

    2014-01-01

    Abstract Background: The needs of patients feeling severely affected by multiple sclerosis (MS) have rarely been investigated. However this is essential information to know before care can be improved, including adding palliative care (PC) services where helpful. Since it remains unclear at what point specialized palliative care should begin for this patient group, this study focuses on needs in general. Objective: The objective was to explore the subjectively unmet needs of patients feeling severely affected by MS. Methods: The study used a qualitative cross-sectional approach for needs assessment. Fifteen patients self-reporting feeling severely affected by MS were recruited and interviewed using a combination of purposive and convenience sampling (five were accompanied by a caregiver relative). Interviews were recorded and transcribed verbatim, followed by qualitative content analysis. Results: Unmet needs were identified in the main categories “support of family and friends,” “health care services,” “managing everyday life,” and “maintaining biographical continuity.” Patients expressed the desire for more support from their families and to be viewed as distinct individuals. They see a substantial deficit in the physician-patient relationship and in the coordination of services. A decrease in expressed unmet needs was found for patients more severely affected and less socially integrated. Conclusions: To address the unmet needs of severely affected MS patients, health care services need to be improved and linked with existing PC services. Special attention is required to form supporting professional-patient relationships. Multiprofessional services should be accessible for patients, while integrating relatives. All services should have an individual approach to provide needs-tailored support. PMID:24527993

  6. Communicating with Patients with Special Health Care Needs.

    PubMed

    Espinoza, Kimberly M; Heaton, Lisa J

    2016-07-01

    People with special health care needs (PSHCN) often have difficulty communicating with providers in health care settings, including dental practices. This difficulty can affect access to care as well as the quality of care received. This article provides practical tips and tools dental professionals can use to facilitate communication for a diverse population of PSHCNs. The article discusses communication needs of patients with communication disorders; augmentative and alternative communication; and communication for patients with intellectual disability, psychiatric conditions; and dental fears. Examples are given of communication breakdowns, and descriptions of how communication challenges can be resolved. PMID:27264858

  7. Predicting Individual Affect of Health Interventions to Reduce HPV Prevalence

    SciTech Connect

    Corley, Courtney D.; Mihalcea, Rada; Mikler, Armin R.; Sanfilippo, Antonio P.

    2011-04-01

    Recently, human papilloma virus has been implicated to cause several throat and oral cancers and hpv is established to cause most cervical cancers. A human papilloma virus vaccine has been proven successful to reduce infection incidence in FDA clinical trials and it is currently available in the United States. Current intervention policy targets adolescent females for vaccination; however, the expansion of suggested guidelines may extend to other age groups and males as well. This research takes a first step towards automatically predicting personal beliefs, regarding health intervention, on the spread of disease. Using linguistic or statistical approaches, sentiment analysis determines a texts affective content. Self-reported HPV vaccination beliefs published in web and social media are analyzed for affect polarity and leveraged as knowledge inputs to epidemic models. With this in mind, we have developed a discrete-time model to facilitate predicting impact on the reduction of HPV prevalence due to arbitrary age and gender targeted vaccination schemes.

  8. Challenges in researching violence affecting health service delivery in complex security environments.

    PubMed

    Foghammar, Ludvig; Jang, Suyoun; Kyzy, Gulzhan Asylbek; Weiss, Nerina; Sullivan, Katherine A; Gibson-Fall, Fawzia; Irwin, Rachel

    2016-08-01

    Complex security environments are characterized by violence (including, but not limited to "armed conflict" in the legal sense), poverty, environmental disasters and poor governance. Violence directly affecting health service delivery in complex security environments includes attacks on individuals (e.g. doctors, nurses, administrators, security guards, ambulance drivers and translators), obstructions (e.g. ambulances being stopped at checkpoints), discrimination (e.g. staff being pressured to treat one patient instead of another), attacks on and misappropriation of health facilities and property (e.g. vandalism, theft and ambulance theft by armed groups), and the criminalization of health workers. This paper examines the challenges associated with researching the context, scope and nature of violence directly affecting health service delivery in these environments. With a focus on data collection, it considers how these challenges affect researchers' ability to analyze the drivers of violence and impact of violence. This paper presents key findings from two research workshops organized in 2014 and 2015 which convened researchers and practitioners in the fields of health and humanitarian aid delivery and policy, and draws upon an analysis of organizational efforts to address violence affecting healthcare delivery and eleven in-depth interviews with representatives of organizations working in complex security environments. Despite the urgency and impact of violence affecting healthcare delivery, there is an overall lack of research that is of health-specific, publically accessible and comparable, as well as a lack of gender-disaggregated data, data on perpetrator motives and an assessment of the 'knock-on' effects of violence. These gaps limit analysis and, by extension, the ability of organizations operating in complex security environments to effectively manage the security of their staff and facilities and to deliver health services. Increased research

  9. Does sustained participation in an online health community affect sentiment?

    PubMed

    Zhang, Shaodian; Bantum, Erin; Owen, Jason; Elhadad, Noémie

    2014-01-01

    A large number of patients rely on online health communities to exchange information and psychosocial support with their peers. Examining participation in a community and its impact on members' behaviors and attitudes is one of the key open research questions in the field of study of online health communities. In this paper, we focus on a large public breast cancer community and conduct sentiment analysis on all its posts. We investigate the impact of different factors on post sentiment, such as time since joining the community, posting activity, age of members, and cancer stage of members. We find that there is a significant increase in sentiment of posts through time, with different patterns of sentiment trends for initial posts in threads and reply posts. Factors each play a role; for instance stage-IV members form a particular sub-community with patterns of sentiment and usage distinct from others members. PMID:25954470

  10. Patient Activation: Public Libraries and Health Literacy

    ERIC Educational Resources Information Center

    Malachowski, Margot

    2011-01-01

    Patient activation is a new term for a perennial problem. People know what they need to do for their health: exercise, eat right, and get enough rest--but how are they motivated to actually do these things? This is what patient activation is. From this author's vantage point as a medical librarian, public libraries are well-placed to be part of…

  11. Mental Health Issues and Special Care Patients.

    PubMed

    Clark, David B

    2016-07-01

    Mental illness is a major health issue in the world today, yet often remains misunderstood, unrecognized, and undertreated. Patients suffering from severe psychiatric disorders generally display poor oral health, often as a consequence of both lifestyle and avoidant-type behaviors that become exacerbated by their illness. Individuals with severe mental illness display a greater incidence of oral disease compared with a similar demographic not dealing with these particular disorders. Efforts to enhance the oral health of these vulnerable patients will play a significant role in the overall rebuilding of their self-esteem and contribute positively to their journey toward stability and recovery. PMID:27264850

  12. How will health reform affect demand for RNs?

    PubMed

    Spetz, Joanne

    2014-01-01

    The U.S. Bureau of Labor Statistics forecasts demand for registered nurses (RNs) will result in 3.5 million nursing jobs by 2020, marking a 26% increase over 10 years. RN employment is expected to grow most rapidly in outpatient settings--particularly physician offices--and home health care. The Affordable Care Act will likely impact the places where RNs work, and the skills they need to be successful in these settings. RNs will be expected to serve as care coordinators, case managers, patient educators, and chronic care specialists. RNs with strong skills will be in high demand in the labor market. PMID:24689158

  13. Smartphone Applications for Patients' Health and Fitness.

    PubMed

    Higgins, John P

    2016-01-01

    Healthcare providers are often looking for ways to objectively monitor and improve their patients' health and fitness, especially in between patient visits. Some insurance companies are using applications data as incentives to improve health and lower premiums. As more and more people start to use smartphones, they may provide a tool to help improve a patient's health and fitness. Specifically, fitness applications or "apps" on smartphones are programs that use data collected from a smartphone's inbuilt tools, such as the Global Positioning System, accelerometer, microphone, speaker, and camera, to measure health and fitness parameters. The apps then analyze these data and summarize them, as well as devise individualized plans based on users' goals, provide frequent feedback, personalized coaching, and additional motivation by allowing milestones to be shared on social media. This article introduces evidence that apps can better help patients reach their health and fitness goals. It then discusses what features to look for in an app, followed by an overview of popular health and fitness apps. Last, patient scenarios with app recommendations, limitations of apps, and future research are discussed. PMID:26091764

  14. Impairment of Bone Health in Pediatric Patients with Hemolytic Anemia

    PubMed Central

    Schündeln, Michael M.; Goretzki, Sarah C.; Hauffa, Pia K.; Wieland, Regina; Bauer, Jens; Baeder, Lena; Eggert, Angelika; Hauffa, Berthold P.; Grasemann, Corinna

    2014-01-01

    Introduction Sickle cell anemia and thalassemia result in impaired bone health in both adults and youths. Children with other types of chronic hemolytic anemia may also display impaired bone health. Study Design To assess bone health in pediatric patients with chronic hemolytic anemia, a cross-sectional study was conducted involving 45 patients with different forms of hemolytic anemia (i.e., 17 homozygous sickle cell disease and 14 hereditary spherocytosis patients). Biochemical, radiographic and anamnestic parameters of bone health were assessed. Results Vitamin D deficiency with 25 OH-vitamin D serum levels below 20 ng/ml was a common finding (80.5%) in this cohort. Bone pain was present in 31% of patients. Analysis of RANKL, osteoprotegerin (OPG) and osteocalcin levels indicated an alteration in bone modeling with significantly elevated RANKL/OPG ratios (control: 0.08+0.07; patients: 0.26+0.2, P = 0.0007). Osteocalcin levels were found to be lower in patients compared with healthy controls (68.5+39.0 ng/ml vs. 118.0+36.6 ng/ml, P = 0.0001). Multiple stepwise regression analysis revealed a significant (P<0.025) influence of LDH (partial r2 = 0.29), diagnosis of hemolytic anemia (partial r2 = 0.05) and age (partial r2 = 0.03) on osteocalcin levels. Patients with homozygous sickle cell anemia were more frequently and more severely affected by impaired bone health than patients with hereditary spherocytosis. Conclusion Bone health is impaired in pediatric patients with hemolytic anemia. In addition to endocrine alterations, an imbalance in the RANKL/OPG system and low levels of osteocalcin may contribute to this impairment. PMID:25299063

  15. Health Literacy: An Educationally Sensitive Patient Outcome.

    PubMed

    Yin, H Shonna; Jay, Melanie; Maness, Leslie; Zabar, Sondra; Kalet, Adina

    2015-09-01

    We have previously proposed that by identifying a set of Educationally Sensitive Patient Outcomes (ESPOs), medical education outcomes research becomes more feasible and likely to provide meaningful guidance for medical education policy and practice. ESPOs are proximal outcomes that are sensitive to provider education, measurable, and linked to more distal health outcomes. Our previous model included Patient Activation and Clinical Microsystem Activation as ESPOs. In this paper, we discuss how Health Literacy, defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions," is another important ESPO. Between one-third and one-half of all US adults have limited health literacy skills. Providers can be trained to adopt a "universal precautions approach" to addressing patient health literacy, through the acquisition of specific skills (e.g., teachback, "chunking" information, use of plain language written materials) and by learning how to take action to improve the "health literacy environment." While there are several ways to measure health literacy, identifying which measurement tools are most sensitive to provider education is important, but challenging and complex. Further research is needed to test this model and identify additional ESPOs. PMID:26173523

  16. Oral health related quality of life in diabetic patients.

    PubMed

    Sadeghi, Rokhsareh; Taleghani, Ferial; Farhadi, Sareh

    2014-01-01

    Background and aims. Diabetic patients display an increased risk of oral disorders, and oral health related quality of life (OHRQL) might affect their management and treatment modalities. The aim of the present study was to determine OHRQL and associated parameters in patients with diabetes. Materials and methods. In this study two hundred patients were recruited from the diabetes clinic in Mustafa Khomeini Hospital in Tehran, Iran. OHRQL was assessed using Oral Health Impact Profile Questionnaire (OHIP-20). Also, another questionnaire was designed which contained questions regarding participants' knowledge about oral complications of diabetes and oral health behavior. OHRQL was categorized as low and good. Data were analyzed using logistic regression at P = 0.05. Results. Of the diabetic patients assessed, 77.5% were in good and 22.5% were in low categories of OHRQL. This quality was significantly associated with age (OR = 4.03, 95% CI = 1.63-11.29), knowledge about diabetes oral complications (OR = 18.17 95% CI = 4.42-158.6), educational level (OR = 26.31 95% CI = 4.2-1080.3), referred for dental visit by physician (OR = 3.16 95% CI = 1.48-6.69), frequency of brushing (OR = 10.29 95% CI = 3.96-31.2) and length of time diagnosed with diabetes (OR = 6.21 95% CI = 2.86-13.63). Conclusion. Oral health related quality of life was not negatively affected by diabetes mellitus in the assessed sample. PMID:25587385

  17. Cognitive and affective assessment in day care versus institutionalized elderly patients: a 1-year longitudinal study

    PubMed Central

    Maseda, Ana; Balo, Aránzazu; Lorenzo–López, Laura; Lodeiro–Fernández, Leire; Rodríguez–Villamil, José Luis; Millán–Calenti, José Carlos

    2014-01-01

    Purpose Cognitive decline and depression are two common mental health problems that may create a need for long-term care among the elderly. In the last decade, the percentage of older adults who receive health care in nursing homes, day care centers, or home support services has increased in Europe. The objectives of this descriptive and nonrandomized longitudinal study were to evaluate and to compare the cognitive and affective evolution of day care versus institutionalized older patients through a 1-year period, and to assess the presence of cognitive and affective impairment as a function of the care setting. Patients and methods Ninety-four patients were assessed at baseline, and 63 (67.0%) were reassessed 1 year later. Neuropsychological assessment included measures of cognitive performance (general cognitive status, visuospatial, and language abilities) and affective status (depressive symptoms). Results Our findings indicated that the majority of the participants (day care and institutionalized patients) had mild–moderate cognitive impairment at baseline, which significantly increased in both groups after 1-year follow-up. However, the rate of change in global cognitive function did not significantly differ between groups over time. Regarding language abilities, naming function maintained among day care patients in comparison with institutionalized patients, who showed worse performance at follow-up. As regards to affective status, results revealed that institutionalized patients had a significant reduction in depressive symptoms at follow-up, when compared to day care patients. Results also highlight the high frequency of cognitive impairment and depressive symptoms regardless of the care setting. Conclusion Our findings revealed a similar global cognitive decline rate between patients receiving day care services and those residing in a nursing home at the 1-year follow-up, and slightly different trajectories in other outcomes such as naming function and

  18. Patient expectation: what is comprehensive health care?

    PubMed

    Starr, G C; Norris, R; Patil, K D; Young, P R

    1979-01-01

    A patient expectation survey was developed and implemented in order to define the spectrum of health care activities expected from the University of Nebraska Family Health Centers. The hypothesis underlying the survey is that patient expectations or opinions vary considerably among the members of any given population. High expectation is present for office visits, emergency services, yearly physical examination, and performance of chest x-ray, blood test, proctoscopy, and eye examination. Psychiatric services, marital counseling, youth counseling, nursing home care, and health education are indicated as not necessary by a plurality of the respondents. Examination of the responses by age, sex, and payment status through canonical correlation reveals a number of strong correlations of specific subgroups and expectations. Factor analysis revealed three independent factors or clusters representating health care issues as perceived by the patient. This study and further similar studies will be helpful in aiding the family physician's understanding of what patients expect. Through a better understanding of patient expectation, patient satisfaction and compliance may be improved. PMID:759540

  19. When bad moods may not be so bad: Valuing negative affect is associated with weakened affect-health links.

    PubMed

    Luong, Gloria; Wrzus, Cornelia; Wagner, Gert G; Riediger, Michaela

    2016-04-01

    Bad moods are considered "bad" not only because they may be aversive experiences in and of themselves, but also because they are associated with poorer psychosocial functioning and health. We propose that people differ in their negative affect valuation (NAV; the extent to which negative affective states are valued as pleasant, useful/helpful, appropriate, and meaningful experiences) and that affect-health links are moderated by NAV. These predictions were tested in a life span sample of 365 participants ranging from 14-88 years of age using reports of momentary negative affect and physical well-being (via experience sampling) and assessments of NAV and psychosocial and physical functioning (via computer-assisted personal interviews and behavioral measures of hand grip strength). Our study demonstrated that the more individuals valued negative affect, the less pronounced (and sometimes even nonexistent) were the associations between everyday experiences of negative affect and a variety of indicators of poorer psychosocial functioning (i.e., emotional health problems, social integration) and physical health (i.e., number of health conditions, health complaints, hand grip strength, momentary physical well-being). Exploratory analyses revealed that valuing positive affect was not associated with the analogous moderating effects as NAV. These findings suggest that it may be particularly important to consider NAV in models of affect-health links. (PsycINFO Database Record PMID:26571077

  20. Evaluating a Sexual Health Patient Education Resource

    PubMed Central

    Matzo, Marianne; Troup, Sandi; Hijjazi, Kamal; Ferrell, Betty

    2015-01-01

    This article shares the findings of an evaluation of a patient teaching resource for sexual health entitled Everything Nobody Tells You About Cancer Treatment and Your Sex Life: From A to Z, which was accomplished through systematic conceptualization, construction, and evaluation with women diagnosed with breast or gynecologic cancer. This resource, which has evolved from patient-focused research and has been tested in the clinical setting, can be used in patient education and support. Oncology professionals are committed to addressing quality-of-life concerns for patients across the trajectory of illness. Sexuality is a key concern for patients and impacts relationships and overall quality of life. Through careful assessment, patient education, and support, clinicians can ensure that sexuality is respected as an essential part of patient-centered care. PMID:26557411

  1. Dialysis-related factors affecting quality of life in patients on hemodialysis.

    PubMed

    Anees, Muhammad; Hameed, Farooq; Mumtaz, Asim; Ibrahim, Muhammad; Saeed Khan, Muhammad Nasir

    2011-01-01

    INTRODUCTION. Treatment modalities for end-stage renal disease affect quality of life (QOL) of the patients. This study was conducted to assess the QOL of patients on hemodialysis and compare it with caregivers of these patients. Cause of ESRD and dialysis-related factors affecting QOL were also examined. MATERIALS AND METHODS. This cross-sectional study was conducted on patient on maintenance hemodialysis for more than 3 months at 3 dialysis centers of Lahore. Fifty healthy individuals were included as controls from among the patients' caregivers. The QOL index was measured using the World Health Organization QOL questionnaire, with higher scores corresponding to better QOL of patients. RESULTS. Eighty-nine patients (71.2%) were men, 99 (79.2%) were married, 75 (60.0%) were older than 45 years, and 77 (61.6%) were on dialysis for more than 8 months. Patients on hemodialysis had a poorer QOL as compared to their caregivers in all domains except for domain 4 (environment). There was no difference in the QOL between the three dialysis centers of the study, except for domain 3 (social relationship) of the patients at Mayo Hospital (a public hospital), which was significantly better. Nondiabetic patients had a better QOL in domain 1 (physical health) as compared to diabetic patients. Duration of dialysis had a reverse correlation with the overall QOL. CONCLUSIONS. We found that QOL of hemodialysis patients was poor as compared to caregivers of the patients, especially that of diabetics. Also, duration of dialysis had a reverse correlation with QOL. PMID:21189427

  2. Nocturnal melatonin secretion in multiple sclerosis patients with affective disorders.

    PubMed

    Sandyk, R; Awerbuch, G I

    1993-02-01

    The pineal gland has been implicated recently in the pathogenesis of multiple sclerosis (MS), a chronic demyelinating disease of CNS. Since nocturnal melatonin secretion is low in some groups of patients with mental depression, we predicted lower melatonin secretion in MS patients with history of affective illness compared to those without psychiatric disorders. To test this hypothesis, we studied single nocturnal plasma melatonin levels and the incidence of pineal calcification (PC) on CT scan in a cohort of 25 MS patients (4 men, 21 women; mean age = 39.4 years, SD = 9.3), 15 of whom had a history of coexisting psychiatric disorders with predominant affective symptomatology. Other factors that may be related to depression such as vitamin B12, folic acid, zinc, magnesium, and homocysteine, were also included in the analysis. Neither any of the metabolic factors surveyed nor the incidence of PC distinguished the psychiatric from the control group. However, the mean melatonin level in the psychiatric patients was significantly lower than in the control group. Since low melatonin secretion in patients with depression may be related to a phase-advance of the circadian oscillator regulating the offset of melatonin secretion, we propose that the depression of MS likewise may reflect the presence of dampened circadian oscillators. Furthermore, since exacerbation of motor symptoms in MS patients may be temporally related to worsening of depression, we propose that circadian phase lability may also underlie the relapsing-remitting course of the disease. Consequently, pharmacological agents such as lithium or bright light therapy, which have been shown to phase-delay circadian rhythms, might be effective in the treatment of affective symptoms in MS as well as preventing motor exacerbation and hastening a remission from an acute attack. PMID:8063528

  3. Clinical factors affecting quality of life of patients with asthma

    PubMed Central

    Uchmanowicz, Bartosz; Panaszek, Bernard; Uchmanowicz, Izabella; Rosińczuk, Joanna

    2016-01-01

    Background In recent years, there has been increased interest in the subjective quality of life (QoL) of patients with bronchial asthma. QoL is a significant indicator guiding the efforts of professionals caring for patients, especially chronically ill ones. The identification of factors affecting the QoL reported by patients, despite their existing condition, is important and useful to provide multidisciplinary care for these patients. Aim To investigate the clinical factors affecting asthma patients’ QoL. Methods The study comprised 100 patients (73 female, 27 male) aged 18–84 years (mean age was 45.7) treated in the Allergy Clinic of the Wroclaw Medical University Department and Clinic of Internal Diseases, Geriatrics and Allergology. All asthma patients meeting the inclusion criteria were invited to participate. Data on sociodemographic and clinical variables were collected. In this study, we used medical record analysis and two questionnaires: the Asthma Quality of Life Questionnaire (AQLQ) to assess the QoL of patients with asthma and the Asthma Control Test to measure asthma control. Results Active smokers were shown to have a significantly lower QoL in the “Symptoms” domain than nonsmokers (P=0.006). QoL was also demonstrated to decrease significantly as the frequency of asthma exacerbations increased (R=−0.231, P=0.022). QoL in the domain “Activity limitation” was shown to increase significantly along with the number of years of smoking (R=0.404; P=0.004). Time from onset and the dominant symptom of asthma significantly negatively affected QoL in the “Activity limitation” domain of the AQLQ (R=−0.316, P=0.001; P=0.029, respectively). QoL scores in the “Emotional function” and “Environmental stimuli” subscale of the AQLQ decreased significantly as time from onset increased (R=−0.200, P=0.046; R=−0.328, P=0.001, respectively). Conclusion Patients exhibiting better symptom control have higher QoL scores. Asthma patients’ Qo

  4. [The Catalan Patient Council: the direct voice of the patient in health policies in Catalonia].

    PubMed

    Vallès Navarro, Roser; Costa Vilar, Núria; Davins Miralles, Josep; Garcia Cirera, Montserrat; Hernando Ortega, Maria Rosario; Iniesta Blasco, Cristina

    2015-11-01

    The transition from a more paternalistic model of care focused on the disease and on the medical professional's authority towards a more participatory model centered on the rights and duties of informed patients represents a significant change in public health policy. One of the most widespread methods of social participation in Catalonia today is the tendency to form associations around a particular disease. This kind of organizational participation is a pioneering tool in the debate around public health policy. The Government of the Generalitat de Catalunya undertook to promote the Strategic Plan of patient participation within the public health system. The Department of Health created the Patient Advisory Council of Catalonia (CCPC, as per the acronym in Catalan). This initiative constitutes a permanent consultative and participatory body for patient representatives in the Catalan healthcare system. The CCPC was set up with a solid determination to place the patient at the centre of the healthcare system, including them in the decision-making processes which directly affect them. This patient participation plan has defined and developed 8 different lines approved by the government, with consensus approval between regional government and the organisations. The CCPC has proven itself to be an effective tool for fostering active patient participation in health policy and its relationship with the system has evolved from that of a monologue to becoming the mechanism for dialogue it is today. PMID:26711058

  5. Patterns of Emotion Attribution are Affected in Patients with Schizophrenia.

    PubMed

    Romero-Ferreiro, María Verónica; Aguado, Luis; Rodriguez-Torresano, Javier; Palomo, Tomás; Rodriguez-Jimenez, Roberto

    2015-01-01

    Deficits in facial affect recognition have been repeatedly reported in schizophrenia patients. The hypothesis that this deficit is caused by poorly differentiated cognitive representation of facial expressions was tested in this study. To this end, performance of patients with schizophrenia and controls was compared in a new emotion-rating task. This novel approach allowed the participants to rate each facial expression at different times in terms of different emotion labels. Results revealed that patients tended to give higher ratings to emotion labels that did not correspond to the portrayed emotion, especially in the case of negative facial expressions (p < .001, η 2 = .131). Although patients and controls gave similar ratings when the emotion label matched with the facial expression, patients gave higher ratings on trials with "incorrect" emotion labels (p s < .05). Comparison of patients and controls in a summary index of expressive ambiguity showed that patients perceived angry, fearful and happy faces as more emotionally ambiguous than did the controls (p < .001, η 2 = .135). These results are consistent with the idea that the cognitive representation of emotional expressions in schizophrenia is characterized by less clear boundaries and a less close correspondence between facial configurations and emotional states. PMID:26255714

  6. The free health care initiative: how has it affected health workers in Sierra Leone?

    PubMed Central

    Witter, Sophie; Wurie, Haja; Bertone, Maria Paola

    2016-01-01

    There is an acknowledged gap in the literature on the impact of fee exemption policies on health staff, and, conversely, the implications of staffing for fee exemption. This article draws from five research tools used to analyse changing health worker policies and incentives in post-war Sierra Leone to document the effects of the Free Health Care Initiative (FHCI) of 2010 on health workers. Data were collected through document review (57 documents fully reviewed, published and grey); key informant interviews (23 with government, donors, NGO staff and consultants); analysis of human resource data held by the MoHS; in-depth interviews with health workers (23 doctors, nurses, mid-wives and community health officers); and a health worker survey (312 participants, including all main cadres). The article traces the HR reforms which were triggered by the FHCI and evidence of their effects, which include substantial increases in number and pay (particularly for higher cadres), as well as a reported reduction in absenteeism and attrition, and an increase (at least for some areas, where data is available) in outputs per health worker. The findings highlight how a flagship policy, combined with high profile support and financial and technical resources, can galvanize systemic changes. In this regard, the story of Sierra Leone differs from many countries introducing fee exemptions, where fee exemption has been a stand-alone programme, unconnected to wider health system reforms. The challenge will be sustaining the momentum and the attention to delivering results as the FHCI ceases to be an initiative and becomes just ‘business as normal’. The health system in Sierra Leone was fragile and conflict-affected prior to the FHCI and still faces significant challenges, both in human resources for health and more widely, as vividly evidenced by the current Ebola crisis. PMID:25797469

  7. The free health care initiative: how has it affected health workers in Sierra Leone?

    PubMed

    Witter, Sophie; Wurie, Haja; Bertone, Maria Paola

    2016-02-01

    There is an acknowledged gap in the literature on the impact of fee exemption policies on health staff, and, conversely, the implications of staffing for fee exemption. This article draws from five research tools used to analyse changing health worker policies and incentives in post-war Sierra Leone to document the effects of the Free Health Care Initiative (FHCI) of 2010 on health workers.Data were collected through document review (57 documents fully reviewed, published and grey); key informant interviews (23 with government, donors, NGO staff and consultants); analysis of human resource data held by the MoHS; in-depth interviews with health workers (23 doctors, nurses, mid-wives and community health officers); and a health worker survey (312 participants, including all main cadres). The article traces the HR reforms which were triggered by the FHCI and evidence of their effects, which include substantial increases in number and pay (particularly for higher cadres), as well as a reported reduction in absenteeism and attrition, and an increase (at least for some areas, where data is available) in outputs per health worker. The findings highlight how a flagship policy, combined with high profile support and financial and technical resources, can galvanize systemic changes. In this regard, the story of Sierra Leone differs from many countries introducing fee exemptions, where fee exemption has been a stand-alone programme, unconnected to wider health system reforms. The challenge will be sustaining the momentum and the attention to delivering results as the FHCI ceases to be an initiative and becomes just 'business as normal'. The health system in Sierra Leone was fragile and conflict-affected prior to the FHCI and still faces significant challenges, both in human resources for health and more widely, as vividly evidenced by the current Ebola crisis. PMID:25797469

  8. Money and trust: relationships between patients, physicians, and health plans.

    PubMed

    Goold, S D

    1998-08-01

    In response to three articles on managed care by Allen Buchanan, David Mechanic, and Ezekiel Emanual and Lee Goldman (this issue), I discuss doctor-patient and organization-member trust and the moral obligations of those relationships. Trust in managed care organizations (providers of and payers for health care) stands in stark contrast to the current contractual model of health insurance purchase, but is more coherent with consumer expectations and with the provider role of such organizations. Such trust is likely to differ from that between doctors and patients. Financial reimbursement systems for physicians, one example of organizational change in our health system, can be evaluated for their impact on both kinds of trust according to their intrusiveness, openness, and goals. Although involving managed care enrollees in value-laden decisions that affect them is commendable, restrictions on or regulation of physician incentive systems may be better accomplished on a national level. PMID:9718519

  9. Factors affecting medication adherence in patients with hypertension.

    PubMed

    Karakurt, Papatya; Kaşikçi, Mağfiret

    2012-12-01

    The aim of this study descriptive study was to evaluate concordance with medication and those factors that affect the use of medicine in patients with hypertension. Data were collected using a questionnaire completed by 750 patients with hypertension between December 25, 2003, and April 30, 2004, in an outpatient hypertension clinic in Erzincan, Turkey. It was found that 57.9% of the patients did not use their medicines as prescribed. Forgetfulness, aloneness, and negligence were ranked as the top three reasons for this non-concordance, accounting for almost half (49.3%) of all patients with hypertension studied; price (expensive medicines) accounted for another quarter (26.5%). A statistically significant relationship with non-concordance was found for age, education level and profession. Patients' lack of knowledge related to the complications of hypertension was also found to have a statistically significant relationship with not taking medicines as prescribed. Gender, location of residence and salary were not found to be statistically related to concordance. These results indicate the need to educate patients with hypertension on how to use their medicine regularly and indicate also the target populations for this. PMID:23127428

  10. Demographic factors affecting quality of life of hemodialysis patients – Lahore, Pakistan

    PubMed Central

    Anees, Muhammad; Malik, Muzammil Riaz; Abbasi, Tanzeel; Nasir, Zeeshan; Hussain, Yasir; Ibrahim, Muhamamd

    2014-01-01

    Objective: The objective of the study was to determine the demographic factors affecting Quality Of Life (QOL) of hemodialysis (HD) patients. Methods: This observational study was conducted at Shalamar Hospital, Lahore. Patients of End Stage Renal Disease (ESRD) and on maintenance HD for more than three months were included during the period March to June 2012. Patient of ESRD not on dialysis and Acute Renal Failure were excluded. One hundred and twenty five patients who fulfilled the criteria were included. Demographic data containing age, sex, residence, socio economic status, education, mode of traveling for dialysis, total time consumed in dialysis were collected by the investigators. QOL index was measured using 26 items, WHO QOL BREF. Results: There were 89(71.2%) male and 36(28.8%) female patients. Environmental domain score was highest (p=0.000) than all other domains in HD Patients. In overall analysis age, marital status and total time consumed in getting HD effect QOL significantly (p=<0.05). In domain wise analysis, male has better QOL in social relationship domain than female. Age has negative relationship with physical health and psychological health domain. QOL of unmarried and literate patients is significantly better (p=<0.05) in physical health domain. Employed patients have better QOL in physical, psychological and social relationship domain (p=<0.05) than unemployed patients. Patients of residence of rural areas have better QOL in physical and environment domain. Financial status of HD patients affect QOL in social domain. Distance covered to reach hospital effect QOL in psychological domain (p=<0.05). Patients traveling in private transport have better QOL in environmental domain (p=<0.05). Total time consumed in getting HD effect social relation in QOL (p=<0.05). According to linear regression model, marital status is positive predictor and unemployment is negative predictor of QOL in physical health domain. Age is negative predictor of QOL in

  11. Patients Respond More Positively to Physicians Who Focus on Their Ideal Affect

    PubMed Central

    Sims, Tamara; Tsai, Jeanne L.

    2014-01-01

    Previous findings suggest that patients choose physicians whose affective focus matches how they ideally want to feel (Sims et al., 2014). For instance, the more people wanted to feel excitement, the more likely they were to hypothetically choose a new physician who promoted excitement. What remains unknown is whether this match shapes how patients actually respond to physicians after being assigned to them (i.e., whether they adhere to physicians’ recommendations more and evaluate physicians more positively). To this end, community adults reported their global ideal affect and actual affect (how they ideally want to feel and actually feel during a typical week, respectively), and were randomly assigned to receive health recommendations from either a physician who expressed and promoted high arousal positive states (HAP) (e.g., excitement), or one who expressed and promoted low arousal positive states (LAP) (e.g., calm). For the next five days, participants reported their daily adherence to the recommendations and their daily ideal and actual affect. At the end of the week, participants evaluated their physician. As predicted, the more participants wanted to feel HAP, the more they adhered to the “HAP-focused” physician’s recommendations, and the more participants wanted to feel LAP, the more they adhered to the “LAP-focused” physician’s recommendations. Participants also evaluated their physician more positively when his affective focus matched their ideal affect. Neither global nor daily actual affect systematically predicted how patients responded to their physicians. These findings suggest that patients respond better to physicians whose affective focus matches their ideal affect. PMID:25313670

  12. A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness

    PubMed Central

    2013-01-01

    Background The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers. Method We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease. Results Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes. Conclusions In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case. PMID:23819721

  13. The affective response to health-related information and its relationship to health anxiety: an ambulatory approach.

    PubMed

    Jasper, Fabian; Hiller, Wolfgang; Berking, Matthias; Rommel, Thilo; Witthöft, Michael

    2015-01-01

    Affective reactions to health-related information play a central role in health anxiety. Therefore, using ambulatory assessment, we analysed the time course of negative affect in a control group (CG, n = 60) which only rated their negative affect and an experimental group (EG, n = 97) which also rated the presence of somatic symptoms (e.g., back pain). By means of mixed regression models, we observed a decline of negative affect following the symptom self-ratings in the EG and a stable affect in the CG. The decline of negative affect was not moderated by the degree of health anxiety. Our findings might indicate that evaluating one's health status leads to a general reduction of negative affect in healthy individuals. The results of the study are in line with a bidirectional symptom perception model and underline the crucial role of affect regulation in the processing of health-related information. PMID:24955947

  14. Medicus Deus: a review of factors affecting hospital library services to patients between 1790–1950

    PubMed Central

    Perryman, Carol

    2006-01-01

    Question: What are some of the historical societal, medical, and public health trends leading to today's provision of hospital library services to patients? Data Sources: Literature from the archives of the Bulletin of the Medical Library Association and other library sources, medical journals, primary historical documents, and texts from the history of medicine form the core of this review. Study Selection: The period of review extends from about 1790 through 1950 and focuses solely on trends in the United States. Of primary concern are explicitly documented examples that appear to illustrate the patient-physician relationship and those between librarians and their patient-patrons during the earliest years of the profession's development. Data Extraction: An historical timeline was created to allow the identification of major trends that may have affected library services. Multiple literature searches were conducted using library, medical, and health anthropology resources. When possible, primary sources were preferred over reviews. Main Results: Juxtapositioning historical events allows the reader to obtain an overview of the roots of consumer health services in medical libraries and to consider their potential legacy in today's health care libraries. Conclusion: This review article highlights early developments in hospital library service to patients. Further research is needed to verify a preliminary conclusion that in some medical library settings, services to the general public are shaped by the broader health care environment as it has evolved. PMID:16888658

  15. Comparable low-level mosaicism in affected and non affected tissue of a complex CDH patient.

    PubMed

    Veenma, Danielle; Beurskens, Niels; Douben, Hannie; Eussen, Bert; Noomen, Petra; Govaerts, Lutgarde; Grijseels, Els; Lequin, Maarten; de Krijger, Ronald; Tibboel, Dick; de Klein, Annelies; Van Opstal, Dian

    2010-01-01

    In this paper we present the detailed clinical and cytogenetic analysis of a prenatally detected complex Congenital Diaphragmatic Hernia (CDH) patient with a mosaic unbalanced translocation (5;12). High-resolution whole genome SNP array confirmed a low-level mosaicism (20%) in uncultured cells, underlining the value of array technology for identification studies. Subsequently, targeted Fluorescence In-Situ Hybridization in postmortem collected tissues demonstrated a similar low-level mosaicism, independently of the affected status of the tissue. Thus, a higher incidence of the genetic aberration in affected organs as lung and diaphragm cannot explain the severe phenotype of this complex CDH patient. Comparison with other described chromosome 5p and 12p anomalies indicated that half of the features presented in our patient (including the diaphragm defect) could be attributed to both chromosomal areas. In contrast, a few features such as the palpebral downslant, the broad nasal bridge, the micrognathia, microcephaly, abnormal dermatoglyphics and IUGR better fitted the 5p associated syndromes only. This study underlines the fact that low-level mosaicism can be associated with severe birth defects including CDH. The contribution of mosaicism to human diseases and specifically to congenital anomalies and spontaneous abortions becomes more and more accepted, although its phenotypic consequences are poorly described phenomena leading to counseling issues. Therefore, thorough follow-up of mosaic aberrations such as presented here is indicated in order to provide genetic counselors a more evidence based prediction of fetal prognosis in the future. PMID:21203572

  16. The effects of physical environments in medical wards on medication communication processes affecting patient safety.

    PubMed

    Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

    2014-03-01

    Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces. PMID:24486620

  17. [Handicapped and chronically ill patients: special effect on the affected].

    PubMed

    Rinn, F

    1997-05-01

    The Bonn coalition government's determination to reduce incidental wage costs, to be realized by way of benefit cutbacks in the social insurance systems and social assistance domain as well as increasing the burdens on insurers through higher retention and cost sharing levels, has particularly serious implications for people with disabilities and chronic illness. Apart from facing numerous direct changes for the worse, they in addition are affected by restrictive regulations applicable generally, inter alia in the labour market or the health and pension insurance schemes; adverse effects, hence, accumulate and heighten out of proportion. The implications of the Bonn austerity legislation are dealt with in the present contribution on the examples of the health-care reform acts as well as the changes to the federal social assistance act, in as far as they affect the provision and care of disabled individuals in residential or community settings. Also dealt with are various problems arising due to the integration assistance/long-term care insurance overlap. PMID:9324712

  18. [Familial incidence of affective diseases in patients with anorexia nervosa].

    PubMed

    Herpertz-Dahlmann, B

    1988-03-01

    Analysis of family history information about first-, second- and third-degree relatives of 45 anorectic patients and 38 control subjects with different types of neurosis showed significantly more depression and eating disorders in the families of the anorectic group. Our data revealed the same prevalence of psychiatric disorders in general for both groups; the alcoholism rate was higher in the anorectic group without a statistic significance. These findings might provide further evidence of a possible genetic relationship between anorexia nervosa and affective illness. PMID:3388987

  19. Evaluation of macrophage antiviral activity in patients affected by neoplasia.

    PubMed

    Merendino, R A; Iannello, D; Arena, A; Bonina, L; Greco, V; Mesiti, M; Chillemi, S; Mastroeni, P

    1988-01-01

    The intrinsic antiviral activity of macrophages has been studied in healthy donors and in patients affected by breast cancer and melanoma. In vitro differentiated macrophages from blood-derived monocytes were infected with measles virus, herpes simplex virus type 2 and adenovirus 17. The challenge was carried out with different multiplicities of infection and the synthesis of virus was tested by evaluating the single cycle growth curve in 24 h. The results obtained show that the restriction of virus infectivity by macrophages is strongly influenced by the multiplicity of infection. This was particularly evident with the adenovirus 17. Moreover, macrophages from patients with melanoma and breast cancer showed an impairment of the intrinsic antiviral activity in comparison with normal subjects. PMID:2842553

  20. Identification of mutations in Colombian patients affected with Fabry disease.

    PubMed

    Uribe, Alfredo; Mateus, Heidi Eliana; Prieto, Juan Carlos; Palacios, Maria Fernanda; Ospina, Sandra Yaneth; Pasqualim, Gabriela; da Silveira Matte, Ursula; Giugliani, Roberto

    2015-12-15

    Fabry Disease (FD) is an X-linked inborn error of glycosphingolipid catabolism, caused by a deficiency of the lisosomal α-galactosidase A (AGAL). The disorder leads to a vascular disease secondary to the involvement of kidney, heart and the central nervous system. The mutation analysis is a valuable tool for diagnosis and genetic counseling. Although more than 600 mutations have been identified, most mutations are private. Our objective was to describe the analysis of nine Colombian patients with Fabry disease by automated sequencing of the seven exons of the GLA gene. Two novel mutations were identified in two patients affected with the classical subtype of FD, in addition to other 6 mutations previously reported. The present study confirms the heterogeneity of mutations in Fabry disease and the importance of molecular analysis for genetic counseling, female heterozygotes detection as well as therapeutic decisions. PMID:26297554

  1. Endocrinological disorders affecting neurosurgical patients: An intensivists perspective

    PubMed Central

    Bajwa, Sukhminder Jit Singh; Haldar, Rudrashish

    2014-01-01

    Management of critically ill neurosurgical patients is often complicated by the presence or development of endocrinological ailments which complicate the clinical scenario and adversely affect the prognosis of these patients. The anatomical proximity to the vital centers regulating the endocrinological physiology and alteration in the neurotransmitter release causes disturbances in the hormonal homeostasis. This paves the way for development of diverse disorders where single or multiple hormones may be involved which can have deleterious effect on the different organ system. Understanding and awareness of these disorders is important for the treating intensivist to recognize these changes early in their course, so that appropriate and timely therapeutic measures can be initiated along with the treatment of the primary malady. PMID:25364671

  2. Factors affecting medication discontinuation in patients with overactive bladder symptoms

    PubMed Central

    Shim, Eun-Jung; Kim, Young-Mi; Kim, Donguk

    2015-01-01

    Objective To find out the factors affecting medication discontinuation in patients with overactive bladder (OAB) symptoms. Methods The clinical data of 125 patients with OAB symptoms who had taken antimuscarinics and behavioral therapy were retrospectively reviewed. Antimuscarinics related outcomes were evaluated by an independent observer with telephone interview. All patients were asked about duration of medication and reason of continuation or discontinuation of antimuscarinics. To determine pre-treatment factors predicting self-report discontinuation of antimuscarinics, variables of only those with P-values <0.25 on the univariate analysis were included in the Cox proportional hazard modeling. Results Mean follow-up was 39.6 months and the proportion of discontinuation of antimuscarinics was 60.0% (75/125). The mean duration of medication was 21.2 months in the continuation group and 3.3 months in the discontinuation group. The reasons of discontinuation of antimuscarinics were improved OAB symptoms (46.7%), tolerable OAB symptoms (33.3%), no change of OAB symptoms (1.3%), side-effects (8.0%) and no desire to take long-term medication (10.7%). The variables affecting remaining cumulative probability of antimuscarinics were age, history of anti-incontinence surgery or vaginal surgery, and having stress predominant urinary incontinence on urodynamic study. Conclusion The lower rate of cumulative continuation of antimuscarinics encourages us to give a more detailed counseling and education to the patients with OAB symptoms before prescription. And explorations about newer agent and non-pharmacologic treatment with good efficacy and lower side-effects are needed. PMID:26623416

  3. Following the Francis report: investigating patient experience of mental health in-patient care

    PubMed Central

    Csipke, E.; Williams, P.; Rose, D.; Koeser, L.; McCrone, P.; Wykes, T.; Craig, T.

    2016-01-01

    Background The Francis report highlights perceptions of care that are affected by different factors including ward structures. Aims To assess patient and staff perceptions of psychiatric in-patient wards over time. Method Patient and staff perceptions of in-patient psychiatric wards were assessed over 18 months. We also investigated whether the type of ward or service structure affected these perceptions. We included triage and routine care. The goal was to include at least 50% of eligible patients and staff. Results The most dramatic change was a significant deterioration in all experiences over the courseof the study. Systems of care or specific wards did not affect patient experience but staff were more dissatisfied in the triage system. Conclusions This is the first report of deterioration in perceptions of the therapeutic in-patient environment that has been captured in a rigorous way. It may reflect contemporaneous experiences across the National Health Service of budget reductions and increased throughput. The ward systems we investigated did not improve patient experience and triage may have been detrimental to staff. PMID:26989098

  4. Can consumer choice replace trust in the National Health Service in England? Towards developing an affective psychosocial conception of trust in health care.

    PubMed

    Fotaki, Marianna

    2014-11-01

    Trust has long been regarded as a vitally important aspect of the relationship between health service providers and patients. Recently, consumer choice has been increasingly advocated as a means of improving the quality and effectiveness of health service provision. However, it is uncertain how the increase of information necessary to allow users of health services to exercise choice, and the simultaneous introduction of markets in public health systems, will affect various dimensions of trust, and how changing relations of trust will impact upon patients and services. This article employs a theory-driven approach to investigate conceptual and material links between choice, trust and markets in health care in the context of the National Health Service in England. It also examines the implications of patient choice on systemic, organisational and interpersonal trust. The article is divided into two parts. The first argues that the shift to marketisation in public health services might lead to an over-reliance on rational-calculative aspects of trust at the expense of embodied, relational and social attributes. The second develops an alternative psychosocial conception of trust: it focuses on the central role of affect and accounts for the material and symbolic links between choice, trust and markets in health care. PMID:25470326

  5. Multiple dietary supplements do not affect metabolic and cardiovascular health.

    PubMed

    Soare, Andreea; Weiss, Edward P; Holloszy, John O; Fontana, Luigi

    2013-09-01

    Dietary supplements are widely used for health purposes. However, little is known about the metabolic and cardiovascular effects of combinations of popular over-the-counter supplements, each of which has been shown to have anti-oxidant, anti-inflammatory and pro-longevity properties in cell culture or animal studies. This study was a 6-month randomized, single-blind controlled trial, in which 56 non-obese (BMI 21.0-29.9 kg/m2) men and women, aged 38 to 55 yr, were assigned to a dietary supplement (SUP) group or control (CON) group, with a 6-month follow-up. The SUP group took 10 dietary supplements each day (100 mg of resveratrol, a complex of 800 mg each of green, black, and white tea extract, 250 mg of pomegranate extract, 650 mg of quercetin, 500 mg of acetyl-l-carnitine, 600 mg of lipoic acid, 900 mg of curcumin, 1 g of sesamin, 1.7 g of cinnamon bark extract, and 1.0 g fish oil). Both the SUP and CON groups took a daily multivitamin/mineral supplement. The main outcome measures were arterial stiffness, endothelial function, biomarkers of inflammation and oxidative stress, and cardiometabolic risk factors. Twenty-four weeks of daily supplementation with 10 dietary supplements did not affect arterial stiffness or endothelial function in nonobese individuals. These compounds also did not alter body fat measured by DEXA, blood pressure, plasma lipids, glucose, insulin, IGF-1, and markers of inflammation and oxidative stress. In summary, supplementation with a combination of popular dietary supplements has no cardiovascular or metabolic effects in non-obese relatively healthy individuals. PMID:24036417

  6. Multiple dietary supplements do not affect metabolic and cardiovascular health

    PubMed Central

    Holloszy, John O.; Fontana, Luigi

    2014-01-01

    Dietary supplements are widely used for health purposes. However, little is known about the metabolic and cardiovascular effects of combinations of popular over-the-counter supplements, each of which has been shown to have anti-oxidant, anti-inflammatory and pro-longevity properties in cell culture or animal studies. This study was a 6-month randomized, single-blind controlled trial, in which 56 non-obese (BMI 21.0-29.9 kg/m2) men and women, aged 38 to 55 yr, were assigned to a dietary supplement (SUP) group or control (CON) group, with a 6-month follow-up. The SUP group took 10 dietary supplements each day (100 mg of resveratrol, a complex of 800 mg each of green, black, and white tea extract, 250 mg of pomegranate extract, 650 mg of quercetin, 500 mg of acetyl-l-carnitine, 600 mg of lipoic acid, 900 mg of curcumin, 1 g of sesamin, 1.7 g of cinnamon bark extract, and 1.0 g fish oil). Both the SUP and CON groups took a daily multivitamin/mineral supplement. The main outcome measures were arterial stiffness, endothelial function, biomarkers of inflammation and oxidative stress, and cardiometabolic risk factors. Twenty-four weeks of daily supplementation with 10 dietary supplements did not affect arterial stiffness or endothelial function in nonobese individuals. These compounds also did not alter body fat measured by DEXA, blood pressure, plasma lipids, glucose, insulin, IGF-1, and markers of inflammation and oxidative stress. In summary, supplementation with a combination of popular dietary supplements has no cardiovascular or metabolic effects in non-obese relatively healthy individuals. PMID:24659610

  7. Contextual factors affecting autonomy for patients in Iranian hospitals: A qualitative study

    PubMed Central

    Ebrahimi, Hossein; Sadeghian, Efat; Seyedfatemi, Naeimeh; Mohammadi, Eesa; Crowley, Maureen

    2016-01-01

    Background: Consideration of patient autonomy is an essential element in individualized, patient-centered, ethical care. Internal and external factors associated with patient autonomy are related to culture and it is not clear what they are in Iran. The aim of this study was to explore contextual factors affecting the autonomy of patients in Iranian hospitals. Materials and Methods: This was a qualitative study using conventional content analysis methods. Thirty-four participants (23 patients, 9 nurses, and 2 doctors) from three Iranian teaching hospitals, selected using purposive sampling, participated in semi-structured interviews. Unstructured observation and filed notes were other methods for data collection. The data were subjected to qualitative content analysis and analyzed using the MAXQDA-10 software. Results: Five categories and sixteen subcategories were identified. The five main categories related to patient autonomy were: Intrapersonal factors, physical health status, supportive family and friends, communication style, and organizational constraints. Conclusions: In summary, this study uncovered contextual factors that the care team, managers, and planners in the health field should target in order to improve patient autonomy in Iranian hospitals. PMID:27186203

  8. "Health courts" and accountability for patient safety.

    PubMed

    Mello, Michelle M; Studdert, David M; Kachalia, Allen B; Brennan, Troyen A

    2006-01-01

    Proposals that medical malpractice claims be removed from the tort system and processed in an alternative system, known as administrative compensation or "health courts," attract considerable policy interest during malpractice "crises," including the current one. This article describes current proposals for the design of a health court system and the system's advantages for improving patient safety. Among these advantages are the cultivation of a culture of transparency regarding medical errors and the creation of mechanisms to gather and analyze data on medical injuries. The article discusses the experiences of foreign countries with administrative compensation systems for medical injury, including their use of claims data for research on patient safety; choices regarding the compensation system's relationship to physician disciplinary processes; and the proposed system's possible limitations. PMID:16953807

  9. Sociodemographic factors affecting the quality of life of patients with asthma

    PubMed Central

    Uchmanowicz, Bartosz; Panaszek, Bernard; Uchmanowicz, Izabella; Rosińczuk, Joanna

    2016-01-01

    Background In recent years, there has been an increased interest in the subjective quality of life (QoL) of patients with bronchial asthma. Patients diagnosed with asthma experience a number of problems with regard to everyday activities and functions, which adversely affects their health-related QoL. Aim The aim of this study is to analyze the sociodemographic factors affecting the QoL of patients with asthma. Patients and methods The study comprised of 100 patients (73 females and 27 males) aged 18–84 years (mean age 45.7 years) treated in the Department and Clinic of Internal Diseases, Geriatrics and Allergology, Wroclaw Medical University. All patients with asthma who met the inclusion criteria participated in the study. We used medical record analysis and two questionnaires: the asthma quality of life questionnaire (AQLQ) and the asthma control test. Up-to-date sociodemographic data were collected from all participants, including sex, age, marital status, education, and sources of income. Results The sociodemographic variables that correlated positively with QoL in all domains of the AQLQ were professional activity and higher education level of respondents. Factors that negatively influenced the AQLQ domains were older age and lack of professional activity. Conclusion This study shows that age, physical work, and lack of professional activity decreased the QoL in this patient group. It was found that higher education contributes to better QoL scores. PMID:27051276

  10. Correlation between headaches and affective symptoms in patients with epilepsy.

    PubMed

    Seo, Ji-Hye; Joo, Eun Yeon; Seo, Dae-Won; Hong, Seung Bong

    2016-07-01

    Headaches are a neglected entity in patients with epilepsy (PWE), although PWE have a high chance of suffering from seizure-related as well as seizure-unrelated headaches. We aimed to identify the prevalence and characteristics of headaches and investigate the correlation between headaches and affective symptoms in PWE. Consecutive PWE who visited our tertiary outpatient clinic were interviewed about headaches and epilepsy. Affective symptoms were evaluated using the Korean version of the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and suicidality portion of the Mini-International Neuropsychiatric Interview. We classified headaches as interictal or seizure-related headaches (SRHs; pre- and postictal). Tension-type headache and migraine were defined based on International Classification of Headache Disorders criteria. From the initial cohort of 177 patients (92 men, mean age: 37.1years), 73 (41.2%) reported suffering from interictal (N=34, 19.2%), preictal (N=3, 1.7%), and postictal (N=48, 27.1%) headaches. Univariate analysis revealed significantly higher BDI and BAI scores in the headache group. Tension-type headaches were the most frequent, and half of the interictal headaches and most of the SRHs were untreated. Spearman's partial correlation analyses showed that headaches overall were significantly related with depression and anxiety. Interictal headaches were correlated with depression only, and postictal headaches were correlated with depression as well as suicidality, separately. These results show that investigating and controlling headaches may relieve affective symptoms and ultimately improve the quality of life of PWE. PMID:27236023

  11. Mental health clustering and diagnosis in psychiatric in-patients.

    PubMed

    Trevithick, Liam; Painter, Jon; Keown, Patrick

    2015-06-01

    Aims and method This paper investigates the relationship between cluster (Mental Health Clustering Tool, MHCT) and diagnosis in an in-patient population. We analysed the diagnostic make-up of each cluster and the clinical utility of the diagnostic advice in the Department of Health's Mental Health Clustering Booklet. In-patients discharged from working-age adult and older people's services of a National Health Service trust over 1 year were included. Cluster on admission was compared with primary diagnosis on discharge. Results Organic, schizophreniform, anxiety disorder and personality disorders aligned to one superclass cluster. Alcohol and substance misuse, and mood disorders distributed evenly across psychosis and non-psychosis superclass clusters. Two-thirds of diagnoses fell within the MHCT 'likely' group and a tenth into the 'unlikely' group. Clinical implications Cluster and diagnosis are best viewed as complimentary systems to describe an individual's needs. Improvements are suggested to the MHCT diagnostic advice in in-patient settings. Substance misuse and affective disorders have a more complex distribution between superclass clusters than all other broad diagnostic groups. PMID:26191449

  12. Working on reform. How workers' compensation medical care is affected by health care reform.

    PubMed Central

    Himmelstein, J; Rest, K

    1996-01-01

    The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies? Images p13-a p14-a p15-a p16-a p18-a p19-a p20-a p22-a p24-a PMID:8610187

  13. 42 CFR 491.10 - Patient health records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health...

  14. 42 CFR 491.10 - Patient health records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health...

  15. 42 CFR 491.10 - Patient health records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health...

  16. 42 CFR 491.10 - Patient health records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health...

  17. 42 CFR 491.10 - Patient health records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health...

  18. Applications of Text Messaging, and Bibliotherapy for Treatment of Patients Affected by Depressive Symptoms

    PubMed Central

    Taleban, Roya; Zamani, Ahmadreza; Moafi, Mohammad; Jiryaee, Nasrin; Khadivi, Reza

    2016-01-01

    Background: Intensity of depressive symptoms could be exacerbated due to the paucity of appropriate treatments. We assessed the effectiveness of bibliotherapy and text messaging, which aimed at amelioration of patient's behavior and consciousness, which could lead to suicide prevention. Methods: This was a randomized clinical trial implemented in rural health centers of Isfahan district (Iran). Health centers were assigned in three trials consisting of the booklet, text messaging, and control groups. Each group consisted of 70 patients. Inclusion criteria were being affected by depressive symptom, <18 years, and cell phone accessibility. Mental retardation, drug and alcohol abuse, visual disability, dementia, suicide attempt history, electrotherapy, and receiving psychological interventions were our not met criteria. Our patient outcomes comprised intensity of depressive symptom and treatment compliance. The first two trials were requested to study instructive booklets in 30 days while the second cohort was demanded to study the booklet in accordance with the daily delivered text messaging. Results: Out of 210 individuals, 198 patients finished this study. The intensity of depressive symptom was significantly affected through time and group factors as well as time-group interaction (F = 12.30, P < 0.001). Based on treatment compliance, the interactive effect of group factor and the time factor was statistically significant. Conclusions: It seems that bibliotherapy could efficiently decrease the intensity of depressive symptoms. Nevertheless, in comparison with our booklet trial, the text messaging group achieved neither durable nor significant success; thus, bibliotherapy could be utilized as a complementary methodology aiming depression treatment. PMID:27076884

  19. Factors affecting daily activities of patients with cerebral infarction

    PubMed Central

    Liu, Peng; Zhou, Cheng-ye; Zhang, Ying; Wang, Yun-feng; Zou, Chang-lin

    2010-01-01

    BACKGROUND: Stroke is the leading cause of death and long-term disability. This study was undertaken to investigate the factors influencing daily activities of patients with cerebral infarction so as to take interventional measures earlier to improve their daily activities. METHODS: A total of 149 patients with first-episode cerebral infarction were recruited into this prospective study. They were admitted to the Encephalopathy Center, Department of Neurology, the First Affiliated Hospital of Wenzhou Medical College in Zhejiang Province from August 2008 to December 2008. The baseline characteristics of the patients and cerebral infarction risk factors on the first day of admission were recorded. White blood cell (WBC) count, plasma glucose (PG), and many others of laboratory targets were collected in the next morning. Barthel index (BI) was calculated at 2 weeks and 3 months respectively after onset of the disease at the outpatient clinic or by telephone call. Lung infection, urinary tract infection and atrial fibrillation if any were recorded on admission. The National Institute of Health Stroke Scale (NIHSS) scores and the GCS scores were recorded within 24 hours on and after admission, at the second week, and at the third month after the onset of cerebral infarction respectively. RESULTS: The factors of BI at 2 weeks and 3 months after onset were the initial PG level, WBC count and initial NIHSS scores. Besides, urinary tract infection on admission was also the factor for BI at 3 months. CONCLUSION: Active measures should be taken to control these factors to improve the daily activities of patients with cerebral infarction. PMID:25214953

  20. What Health Issues or Conditions Affect Women Differently Than Men?

    MedlinePlus

    ... than women are throughout their lifetime, the health effects of alcohol abuse and alcoholism (when someone shows signs of ... alcohol) are more serious in women. These health effects include an ... disease, and fetal alcohol syndrome, in which infants born to mothers who ...

  1. Mental health issues affecting homeless women: implications for intervention.

    PubMed

    Buckner, J C; Bassuk, E L; Zima, B T

    1993-07-01

    A review of the relevant literature is followed by an exploration of the complex relationship, especially for women, between homelessness and mental health. Various mental health and gender-related concerns that have implications for the design of interventions for homeless women are explored. PMID:8372905

  2. Electronic Health Records and Patient Safety

    PubMed Central

    Gans, D.; White, J.; Nath, R.; Pohl, J.

    2015-01-01

    Summary Background The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. Methods We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Results Data from 209 primary care practices responding between 2006–2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Conclusions Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings. PMID:25848419

  3. Patient Education and Health Promotion: Clinical Health Promotion--The Conceptual Link.

    ERIC Educational Resources Information Center

    Caraher, Martin

    1998-01-01

    Presents a model linking health promotion, health education, and patient education. The bases for distinctions between health education, patient education, and clinical health promotion are examined. The linking elements of the model are patient role, relationships adopted, and focus of the encounter; i.e., disease process vs. disease management.…

  4. The role of affect in consumer evaluation of health care services.

    PubMed

    Ng, Sandy; Russell-Bennett, Rebekah

    2015-01-01

    Health care services are typically consumed out of necessity, typically to recover from illness. While the consumption of health care services can be emotional given that consumers experience fear, hope, relief, and joy, surprisingly, there is little research on the role of consumer affect in health care consumption. We propose that consumer affect is a heuristic cue that drives evaluation of health care services. Drawing from cognitive appraisal theory and affect-as-information theory, this article tests a research model (N = 492) that investigates consumer affect resulting from service performance on subsequent service outcomes. PMID:25751317

  5. Group health cooperative's transformation toward patient-centered access.

    PubMed

    Ralston, James D; Martin, Diane P; Anderson, Melissa L; Fishman, Paul A; Conrad, Douglas A; Larson, Eric B; Grembowski, David

    2009-12-01

    The Institute of Medicine suggests redesigning health care to ensure safe, effective, timely, efficient, equitable, and patient-centered care. The concept of patient-centered access supports these goals. Group Health, a mixed-model health care system, attempted to improve patients' access to care through the following changes: (a) offering a patient Web site with patient access to patient-physician secure e-mail, electronic medical records, and health promotion information; (b) offering advanced access to primary physicians; (c) redesigning primary care services to enhance care efficiency; (d) offering direct access to physician specialists; and (e) aligning primary physician compensation through incentives for patient satisfaction, productivity, and secure messaging with patients. In the 2 years following the redesign, patients reported higher satisfaction with certain aspects of access to care, providers reported improvements in the quality of service given to patients, and enrollment in Group Health stayed aligned with statewide trends in health care coverage. PMID:19549993

  6. Does varicocelectomy affect DNA fragmentation in infertile patients?

    PubMed Central

    Telli, Onur; Sarici, Hasmet; Kabar, Mucahit; Ozgur, Berat Cem; Resorlu, Berkan; Bozkurt, Selen

    2015-01-01

    Introduction: The aims of this study were to investigate the effect of varicocelectomy on DNA fragmentation index and semen parameters in infertile patients before and after surgical repair of varicocele. Materials and Methods: In this prospective study, 72 men with at least 1-year history of infertility, varicocele and oligospermia were examined. Varicocele sperm samples were classified as normal or pathological according to the 2010 World Health Organization guidelines. The acridine orange test was used to assess the DNA fragmentation index (DFI) preoperatively and postoperatively. Results: DFI decreased significantly after varicocelectomy from 34.5% to 28.2% (P = 0.024). In addition all sperm parameters such as mean sperm count, sperm concentration, progressive motility and sperm morphology significantly increased from 19.5 × 106 to 30.7 × 106, 5.4 × 106/ml to 14.3 × 106/ml, and 19.9% to 31.2% (P < 0.001) and 2.6% to 3.1% (P = 0.017). The study was limited by the loss to follow-up of some patients and unrecorded pregnancy outcome due to short follow-up. Conclusion: Varicocele causes DNA-damage in spermatozoa. We suggest that varicocelectomy improves sperm parameters and decreases DFI. PMID:25878412

  7. Commentary: Medicaid reform issues affecting the Indian health care system.

    PubMed

    Wellever, A; Hill, G; Casey, M

    1998-02-01

    Substantial numbers of Indian people rely on Medicaid for their primary health insurance coverage. When state Medicaid programs enroll Indians in managed care programs, several unintended consequences may ensue. This paper identifies some of the perverse consequences of Medicaid reform for Indians and the Indian health care system and suggests strategies for overcoming them. It discusses the desire of Indian people to receive culturally appropriate services, the need to maintain or improve Indian health care system funding, and the duty of state governments to respect tribal sovereignty. Because of their relatively small numbers, Indians may be treated differently under Medicaid managed care systems without significantly endangering anticipated program savings. Failure of Medicaid programs to recognize the uniqueness of Indian people, however, may severely weaken the Indian health care system. PMID:9491006

  8. Mind/Body Connection: How Your Emotions Affect Your Health

    MedlinePlus

    ... health and lead to strong feelings of sadness, stress, or anxiety. These things include: Being laid off from your ... having them. Sorting out the causes of sadness, stress, and anxiety in your life can help you manage your ...

  9. Interventions That Affect Gastrointestinal Motility in Hospitalized Adult Patients

    PubMed Central

    Asrani, Varsha M.; Yoon, Harry D.; Megill, Robin D.; Windsor, John A.; Petrov, Maxim S.

    2016-01-01

    Abstract Gastrointestinal (GI) dysmotility is a common complication in acute, critically ill, postoperative, and chronic patients that may lead to impaired nutrient delivery, poor clinical, and patient-reported outcomes. Several pharmacological and nonpharmacological interventions to treat GI dysmotility were investigated in dozens of clinical studies. However, they often yielded conflicting results, at least in part, because various (nonstandardized) definitions of GI dysmotility were used and methodological quality of studies was poor. While a universally accepted definition of GI dysmotility is yet to be developed, a systematic analysis of data derived from double-blind placebo-controlled randomized trials may provide robust data on absolute and relative effectiveness of various interventions as the study outcome (GI motility) was assessed in the least biased manner. To systematically review data from double-blind placebo-controlled randomized trials to determine and compare the effectiveness of interventions that affect GI motility. Three electronic databases (MEDLINE, SCOPUS, and EMBASE) were searched. A random effects model was used for meta-analysis. The summary estimates were reported as mean difference (MD) with the corresponding 95% confidence interval (CI). A total of 38 double-blind placebo-controlled randomized trials involving 2371 patients were eligible for inclusion in the systematic review. These studies investigated a total of 20 different interventions, of which 6 interventions were meta-analyzed. Of them, the use of dopamine receptor antagonists (MD, −8.99; 95% CI, −17.72 to −0.27; P = 0.04) and macrolides (MD, −26.04; 95% CI, −51.25 to −0.82; P = 0.04) significantly improved GI motility compared with the placebo group. The use of botulism toxin significantly impaired GI motility compared with the placebo group (MD, 5.31; 95% CI, −0.04 to 10.67; P = 0.05). Other interventions (dietary factors, probiotics, hormones) did

  10. Factors affecting effectiveness of vaccination against hepatitis B virus in hemodialysis patients

    PubMed Central

    Eleftheriadis, Theodoros; Pissas, Georgios; Antoniadi, Georgia; Liakopoulos, Vassilios; Stefanidis, Ioannis

    2014-01-01

    Hepatitis B virus (HBV) is a major global health problem. Despite the success of the general measures against blood transmitted infections in hemodialysis (HD) units, the prevalence of HBV infection among the HD patients is still high. Thus vaccination against HBV is indicating in this population. However, compared with the general population the seroprotection achieved in HD patients remains relatively low, at about 70%. In this review patient, HD procedure and vaccine-associated factors that affect the efficacy of HBV vaccination are analyzed. Also alternative routes of HBV vaccine administration as well as new and more immunogenic vaccine formulations are discussed. However, besides scientific progress, vigilance of HD physicians and staff regarding the general measures against the transmission of blood borne infections and the vaccination against HBV is also required for reducing the prevalence of this viral infection. PMID:25232238

  11. Factors affecting effectiveness of vaccination against hepatitis B virus in hemodialysis patients.

    PubMed

    Eleftheriadis, Theodoros; Pissas, Georgios; Antoniadi, Georgia; Liakopoulos, Vassilios; Stefanidis, Ioannis

    2014-09-14

    Hepatitis B virus (HBV) is a major global health problem. Despite the success of the general measures against blood transmitted infections in hemodialysis (HD) units, the prevalence of HBV infection among the HD patients is still high. Thus vaccination against HBV is indicating in this population. However, compared with the general population the seroprotection achieved in HD patients remains relatively low, at about 70%. In this review patient, HD procedure and vaccine-associated factors that affect the efficacy of HBV vaccination are analyzed. Also alternative routes of HBV vaccine administration as well as new and more immunogenic vaccine formulations are discussed. However, besides scientific progress, vigilance of HD physicians and staff regarding the general measures against the transmission of blood borne infections and the vaccination against HBV is also required for reducing the prevalence of this viral infection. PMID:25232238

  12. 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

  13. Health status: patient and physician judgments.

    PubMed Central

    Martini, C J; McDowell, I

    1976-01-01

    Patients at a rehabilitation center in Derbyshire, England, were asked to assess their own functional abilities at admission and again at discharge, using an 82-item questionnaire concerning 12 areas of daily living. Questionnaire responses were correlated with results of physical examinations, assessments by center personnel, and assessments of capacity for specific body movements. The highest correlations were observed in areas that related most directly to physical movements and to dressing and toileting. The results suggest that self-assessment of health status using this questionnaire may provide a viable alternative to judgments made by trained assessors. PMID:1025054

  14. When Health Systems Are Barriers to Health Care: Challenges Faced by Uninsured Mexican Kidney Patients

    PubMed Central

    Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J.

    2013-01-01

    Background Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. Methods The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. Results In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Conclusions Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an

  15. Myasthenia gravis in patients with thymoma affects survival rate following extended thymectomy

    PubMed Central

    ZHANG, ZHEFENG; CUI, YOUBIN; JIA, RUI; XUE, LEI; LIANG, HUAGANG

    2016-01-01

    Thymomas are the most common adult tumors in the anterior mediastinal compartment, and a significant amount of thymomas are complicated by myasthenia gravis (MG). Extended thymectomy (ET) is the primary treatment method for thymomas and is used to completely resect possible ectopic thymus to avoid recurrence. Studies on the effect of MG in thymoma patients following ET are limited. The aim of the present study was to determine whether the presence of MG affects the prognosis of patients with thymoma. The present study consisted of 104 patients with thymoma that underwent ET; 61 men (58.7%) and 43 women (41.3%) (mean age, 54.6 years). In total, 38 patients had MG (36.5%). MG was most frequently observed in World Health Organization (WHO) classification type B2 thymoma compared with other types of thymoma. During the 5-year follow-up period, 11 patients succumbed to a recurrence of thymoma or respiratory failure due to MG. The overall 5-year survival rate in patients without MG or with MG was 89.1 and 76.0%, respectively. The overall survival (OS) rate in patients with Masaoka stages I + II and III + IV was 90.0 and 68.0%, respectively. The OS rate in patients with WHO type A + AB + B1 and type B2 + B3 was 96.9 and 76.8%, respectively. The patients with MG (P=0.026), Masaoka stages III + IV (P=0.008) and WHO type B2 + B3 (P=0.032) had a poorer prognosis compared with patients without these characteristics. Furthermore, multivariate analysis by Cox regression revealed that age [P=0.032; relative risk (RR)=1.097; 95% confidence interval (CI)=1.097–1.192] and MG (P=0.042; RR=0.167; 95% CI=0.037–0.940) significantly affected OS rate. In summary, ET is a reliable method for the treatment of thymoma. Long-term survival is expected for patients at early Masaoka stages, and for patients without MG. The prognosis of patients with thymomas with MG is poorer compared with patients without MG. The present findings provide useful information for the future management of

  16. Does organizational culture affect out-patient DNA (did not attend) rates?

    PubMed

    Jackson, S

    1997-01-01

    Government interest in health service "did not attend" (DNA) rates was seen to occur by accident, following which efforts to reduce DNAs have tended to concentrate on operational rather than strategic issues. Considers the effect hospital culture has had on DNA rates from an organizational and patient perspective. Identifies some of the key cultural issues that impacted on DNA rates by utilizing observation and telephone survey research methods. Concludes that, in the main, the lack of customer-oriented organizational culture was seen to affect DNA rates adversely within one NHS provider trust. PMID:10179096

  17. How Does Sensitivity Training of Health Care Workers Impact Patient Satisfaction?

    ERIC Educational Resources Information Center

    De Vinci, Katrina Marie

    2010-01-01

    Health care of the 21st century is undergoing major changes due to a myriad of social factors affecting every level of society. From financial desperation due to the high cost of health care to the increased awareness of a generation asking for better services, the importance of patient satisfaction is paramount. The Centers for Medicare and…

  18. Skin Blood Perfusion and Oxygenation Colour Affect Perceived Human Health

    PubMed Central

    Stephen, Ian D.; Coetzee, Vinet; Law Smith, Miriam; Perrett, David I.

    2009-01-01

    Skin blood perfusion and oxygenation depends upon cardiovascular, hormonal and circulatory health in humans and provides socio-sexual signals of underlying physiology, dominance and reproductive status in some primates. We allowed participants to manipulate colour calibrated facial photographs along empirically-measured oxygenated and deoxygenated blood colour axes both separately and simultaneously, to optimise healthy appearance. Participants increased skin blood colour, particularly oxygenated, above basal levels to optimise healthy appearance. We show, therefore, that skin blood perfusion and oxygenation influence perceived health in a way that may be important to mate choice. PMID:19337378

  19. Factors Affecting Canadian Teachers' Willingness to Teach Sexual Health Education

    ERIC Educational Resources Information Center

    Cohen, Jacqueline N.; Byers, E. Sandra; Sears, Heather A.

    2012-01-01

    Non-specialist teachers in Canada are increasingly required to teach sexual health topics. However, research suggests that they do not always do so willingly. This study examined the associations between the characteristics of non-specialist elementary and middle school teachers (n = 294) in Canadian schools and their willingness to provide sexual…

  20. Adolescents' health behaviors and obesity: Does race affect this epidemic?

    PubMed Central

    Shelley, Mack C.; Hausafus, Cheryl O.

    2010-01-01

    This study explores the influence of health behaviors and individual attributes on adolescent overweight and obesity using data from Wave II (Add Health). Structural equation model/path analysis using maximum likelihood estimation was utilized to analyze the relationships of health behaviors and attributes with obesity. Results of the model reveal that the causal paths (adolescents' attributes and health behaviors) for overweight and obesity were different for African American and Caucasian adolescents. Generally, African Americans were more susceptible to overweight and obesity than Caucasians. Although increasing levels of vigorous physical activities lowers the risk for obesity among African American and Caucasian adolescents alike, low family SES and being sedentary were associated with overweight and obesity among Caucasians. No significant associations were found among African Americans. Increased hours of sleep at night relate positively with obesity among African Americans. These findings suggest important elements in the consideration of race in developing effective intervention and prevention approaches for curbing the obesity epidemic among U.S. adolescents. PMID:21286412

  1. Financial Health of Child Care Facilities Affects Quality of Care.

    ERIC Educational Resources Information Center

    Brower, Mary R.; Sull, Theresa M.

    2003-01-01

    Contends that child care facility owners, boards of directors, staff, and parents need to focus on financial management, as poor financial health compromises the quality of care for children. Specifically addresses the issues of: (1) concern for providing high quality child care; (2) the connection between quality and money; and (3) strengthening…

  2. Lineage Affect Similarity and Health of Older Family Members.

    ERIC Educational Resources Information Center

    Troll, Lillian E.

    Interviews with same-sex adult members of three-generation family lines can dramatize similarities and differences by age and generation in ways of thinking and feeling. An analysis of interviews with 157 families examined the health of the grandparent, the happiness of each of the three generational representatives, and family salience. Twelve…

  3. Transforming Health Care Delivery Through Consumer Engagement, Health Data Transparency, and Patient-Generated Health Information

    PubMed Central

    Wald, J. S.

    2014-01-01

    Summary Objectives Address current topics in consumer health informatics. Methods Literature review. Results Current health care delivery systems need to be more effective in the management of chronic conditions as the population turns older and experiences escalating chronic illness that threatens to consume more health care resources than countries can afford. Most health care systems are positioned poorly to accommodate this. Meanwhile, the availability of ever more powerful and cheaper information and communication technology, both for professionals and consumers, has raised the capacity to gather and process information, communicate more effectively, and monitor the quality of care processes. Conclusions Adapting health care systems to serve current and future needs requires new streams of data to enable better self-management, improve shared decision making, and provide more virtual care. Changes in reimbursement for health care services, increased adoption of relevant technologies, patient engagement, and calls for data transparency raise the importance of patient-generated health information, remote monitoring, non-visit based care, and other innovative care approaches that foster more frequent contact with patients and better management of chronic conditions. PMID:25123739

  4. Mental health issues affecting ethnic minorities in Japan.

    PubMed

    Noda, F

    1998-12-01

    Although Japan is becoming a multicultural society, the policy for ethnic minorities is not as mature as that in Western countries. Mental health issues among new ethnic minorities will be discussed. New minorities are mainly South-East Asian refugees, foreign brides from the Philippines, Korea and China, and returnees from China. Because their communities are very small, they tend to have great difficulties in coping with the Japanese society. Problems in their adjustment to the host country will be discussed. PMID:9895196

  5. 29 CFR 1960.19 - Other Federal agency standards affecting occupational safety and health.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... safety and health. 1960.19 Section 1960.19 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... EMPLOYEE OCCUPATIONAL SAFETY AND HEALTH PROGRAMS AND RELATED MATTERS Standards § 1960.19 Other Federal agency standards affecting occupational safety and health. (a) Where employees of different...

  6. 29 CFR 1960.19 - Other Federal agency standards affecting occupational safety and health.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... safety and health. 1960.19 Section 1960.19 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... EMPLOYEE OCCUPATIONAL SAFETY AND HEALTH PROGRAMS AND RELATED MATTERS Standards § 1960.19 Other Federal agency standards affecting occupational safety and health. (a) Where employees of different...

  7. Complementary and Alternative Medicine Use Among Cancer Patients and Determination of Affecting Factors: A Questionnaire Study.

    PubMed

    Üstündağ, Sema; Demir Zencirci, Ayten

    2015-01-01

    This descriptive and cross-sectional study was conducted to determine the use and effects of complementary and alternative medicine on cancer patients receiving chemotherapy. The research was conducted in Daytime Chemotherapy Unit of the College District Outpatients in the Ankara Numune Education and Research Hospital and comprised 397 patients in the oncology outpatients. Written informed consents were obtained from all participants. Among the participants, 52.6% were women, 85.1% married, 10.6% illiterate, 41.1% housewife, and 8.8% civil servants. Among the patients participated in the study, 27.7% had cancer in the family, 22.6% had gastrointestinal cancer, and 22.1% had breast cancer. Most of the patients (92.2%) resorted to religious and cultural approaches, and some patients (33.8%) used nutritional and herbal products besides medical treatment. The nutritional and herbal products used as remedy included stinging nettle (22.3%), fennel flower (20.1%), and herbal products that were advertised by herbalists in media (9.7%). It was determined that most of the patients resorting to complementary or alternative medicine were women (52.6%), housewife (51.5%), and patients with a history of cancer in the family (37.7%). Complementary and alternative medicine use as a remedy for cure is common among patients in Turkey. But when it is considered that many of these products had the potential to negatively affect cancer therapy, it is crucial that nurses providing care to cancer patients should be well informed about complementary therapies, be aware of the potential risks and benefits, and communicate openly with patients on their health care choices. PMID:26465625

  8. Factors That Affect Patient Attitudes toward Infection Control Measures.

    ERIC Educational Resources Information Center

    Jones, Daniel J.; And Others

    1991-01-01

    A study investigated patient attitudes toward different disease control measures taken in dental school clinics (n=272 patients) and private practices (n=107 patients). Variables examined included sex, age, educational background, and knowledge of infectious diseases. Patients tended to accept the control measures being used in each context. (MSE)

  9. Tracking Official Development Assistance for Reproductive Health in Conflict-Affected Countries

    PubMed Central

    Patel, Preeti; Roberts, Bayard; Guy, Samantha; Lee-Jones, Louise; Conteh, Lesong

    2009-01-01

    Background Reproductive health needs are particularly acute in countries affected by armed conflict. Reliable information on aid investment for reproductive health in these countries is essential for improving the efficiency and effectiveness of aid. The purpose of this study was to analyse official development assistance (ODA) for reproductive health activities in conflict-affected countries from 2003 to 2006. Methods and Findings The Creditor Reporting System and the Financial Tracking System databases were the chosen data sources for the study. ODA disbursement for reproductive health activities to 18 conflict-affected countries was analysed for 2003, 2004, 2005, and 2006. An average of US$20.8 billion in total ODA was disbursed annually to the 18 conflict-affected countries between 2003 and 2006, of which US$509.3 million (2.4%) was allocated to reproductive health. This represents an annual average of US$1.30 disbursed per capita in the 18 sampled countries for reproductive health activities. Non-conflict-affected least-developed countries received 53.3% more ODA for reproductive health activities than conflict-affected least-developed countries, despite the latter generally having greater reproductive health needs. ODA disbursed for HIV/AIDS prevention and treatment increased by 119.4% from 2003 to 2006. The ODA disbursed for other direct reproductive health activities declined by 35.9% over the same period. Conclusions This study provides evidence of inequity in disbursement of reproductive health ODA between conflict-affected countries and non-conflict-affected countries, and between different reproductive health activities. These findings and the study's recommendations seek to support initiatives to make aid financing more responsive to need in the context of armed conflict. PMID:19513098

  10. Accountable communities: how norms and values affect health system change.

    PubMed

    Steinberg, C R; Baxter, R J

    1998-01-01

    Economic forces, policy initiatives, and technological change push markets along what some hypothesize is a common evolutionary path. Observations from twelve sites, however, indicate that the pace and direction of change are highly variable across markets. Other forces, internal and unique to a community, help to explain this variation. These forces emanate from the underlying history, culture, and values of a community and in part dictate the response of various players to the more common forces. This paper explores the mechanisms through which these forces operate and their relationship to health system change. PMID:9691558

  11. Health literacy and its influencing factors in Iranian diabetic patients

    PubMed Central

    Mohammadi, Zahra; Tehrani Banihashemi, Arash; Asgharifard, Homa; Bahramian, Mehran; Baradaran, Hamid Reza; Khamseh, Mohammad E

    2015-01-01

    Background: Health literacy is the ability to obtain, read, understand and use healthcare information to make appropriate health decisions and follow instructions for treatment. The aim of this study was to identify the effect of various factors on health literacy in patients with diabetes. Methods: 407 patients with diabetes older than 15 years of age were identified from the Diabetes Clinic affiliated to the Institute of Endocrinology and Metabolism (IEM) of Iran University of Medical Sciences. We assessed patients' health literacy using the Persian version of Test of Functional Health Literacy in Adults (TOFHLA) questionnaire. Results: Mean age of the patients was 55.8 ± 11.3 years, and 61.7% the participants were female.. Overall, 18.2% of the patients had adequate health literacy skills, 11.8% had marginal and 70.0% inadequate health literacy skills. Male participants performed better than females (p< 0.01) and older patients had lower health literacy score than younger patients (p< 0.001). Furthermore, patients with higher educational and occupational levels had higher functional health literacy score than those with lower levels (p< 0.001). Conclusion: Health literacy score in Iranian patients with diabetes seems inadequate. Therefrom effective interventions should be designed and implemented for this group of patients to improve diabetes outcomes. PMID:26478888

  12. [Statins available from chemist shops will not positively affect health].

    PubMed

    Stalenhoef, A F H

    2007-06-23

    Statins should not become available as over- or behind-the-counter drugs at chemist shops. The efficacy of these drugs when given in low dosages has not been proved although the negative aspect of possible side effects remains a realistic possibility. The use of statins as compensation for an unhealthy lifestyle is not desirable and there is a danger that patients with high vascular risk would receive treatment without being adequately supervised. PMID:17668606

  13. Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities

    ERIC Educational Resources Information Center

    Chen, Jie; Mullins, C. Daniel; Novak, Priscilla; Thomas, Stephen B.

    2016-01-01

    Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and…

  14. Consumer Health Informatics--integrating patients, providers, and professionals online.

    PubMed

    Klein-Fedyshin, Michele S

    2002-01-01

    Consumer Health Informatics (CHI) means different things to patients, health professionals, and health care systems. A broader perspective on this new and rapidly developing field will enable us to understand and better apply its advances. This article provides an overview of CHI discussing its evolution and driving forces, along with advanced applications such as Personal Health Records, Internet transmission of personal health data, clinical e-mail, online pharmacies, and shared decision-making tools. Consumer Health Informatics will become integrated with medical care, electronic medical records, and patient education to impact the whole process and business of health care. PMID:12238015

  15. Ethical Justification for Conducting Public Health Surveillance Without Patient Consent

    PubMed Central

    Heilig, Charles M.; White, Angela

    2012-01-01

    Public health surveillance by necessity occurs without explicit patient consent. There is strong legal and scientific support for maintaining name-based reporting of infectious diseases and other types of public health surveillance. We present conditions under which surveillance without explicit patient consent is ethically justifiable using principles of contemporary clinical and public health ethics. Overriding individual autonomy must be justified in terms of the obligation of public health to improve population health, reduce inequities, attend to the health of vulnerable and systematically disadvantaged persons, and prevent harm. In addition, data elements collected without consent must represent the minimal necessary interference, lead to effective public health action, and be maintained securely. PMID:22095338

  16. The Effects of Daily Co-Occurrence of Affect on Older Adults’ Reactivity to Health Stressors

    PubMed Central

    Ramsey, Jennifer L.; Neupert, Shevaun D.; Mroczek, Daniel K.; Spiro, Avron

    2015-01-01

    Objectives The present study examined age differences among older adults in the daily co-occurrence of affect and its potential role in buffering the negative effects of health stressors. Design Participants were from the Veterans Affairs Normative Aging Study (NAS) and included 249 young-old adults (age = 60–79 years, M=71.6) and 64 old-old adults (age = 80–89, M = 82.9) who completed questionnaires assessing stressors, physical health symptoms, and positive and negative affect on eight consecutive days. Results An independent samples t-test showed young-old and old-old adults did not significantly differ in their mean levels of daily co-occurrence of affect. The between-person relationships among stressors, health, and daily co-occurrence of affect revealed that neither stressors nor health were significantly related to daily co-occurrence of affect. However, results from a multilevel model revealed a three-way cross-level interaction (Health Stressor X Age Group X Co-Occurrence of Affect) where old-old adults with higher levels of co-occurrence of affect were less emotionally reactive to health stressors than young-old adults. Conclusion These findings provide support for the assertion that co-occurrence of affect functions in an adaptive capacity and highlight the importance of examining domain specific stressors. PMID:26518259

  17. MISR Satellite Observations of Aerosol Types Affecting Human Health

    NASA Astrophysics Data System (ADS)

    Kalashnikova, O. V.; Franklin, M.; Garay, M. J.; Diner, D. J.

    2015-12-01

    Ground-based observations of pollutants and concentrations of particulate matter (PM), that includes small particles designated PM2.5 and dust-dominated PM10, are the gold standard in studies of environmental impacts on human health. However, because monitoring stations are costly, they typically provide only limited spatial coverage, especially in rural and remote areas. We will demonstrate how data from the Multi-angle Imaging SpectroRadiometer (MISR) instrument that has been flying on NASA's Terra Earth Observing System satellite since early 2000 can be used to provide estimates of surface PM types. The current MISR operational aerosol retrieval uses a combination of multi-spectral and multi-angle data to retrieve aerosol optical depth (AOD) and particle property information (including dust AOD) globally at 17.6 km spatial resolution. Using the same algorithm with data collected in all 36-channels at 275 m resolution (Local Mode), which is available over greater Los Angeles area, and also was activated during 2013 DISCOVER-AQ California field campaign, high-resolution 4.4 km aerosol retrievals were performed in addition to the standard 17.6 km retrievals. The 4.4 km spatial resolution of the PM information data is fine enough to be able to resolve local differences in PM loading that may be important for understanding regional health effects of pollution in the region. In particular, we demonstrate that MISR high-resolution AOD retrievals are in better agreement with ground-based aerosol observations and reveal more details about the aerosol spatial variability compared to the MISR standard 17.6 km product. Then we will discuss techniques and show examples of the application of high-resolution MISR data to provide estimates of surface PM for the greater Los Angeles area in 2008 and for California San Joaquin Valley during the 2013 DISCOVER-AQ field campaign. Finally, we will discuss future NASA instruments that will provide new information allowing for better

  18. Gender-related differences in lifestyle may affect health status.

    PubMed

    Varì, Rosaria; Scazzocchio, Beatrice; D'Amore, Antonio; Giovannini, Claudio; Gessani, Sandra; Masella, Roberta

    2016-01-01

    Consistent epidemiological and clinical evidence strongly indicates that chronic non-communicable diseases are largely associated with four lifestyle risk factors: inadequate diet, physical inactivity, tobacco use, and excessive alcohol use. Notably, obesity, a worldwide-growing pathological condition determined by the combination between inadequate diet and insufficient physical activity, is now considered a main risk factor for most chronic diseases. Dietary habits and physical activity are strongly influenced by gender attitudes and behaviors that promote different patterns of healthy or unhealthy lifestyles among women and men. Furthermore, different roles and unequal relations between genders strongly interact with differences in social and economic aspects as well as cultural and societal environment. Because of the complex network of factors involved in determining the risk for chronic diseases, it has been promoting a systemic approach that, by integrating sex and gender analysis, explores how sex-specific biological factors and gender-related social factors can interact to influence the health status. PMID:27364389

  19. Specificity of Affective Instability in Patients With Borderline Personality Disorder Compared to Posttraumatic Stress Disorder, Bulimia Nervosa, and Healthy Controls

    PubMed Central

    Santangelo, Philip; Mussgay, Lutz; Sawitzki, Günther; Trull, Timothy J.; Reinhard, Iris; Steil, Regina; Klein, Christoph; Bohus, Martin; Ebner-Priemer, Ulrich W.

    2014-01-01

    Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses. PMID:24661176

  20. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications

    PubMed Central

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service.

  1. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications.

    PubMed

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service. PMID:27559474

  2. Patient portals - An online tool for your health

    MedlinePlus

    ... gov/ency/patientinstructions/000880.htm Patient portals - An online tool for your health To use the sharing ... a website for your personal health care. The online tool helps you to keep track of your ...

  3. Review on the Eyedrop Self-Instillation Techniques and Factors Affecting These Techniques in Glaucoma Patients

    PubMed Central

    Kayikcioglu, Ozcan; Bilgin, Sinan; Uyar, Murat

    2016-01-01

    Objective. This study aims to evaluate eyedrop self-installation techniques and factors affecting these techniques in glaucoma patients. Methods. Researchers directly observed eyedrop instillation procedures of 66 glaucoma patients. Contact with periocular tissues and instillation onto ocular surface or conjunctival fornices were considered. Correlations of instillation patterns with patient characteristics including age, gender, intraocular pressure, cup-to-disc ratio, visual field loss, and total intake of glaucoma medication and handgrip strength score were searched. Results. The average handgrip strength in the instillation without periocular contact group was 66.4 ± 19.7 kg, while the average handgrip strength score was 55.9 ± 20.9 kg in the instillation with contact group. The difference between the two groups was statistically significant (p = 0.039). No statistically significant correlation was found between handgrip strength and the mean number of glaucoma medications, c/d, intraocular pressure (p > 0.05). Also there was no significant relation between mean handgrip strength score and the severity of the visual field defect (p = 0.191). Conclusion. Patients especially with severe glaucomatous damage should be adequately instructed about the proper techniques for self-instillation of eyedrops and motivated to use a proper technique. Also, it is possible to suggest that patients with a higher handgrip strength, indicating the well-being of general health, may be doing better in properly instilling glaucoma eyedrops. PMID:27119046

  4. Predictors of suicide attempts in 3.322 patients with affective disorders and schizophrenia spectrum disorders.

    PubMed

    Gallego, Juan A; Rachamallu, Vivekananda; Yuen, Eunice Y; Fink, Sabina; Duque, Laura M; Kane, John M

    2015-08-30

    This study explores risk factors for suicide attempts using the electronic health records of 3322 patients with either schizophrenia spectrum disorders or affective disorders who underwent a comprehensive psychiatric evaluation at the Emergency Department at the Long Island Jewish Medical Center or the Hillside Evaluation Center at The Zucker Hillside Hospital from August 3rd 2011 to July 5th 2012. Multivariate regression analyses showed, after adjusting for sex, that previous suicidal attempts and financial or relationship losses were significantly associated with a current suicidal attempt. Additionally, higher odds of having a suicidal attempt were also found in those subjects with a diagnosis of an affective disorder, compared to a schizophrenia spectrum diagnosis, and those patients in the children/adolescent group compared to those in the adult/elderly group. Our study results confirm and expand results from prior studies. Therefore, physicians should be alert for the presence of any or all of these factors upon evaluation of psychiatric patients, and if present, either psychiatric hospitalization or a close psychiatric follow up in collaboration with family and a therapist would be key in reducing the risk of potential suicidal behavior. PMID:26077849

  5. Predictors of Suicide Attempts in 3.322 Patients with Affective Disorders and Schizophrenia Spectrum Disorders

    PubMed Central

    Yuen, Eunice Y.; Fink, Sabina; Duque, Laura M.; Kane, John M.

    2015-01-01

    This study explores risk factors for suicide attempts using the electronic health records of 3,322 patients with either schizophrenia spectrum disorders or affective disorders who underwent a comprehensive psychiatric evaluation at the Emergency Department at the Long Island Jewish Medical Center or the Hillside Evaluation Center at The Zucker Hillside Hospital from August 3rd 2011 to July 5th 2012. Multivariate regression analyses showed, after adjusting for sex, that previous suicidal attempts and financial or relationship losses were significantly associated with a current suicidal attempt. Additionally, higher odds of having a suicidal attempt were also found in those subjects with a diagnosis of an affective disorder, compared to a schizophrenia spectrum diagnosis, and those patients in the children/adolescent group compared to those in the adult/elderly group. Our study results confirm and expand results from prior studies. Therefore, physicians should be alert for the presence of any or all of these factors upon evaluation of psychiatric patients, and if present, either psychiatric hospitalization or a close psychiatric follow up in collaboration with family and a therapist would be key in reducing the risk of potential suicidal behavior. PMID:26077849

  6. Patient care outcomes: implications for the Military Health Services System.

    PubMed

    Jennings, B M

    1993-05-01

    Policy makers are targeting patient outcomes and the effectiveness of interventions as possible ways to curb spiraling health care costs. Quality assurance/improvement programs are focusing on patient outcomes as a way to evaluate and improve care delivery. Consequently, members of the Military Health Services System need a solid understanding of the current emphasis on the outcomes of care to be knowledgeable participants in the health care changes precipitated by highlighting patient outcomes. PMID:8502389

  7. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review

    PubMed Central

    Santaguida, Pasqualina L.; Hawker, Gillian A.; Hudak, Pamela L.; Glazier, Richard; Mahomed, Nizar N.; Kreder†, Hans J.; Coyte, Peter C.; Wright, James G.

    2008-01-01

    Background Total joint arthroplasty is a highly efficacious and cost-effective procedure for moderate to severe arthritis in the hip and knee. Although patient characteristics are considered to be important determinants of who receives total joint arthroplasty, no systematic review has addressed how they affect the outcomes of total joint arthroplasty. This study addresses how patient characteristics influence the outcomes of hip and knee arthroplasty in patients with osteoarthritis. Methods We searched 4 bibliographic databases (MEDLINE 1980–2001, CINAHL 1982–2001, EMBASE 1980–2001, HealthStar 1998–1999) for studies involving more than 500 patients with osteoarthritis and 1 or more of the following outcomes after total joint arthroplasty: pain, physical function, postoperative complications (short-and long-term) and time to revision. Prognostic patient characteristics of interest included age, sex, race, body weight, socioeconomic status and work status. Results Sixty-four of 14 276 studies were eligible for inclusion and had extractable data. Younger age (variably defined) and male sex increased the risk of revision 3-fold to 5-fold for hip and knee arthroplasty. The influence of weight on the risk of revision was contradictory. Mortality was greatest in the oldest age group and among men. Function for older patients was worse after hip arthroplasty (particularly in women). Function after knee arthroplasty was worse for obese patients. Conclusion Although further research is required, our findings suggest that, after total joint arthroplasty, younger age and male sex are associated with increased risk of revision, older age and male sex are associated with increased risk of mortality, older age is related to worse function (particularly among women), and age and sex do not influence the outcome of pain. Despite these findings, all subgroups derived benefit from total joint arthroplasty, suggesting that surgeons should not restrict access to these

  8. Complementary and alternative therapies and health literacy in cancer patients.

    PubMed

    Dişsiz, Gülçin; Yilmaz, Medine

    2016-05-01

    The aim was to determine health literacy and the use of complementary and alternative therapies (CATs) in patients with cancer and to investigate the relationship between CAT usage and health literacy. The study cohort consisted of 250 oncology patients. The Patient Interview Form and the Adult Literacy in Medicine Scale were used for collecting data. The use of at least one CAT was reported by 24% of the patients surveyed. Herbal therapies (32.6%) constituted the most popular method, and the most popular herbal therapy was Nigella sativa (54.6%). A total of 29.8% of the patients using CATs reported using herbal therapies for an enhanced immune system. Illiterate patients and those who live in rural areas/towns displayed low levels of health literacy. Healthcare professionals should investigate patients' use of complementary and alternative approaches, and health literacy should be improved so that patients can be informed regarding the possible benefits and disadvantages of CATs. PMID:27157956

  9. Patient portals - An online tool for your health

    MedlinePlus

    A patient portal is a website for your personal health care. The online tool helps you to keep track of ... questions through the portal. Many providers now offer patient portals. For access, you will need to set up ...

  10. Ecological Factors Affecting Efficiency and Health in Warships*

    PubMed Central

    Ellis, F. P.

    1960-01-01

    The environment of those who live and work in warships is closely related to the way the ships are built and employed. In stating the requirements for the atmosphere between decks the emphasis has swung during the past 50 years from the need for controlling the chemical constituents to the control of the factors which comprise the thermal environment, and now, with the advent of the nuclear-powered submarine, to the need for achieving, as nearly as possible, complete physical, chemical, and microbiological control. Between 1944 and 1953 the thermal factors between decks were investigated in a series of studies carried out in H.M. Ships. The average effective temperatures on the mess decks and in the work places of 11 ships in the Eastern Fleet in 1944 exceeded 84°F. (28·9°C.). In compartments where radiant heat was an added factor the average corrected effective temperature levels were 1° or 2°F. (0·55-1·1°C.) higher than the corresponding effective temperatures. The effects of climatic conditions on naval personnel were investigated by psychological studies to determine the levels of warmth at which performance deteriorated; by physiological experiments to show the levels of warmth at which the collapse of men working at different work rates might be expected; by comfort surveys in ships and on shore to determine the levels of warmth at which the majority enjoyed optimum comfort; and by relating the monthly incidence of the common causes of ill-health to the average monthly upper-deck temperature as recorded at noon each day in order to determine the temperature level above which sickness increased. It was concluded that the upper desirable level of warmth to consider when designing ships for hot climates was an effective temperature of 78°F. (25·5°C.). As it is usually impracticable in many compartments to achieve temperatures below 78°F. (25·5°C.) in the tropics without the generous application of air cooling, attention was then directed to the

  11. Health informatics and community health: support for patients as collaborators in care.

    PubMed

    Brennan, P F

    1999-12-01

    Health informatics has much to offer community health care. Computer networks and telecommunications provide particular support that can enhance the collaboration among clinicians, care providers and patients. Special-purpose computer tools referred to as Consumer Health Informatics (CHI) represent the application of computer and information technologies specifically to support the health information and communication needs of patients and lay persons. Research projects like ComputerLink and CHESS demonstrate that CHI is acceptable to patients and promotes self-care and disease management. Three grand challenges must be faced to insure realization of the promise of health informatics to community health care: development of knowledge management and information discovery tools for patients, insurance of health information literacy for all persons, and re-engineering clinical practice to capitalize on patients as full partners in health care. PMID:10805012

  12. Implicit and Explicit Memory for Affective Passages in Temporal Lobectomy Patients

    ERIC Educational Resources Information Center

    Burton, Leslie A.; Rabin, Laura; Vardy, Susan Bernstein; Frohlich, Jonathan; Porter, Gwinne Wyatt; Dimitri, Diana; Cofer, Lucas; Labar, Douglas

    2008-01-01

    Eighteen temporal lobectomy patients (9 left, LTL; 9 right, RTL) were administered four verbal tasks, an Affective Implicit Task, a Neutral Implicit Task, an Affective Explicit Task, and a Neutral Explicit Task. For the Affective and Neutral Implicit Tasks, participants were timed while reading aloud passages with affective or neutral content,…

  13. Tracheal Decannulation Protocol in Patients Affected by Traumatic Brain Injury

    PubMed Central

    Zanata, Isabel de Lima; Santos, Rosane Sampaio; Hirata, Gisela Carmona

    2014-01-01

    Introduction The frequency of tracheostomy in patients with traumatic brain injury (TBI) contrasts with the lack of objective criteria for its management. The study arose from the need for a protocol in the decision to remove the tracheal tube. Objective To evaluate the applicability of a protocol for tracheal decannulation. Methods A prospective study with 20 patients, ranging between 21 and 85 years of age (average 33.55), 4 of whom were women (20%) and 16 were men (80%). All patients had been diagnosed by a neurologist as having TBI, and the anatomical region of the lesion was known. Patients were evaluated following criteria for tracheal decannulation through a clinical evaluation protocol developed by the authors. Results Decannulation was performed in 12 (60%) patients. Fourteen (70%) had a score greater than 8 on the Glasgow Coma Scale and only 2 (14%) of these were not able to undergo decannulation. Twelve (60%) patients maintained the breathing pattern with occlusion of the tube and were successfully decannulated. Of the 20 patients evaluated, 11 (55%) showed no signs suggestive of tracheal aspiration, and of these, 9 (82%) began training on occlusion of the cannula. The protocol was relevant to establish the beginning of the decannulation process. The clinical assessment should focus on the patient's condition to achieve early tracheal decannulation. Conclusion This study allowed, with the protocol, to establish six criteria for tracheal decannulation: level of consciousness, respiration, tracheal secretion, phonation, swallowing, and coughing. PMID:25992074

  14. Teaching Death Management Skills: Health Professionals Confront Patient Avoidance Behavior.

    ERIC Educational Resources Information Center

    Lanham, Raymond; And Others

    Health professionals tend to view dying patients with two intertwined attitudes. On one hand the patient possesses an irreversible pathological condition and the doctor is obliged to help that patient embrace death with as much dignity as possible. On the other hand, the patient's imminent death is daily testimony to the limits of the doctor's…

  15. Discussing the Effects of Poor Health Literacy on Patients Facing HIV: A Narrative Literature Review

    PubMed Central

    Palumbo, Rocco

    2015-01-01

    Background: Scholars describe poor health literacy as a "silent epidemic," which is challenging the functioning of healthcare systems all over the world. Health literacy is mainly meant as an individual trait which concerns the ability to obtain, process, and understand basic health information in order to effectively navigate the health system. Low health literate patients perceive poor self-efficacy dealing with their health conditions, are not willing to be involved in the provision of care, show larger risks of hospitalization and mortality, and are not aware about the determinants of well-being. Hence, limited health literacy has been associated with inadequate management of long-term conditions; nonetheless, several authors argue that health literacy has been an overlooked factor dealing with HIV. Methods: This study is aimed at discussing the effects of poor health literacy on people living with HIV, drawing from the findings of a narrative literature review which involved 41 papers retrieved from the databases "Scopus-Elsevier" and "PubMed." Results: The scientific literature is not consistent dealing with the relationship between health literacy and HIV treatment. For example, health literate patients seem to better understand their health conditions; on the other hand, people living with poor health literacy are likely to report higher compliance with providers’ prescriptions, blindly trusting healthcare professionals. Conclusions: Poor health literacy is a social barrier to access healthcare services and to appropriate health treatment among patients living with HIV. Tailored interventions should be aimed at enhancing the health skills of patients affected by HIV infection to improve their ability to navigate the health system. PMID:26188806

  16. Health in the hot zone - How could global warming affect humans?

    SciTech Connect

    Monastersky, R.

    1996-04-06

    A soon-to-be-released report from the World Health Organization examines the health effects of global warming, calling climate change one of the largest public health challenges for the upcoming century. The issue extends beyond tropical illness: deaths caused directly by heat, dwindling agricultural yields etc. could all affect human health. This article looks at the following health related effects and gives an overview of the scientific information available on each: temperature and mortality; tropical trouble, including vecorborne diseases and increase in susceptable populations; and waterborne problems such as cholera, harmful algal bloomes, food shortages.

  17. Patients, health information, and guidelines: A focus-group study

    PubMed Central

    Liira, Helena; Saarelma, Osmo; Callaghan, Margaret; Harbour, Robin; Jousimaa, Jukkapekka; Kunnamo, Ilkka; Loudon, Kirsty; Mcfarlane, Emma; Treweek, Shaun

    2015-01-01

    Background. Evidence-based clinical guidelines could support shared decision-making and help patients to participate actively in their care. However, it is not well known how patients view guidelines as a source of health information. This qualitative study aimed to assess what patients know about guidelines, and what they think of their presentation formats. Research question. What is the role of guidelines as health information for patients and how could the implementation of evidence-based information for patients be improved? Methods. A qualitative study with focus groups that were built around a semi-structured topic guide. Focus groups were audiotaped and transcribed and analysed using a phenomenographic approach. Results. Five focus groups were carried out in 2012 with a total of 23 participants. Patients searched for health information from the Internet or consulted health professionals or their personal networks. The concepts of guidelines included instructions or standards for health professionals, information given by a health professional to the patient, and material to protect and promote the interests of patients. Some patients did not have a concept for guidelines. Patients felt that health information was abundant and its quality sometimes difficult to assess. They respected conciseness, clarity, clear structure, and specialists or well-known organizations as authors of health information. Patients would like health professionals to deliver and clarify written materials to them or point out to them the relevant Internet sites. Conclusions. The concept of guidelines was not well known among our interviewees; however, they expressed an interest in having more communication on health information, both written information and clarifications with their health professionals. PMID:26205344

  18. Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities

    PubMed Central

    Chen, Jie; Mullins, C. Daniel; Novak, Priscilla; Thomas, Stephen B.

    2015-01-01

    Designing culturally-sensitive personalized interventions is essential to sustain patients’ involvement in their treatment, and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multi-level activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health, and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms, and how they impact patient activation and empowerment. Such policies include Accountable Care Organizations and Value Based Purchasing, Patient Centered Medical Homes, and the Community Health Benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable, and will be critical to engaging patients in their treatment, developing patients’ abilities to manage their health, helping patients to express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making. PMID:25845376

  19. Clinical findings in patients with anorexia nervosa and affective illness in their relatives.

    PubMed

    Gershon, E S; Schreiber, J L; Hamovit, J R; Dibble, E D; Kaye, W; Nurnberger, J I; Andersen, A E; Ebert, M

    1984-11-01

    The most prevalent psychiatric disorders in the families of patients with anorexia nervosa are bipolar and unipolar major affective disorder. The presence of affective disorder, self-induced vomiting, or bulimia in the patient is not predictive of affective illness in the relatives. Thus these features do not define genetic heterogeneity within anorexia nervosa. There may be genetic factors shared between anorexia nervosa and affective disorders. PMID:6496786

  20. Factors affecting nurses' intent to assess for depression in heart failure patients.

    PubMed

    Lea, Patricia

    2014-01-01

    The association between depression and cardiovascular disease has been well established and has been shown to decrease patients' quality of life and increase the risk of mortality, frequency and duration of hospitalization, and health care costs. The inpatient setting provides a potentially valuable opportunity to assess and treat depression among patients with acute cardiac illness, allowing for daily monitoring of treatment side effects. Although systematic depression screening appears to be feasible, efficient, and well accepted on inpatient cardiac units, the current lack of consistent inpatient assessment for depression in heart failure patients suggests the presence of barriers influencing the effective diagnosis and treatment of depression among inpatients with heart failure. The theory of planned behavior describes the cognitive mechanism by which behavioral intent is formed, giving some insight into how nurses' attitudes and beliefs affect their performance of routine depression screening. In addition, application of this cognitive theory suggests that nurses may be influenced to adopt more positive attitudes and beliefs about depression through educational intervention, leading to greater likelihood of routine assessment for depression, ultimately leading to more timely diagnosis and treatment and improved patient outcomes. PMID:25280199

  1. Factors affecting patient outcome in primary cutaneous aspergillosis

    PubMed Central

    Tatara, Alexander M.; Mikos, Antonios G.; Kontoyiannis, Dimitrios P.

    2016-01-01

    Abstract Primary cutaneous aspergillosis (PCA) is an uncommon infection of the skin. There is a paucity of organized literature regarding this entity in regard to patient characteristics, associated Aspergillus species, and treatment modalities on outcome (disease recurrence, disease dissemination, and mortality). We reviewed all published reports of PCA from 1967 to 2015. Cases were deemed eligible if they included the following: patient baseline characteristics (age, sex, underlying condition), evidence of proven or probable PCA, primary treatment strategy, and outcome. We identified 130 eligible cases reported from 1967 to 2015. The patients were predominantly male (63.8%) with a mean age of 30.4 ± 22.1 years. Rates of PCA recurrence, dissemination, and mortality were 10.8%, 18.5%, and 31.5%, respectively. In half of the cases, there was an association with a foreign body. Seven different Aspergillus species were reported to cause PCA. Systemic antifungal therapy without surgery was the most common form of therapy (60% of cases). Disease dissemination was more common in patients with underlying systemic conditions and occurred on average 41.4 days after PCA diagnosis (range of 3–120 days). In a multivariate linear regression model of mortality including only patients with immunosuppressive conditions, dissemination and human immunodeficiency virus/acquired immune deficiency syndrome were statistically significantly associated with increased mortality. Nearly one-third of patients with PCA die with the disease. Dissemination and host status are critical in patient outcome. PMID:27367980

  2. Improving patient flow at a family health clinic.

    PubMed

    Bard, Jonathan F; Shu, Zhichao; Morrice, Douglas J; Wang, Dongyang Ester; Poursani, Ramin; Leykum, Luci

    2016-06-01

    This paper presents an analysis of a residency primary care clinic whose majority of patients are underserved. The clinic is operated by the health system for Bexar County and staffed primarily with physicians in a three-year Family Medicine residency program at The University of Texas School of Medicine in San Antonio. The objective of the study was to obtain a better understanding of patient flow through the clinic and to investigate changes to current scheduling rules and operating procedures. Discrete event simulation was used to establish a baseline and to evaluate a variety of scenarios associated with appointment scheduling and managing early and late arrivals. The first steps in developing the model were to map the administrative and diagnostic processes and to collect time-stamped data and fit probability distributions to each. In conjunction with the initialization and validation steps, various regressions were performed to determine if any relationships existed between individual providers and patient types, length of stay, and the difference between discharge time and appointment time. The latter two statistics along with resource utilization and closing time were the primary metrics used to evaluate system performance.The results showed that up to an 8.5 % reduction in patient length of stay is achievable without noticeably affecting the other metrics by carefully adjusting appointment times. Reducing the no-show rate from its current value of 21.8 % or overbooking, however, is likely to overwhelm the system's resources and lead to excessive congestion and overtime. Another major finding was that the providers are the limiting factor in improving patient flow. With an average utilization rate above 90 % there is little prospect in shortening the total patient time in the clinic without reducing the providers' average assessment time. Finally, several suggestions are offered to ensure fairness when dealing with out-of-order arrivals. PMID:25155098

  3. Characteristics of Health Educators Desired by Inner-City Health Clinic Patients: A Case Study

    ERIC Educational Resources Information Center

    Price, James; Sidani, Jaime

    2007-01-01

    A group (n = 170) of inner-city, predominantly African American, health clinic patients were asked to identify the characteristics they desired in a new clinic health educator. A plurality (44%) of the patients perceived a bachelor's degree would be a sufficient level of education. The vast majority of patients claimed the sex of the health…

  4. Patient-centered medicine and patient-oriented research: improving health outcomes for individual patients

    PubMed Central

    2013-01-01

    Background Patient-centered medicine is developing alongside the concepts of personalized medicine and tailored therapeutics. The main objective of patient-centered medicine is to improve health outcomes of individual patients in everyday clinical practice, taking into account the patient’s objectives, preferences, values as well as the available economic resources. Discussion Patient-centered medicine implies a paradigm shift in the relationship between doctors and patients, but also requires the development of patient-oriented research. Patient-oriented research should not be based on the evaluation of medical interventions in the average patient, but on the identification of the best intervention for every individual patient, the study of heterogeneity and the assignment of greater value to observations and exceptions. The development of information-based technologies can help to close the gap between clinical research and clinical practice, a fundamental step for any advance in this field. Summary Evidence-based medicine and patient centered medicine are not contradictory but complementary movements. It is not possible to practice patient-centered medicine that is not based on evidence, nor is it possible to practice evidence-based medicine at a distance from the individual patient. PMID:23294526

  5. Patient Involvement in Health Care Decision Making: A Review

    PubMed Central

    Vahdat, Shaghayegh; Hamzehgardeshi, Leila; Hessam, Somayeh; Hamzehgardeshi, Zeinab

    2014-01-01

    Background: Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions. Objectives: Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making. Materials and Methods: To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article. Results: Based on the review of articles and books, topics were divided into six general categories: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making. Conclusions: In most studies, factors influencing patient participation consisted of: factors associated with health care professionals such as doctor-patient relationship, recognition of patient’s knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services. PMID:24719703

  6. Understanding Health Literacy and its Impact on Delivering Care to Patients with Inflammatory Bowel Disease.

    PubMed

    Tormey, Lauren K; Farraye, Francis A; Paasche-Orlow, Michael K

    2016-03-01

    Health literacy (HL) is the extent to which individuals have the capacity to obtain, process, and understand basic health information that is needed to make appropriate health decisions. As adults with inflammatory bowel disease engage in complex health decisions throughout their lives, attention is needed regarding the influence of HL on the lives of people with inflammatory bowel disease. About one-third of adults in the United States have limited HL. Limited HL is a potentially modifiable risk factor that has been associated with barriers to patient-provider communication and worse health outcomes for people with a range of chronic diseases. Gastroenterologists must recognize the role of HL in their practice. Limited HL can affect a patient's ability to understand the purpose of a screening test for colorectal cancer, understand the concept of an asymptomatic yet chronic disease, ask questions in an office visit and engage in shared decision making. Gastroenterologists must approach each patient as potentially having limited HL and use clear communication strategies in all encounters. Currently, there is a lack of training, education, and support for health care providers to meet the needs of patients with limited HL. More research is needed in inflammatory bowel disease to understand the impact of limited health literacy on health outcomes in this population and develop effective systems-based interventions to reduce the health literacy burden on patients. PMID:26595554

  7. Navigating to health: Evaluation of a community health center patient navigation program

    PubMed Central

    Wang, Monica L.; Gallivan, Leah; Lemon, Stephenie C.; Borg, Amy; Ramirez, Jose; Figueroa, Brenda; McGuire, Antonia; Rosal, Milagros C.

    2015-01-01

    Patient Navigators are trained, lay health care workers who guide patients in overcoming barriers to health care access and utilization. Little evidence exists regarding reach and impact of Patient Navigators for chronic disease management. This study evaluated a Patient Navigator program aimed at optimizing health care utilization among ethnically diverse patients with diabetes and/or hypertension at a community health center (CHC). Trained Patient Navigators contacted eligible patients who had not seen a primary care provider (PCP) for ≥ 6 months. Outcomes included number of patients reached by Patient Navigators and seen by PCPs after Patient Navigator contact. Distributions and frequencies of outcomes pre- and post-call were compared. A total of 215 patients had ≥ 1 call attempt from Patient Navigators. Of these, 74 were additionally contacted via mailed letters or at the time of a CHC visit. Among the 45 patients reached, 77.8% scheduled an appointment through the Patient Navigator. These patients had higher rates of PCP visits 6 months post-call (90%) than those not reached (42.2%) (p < 0.0001). Findings emphasize the value of direct telephone contact in patient health care re-engagement and may inform the development of future Patient Navigator programs to improve reach and effectiveness. PMID:26844134

  8. Navigating to health: Evaluation of a community health center patient navigation program.

    PubMed

    Wang, Monica L; Gallivan, Leah; Lemon, Stephenie C; Borg, Amy; Ramirez, Jose; Figueroa, Brenda; McGuire, Antonia; Rosal, Milagros C

    2015-01-01

    Patient Navigators are trained, lay health care workers who guide patients in overcoming barriers to health care access and utilization. Little evidence exists regarding reach and impact of Patient Navigators for chronic disease management. This study evaluated a Patient Navigator program aimed at optimizing health care utilization among ethnically diverse patients with diabetes and/or hypertension at a community health center (CHC). Trained Patient Navigators contacted eligible patients who had not seen a primary care provider (PCP) for ≥ 6 months. Outcomes included number of patients reached by Patient Navigators and seen by PCPs after Patient Navigator contact. Distributions and frequencies of outcomes pre- and post-call were compared. A total of 215 patients had ≥ 1 call attempt from Patient Navigators. Of these, 74 were additionally contacted via mailed letters or at the time of a CHC visit. Among the 45 patients reached, 77.8% scheduled an appointment through the Patient Navigator. These patients had higher rates of PCP visits 6 months post-call (90%) than those not reached (42.2%) (p < 0.0001). Findings emphasize the value of direct telephone contact in patient health care re-engagement and may inform the development of future Patient Navigator programs to improve reach and effectiveness. PMID:26844134

  9. Tracing patients exposed to health care workers with tuberculosis.

    PubMed Central

    Zaza, S; Beck-Sagué, C M; Jarvis, W R

    1997-01-01

    OBJECTIVES: Following an outbreak of tuberculosis (TB) among health care workers at a public hospital, the study was undertaken to (a) locate all exposed patients and administer tuberculin skin tests (TSTs) to them, (b) provide clinical treatment or prophylaxis to infected patients, and (c) ascertain the risk of M. tuberculosis transmission from health care workers to patients. METHODS: The authors identified all patients who had been hospitalized on floors where health care workers with symptomatic TB worked. The staff of the hospital's outpatient HIV/AIDS clinic notified and evaluated clinic patients who had been hospitalized on those floors. County health department personnel attempted to contact the remaining patients by letter and phone. RESULTS: The authors identified 586 patients hospitalized during the health care worker outbreak, of whom 503 were potentially susceptible. Of these, 172 (34.2%) could be contacted, and 138 (80.2%) completed tuberculin skin testing or other follow-up evaluation. Of 134 who completed testing, 28 (20.9%) had reactive TSTs. In all, 362 patients (72%) were lost to follow-up, including many HIV-positive and homeless patients, who are at high risk of developing active TB once infected with M. tuberculosis. CONCLUSIONS: The reemergence of TB as a public health threat and the emergence of other infectious diseases make it imperative to elicit accurate addresses and contact information from hospitalized patients and to develop better methods of contacting patients after hospital discharge. PMID:9071278

  10. Patient Records in the Mental Health Disciplines.

    ERIC Educational Resources Information Center

    Reynolds, John Frederick; Mair, David

    1989-01-01

    Examines reports written in mental health hospitals and community mental health centers. Analyzes a total of 150 randomly selected samples of 5 basic mental health records, and evaluates the rhetorical contexts for each with regard to author, purpose, audience and use. (KEH)

  11. Does a clerkship affect students' views of psychiatric patients?

    PubMed

    Fabrega, H

    1995-12-01

    This study deals with the views of medical students toward real psychiatric patients. The students answered seven questions about ten patients who had been interviewed by a senior faculty member. The interviews were recorded on audiovisual tapes. The questions dealt with different aspects of mental illness and included views on how laypersons would evaluate and respond to patients, what it would be like to care for the patients, and whether the patients were potentially dangerous. Answers to questions were correlated. Gender and the student's accuracy in rating psychopathology were used as independent variables to examine students' views and the possible change in these views as a result of participating in a 6-week psychiatric clerkship. The pattern of intercorrelations is reported and discussed. Negative views correlated with anticipated difficulty in caring for patients, and positive views correlated with a higher accuracy in rating psychopathology. In general, student views about mental illness were relatively impervious to the effect of a clerkship. Results are discussed in terms of prior research and knowledge about gender differences in interpersonal sensitivity. Some of the social implications of the results are discussed. PMID:8522934

  12. Mental health of patients with human immunodeficiency virus in Japan: a comparative analysis of employed and unemployed patients.

    PubMed

    Omiya, Tomoko; Yamazaki, Yoshihiko; Shimada, Megumi; Ikeda, Kazuko; Ishiuchi-Ishitani, Seiko; Tsuno, Yoko Sumikawa; Ohira, Katsumi

    2014-01-01

    In developed countries, human immunodeficiency virus (HIV) has become a chronic disease. The aims of this study were to clarify the physical, social, and psychological factors affecting Japanese HIV patients in a stable condition and to identify factors related to mental health of employed and unemployed HIV patients. The target subjects were people with HIV infection who were treated as outpatients at core hospitals for acquired immune deficiency syndrome (AIDS) treatment in Japan. A questionnaire including items from the Hospital Anxiety and Depression Scale (HADS) was sent to each medical facility with a request for participation from the HIV-infected outpatients. Responses from 1199 patients were analyzed. Mental health was reportedly better in the employed patients than in the unemployed patients. The unemployed patients were more likely to have resigned from their jobs because of poor health, to have resigned voluntarily, or to have been unfairly dismissed. Once the patients stopped working because of HIV, returning to work became difficult. In the employed patients, a good workplace environment was strongly related to lower scores on HADS. Higher HADS scores were recorded for employed patients infected with HIV for six years or more. For the unemployed patients, a relationship was observed between strong feelings of stigmatization and HADS scores. Quitting a job because of an experience related to HIV status may be related to feelings of stigmatization. PMID:24839867

  13. Group Health Education in Inpatient Rehabilitation: Patients' Role Perceptions

    ERIC Educational Resources Information Center

    Schöpf, Andrea C.; Ullrich, Antje; Nagl, Michaela; Farin, Erik

    2016-01-01

    Objective: Group health education is an important aspect of medical rehabilitation. While interaction and active involvement are important characteristics of group health education, little is known about patients' understanding of their role in this form of education. This study explored patients' understanding of their role in group health…

  14. The prisoner as patient - a health services satisfaction survey

    PubMed Central

    Bjørngaard, Johan Håkon; Rustad, Åse-Bente; Kjelsberg, Ellen

    2009-01-01

    Background There is evidence for higher morbidity among prison inmates than in the general population. Despite this, patient satisfaction with the prison health services is scarcely investigated. The aim of the present study was to investigate patient satisfaction with prison health services in Norway and to analyze possible patient and service effects. Methods The survey took part in 29 prisons in the southern and central part of Norway, representing 62% of the total prison capacity in Norway. A total of 1,150 prison inmates with prison health services experiences completed a satisfaction questionnaire (90% response rate). The patients' satisfaction was measured on a 12-item index. Multilevel analyses were used to analyze both patient and service characteristics as predictors of satisfaction. Results The study revealed high levels of dissatisfaction with prison health services. There were substantial differences between services, with between-service-variance accounting for 9% of the total variance. Satisfaction was significantly associated with a senior staff member's evaluation of the health services possessing adequate resources and the quality of drug abuse treatment. At the patient level, satisfaction was significantly associated with older age, frequent consultations and better self-perceived health. Conclusion Prison inmates' satisfaction with the health services provided are low compared with patient satisfaction measured in other health areas. The substantial differences observed between services - even when adjusting for several known factors associated with patient satisfaction - indicate a potential for quality improvement. PMID:19785736

  15. Administering the Sarcoidosis Health Questionnaire to sarcoidosis patients in Serbia

    PubMed Central

    Mihailović-Vučinić, Violeta; Gvozdenović, Branislav; Stjepanović, Mihailo; Vuković, Mira; Marković-Denić, Ljiljana; Milovanović, Aleksandar; Videnović-Ivanov, Jelica; Žugić, Vladimir; Škodrić-Trifunović, Vesna; Filipović, Snežana; Omčikus, Maja

    2016-01-01

    Objective: The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country. Methods: This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status. Results: The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate. Conclusions: The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients. PMID:27167430

  16. Behavioral Ratings of Health Professionals' Interactions with the Geriatric Patient.

    ERIC Educational Resources Information Center

    Adelson, R.; And Others

    1982-01-01

    Reports the reliability and validity of the Health Professional-Geriatric Patient Interaction Behavior Rating Code, an observational instrument that is used to quantify the interpersonal behaviors of health professionals in the care of the geriatric patient. Condensed 15 behavioral factors into 10 operationally defined behavioral categories.…

  17. Discrimination and evocation of affectively intoned speech in patients with right parietal disease.

    PubMed

    Tucker, D M; Watson, R T; Heilman, K M

    1977-10-01

    Patients with right parietal disease have disturbed comprehension of affective speech. Ability to discriminate affective speech (make same/different discriminations) and ability to repeat emotionally bland sentences with affective tones were tested in three groups of subjects--patients with right parietal dysfunction and neglect, conduction aphasics with left hemispheric lesions, and patients without intracranial disease. Patients with right parietal dysfunction performed significantly poorer than did aphasic controls on both a recognition and discrimination task. Patients with right parietal dysfunction also scored poorer on the evocative task than the nonaphasic controls. PMID:561908

  18. “So We Adapt Step by Step”: Acculturation Experiences Affecting Diabetes Management and Perceived Health for Chinese American Immigrants

    PubMed Central

    Chun, Kevin M.; Chesla, Catherine A.; Kwan, Christine M.L.

    2011-01-01

    This study examines how acculturation affects type 2 diabetes management and perceived health for Chinese American immigrants in the U.S. Acculturation experiences or cultural adaptation experiences affecting diabetes management and health were solicited from an informant group of immigrant patients and their spouses (N=40) during group, couple and individual interviews conducted in 2005 to 2008. A separate respondent group of immigrant patients and their spouses (N=19) meeting inclusion criteria reviewed and confirmed themes generated by the informant group. Using interpretive phenomenology, three key themes in patients’ and spouses’ acculturation experiences were identified: a) utilizing health care, b) maintaining family relations and roles, and c) establishing community ties and groundedness in the U.S. Acculturation experiences reflecting these themes were broad in scope and not fully captured by current self-report and proxy acculturation measures. In the current study, shifting family roles and evaluations of diabetes care and physical environment in the U.S. significantly affected diabetes management and health, yet are overlooked in acculturation and health investigations. Furthermore, the salience and impact of specific acculturation experiences respective to diabetes management and perceived health varied across participants due to individual, family, developmental, and environmental factors. In regards to salience, maintaining filial and interdependent family relations in the U.S. was of particular concern for older participants and coping with inadequate health insurance in the U.S. was especially distressing for self-described lower-middle to middle-class participants. In terms of impact, family separation and relocating to ethnically similar neighborhoods in the U.S. differentially affected diabetes management and health due to participants’ varied family relations and pre-migration family support levels and diverse cultural and linguistic

  19. Psychosocial outcome following genetic risk counselling for familial colorectal cancer. A comparison of affected patients and family members.

    PubMed

    Keller, M; Jost, R; Haunstetter, C M; Sattel, H; Schroeter, C; Bertsch, U; Cremer, F; Kienle, P; Tariverdian, M; Kloor, M; Gebert, J; Brechtel, A

    2008-11-01

    Few studies have reported prospective data on psychosocial outcomes after genetic counselling in families with suspected hereditary non-polyposis colorectal cancer (HNPCC). This prospective study examines the impact of multidisciplinary risk counselling on the psychosocial outcome of 139 affected cancer patients and 233 family members without cancer at risk for HNPCC. Participants completed questionnaires specific to HNPCC before and 8 weeks after attending the familial cancer clinic. Affected patients' levels of distress were closely related to their health status and exceeded that of unaffected individuals, as did worry regarding their relatives' risk. A significant reduction in general anxiety (Hospital Anxiety and Depression Scale), distress specific to familial CRC (Impact of Events Scale) and general cancer worry (Distress Hereditary Disorder) was demonstrated after counselling in both affected patients and unaffected individuals. Reduction in distress was more pronounced in affected patients given a high risk of HNPCC compared with those at intermediate risk. Among unaffected individuals, distress declined regardless of what clinical risk they were assigned. Their perceptions of risk and cancer-related threat declined, while confidence in effective surveillance increased. These results suggest the beneficial effects of multidisciplinary counselling even when high-risk information is conveyed. A patient's previous cancer experience is likely to contribute to clinically relevant distress (15% of those patients), indicating the need for appropriate counselling. PMID:18954412

  20. Enhancing patient experience through personalization of health services.

    PubMed

    Snowdon, Anne W; Alessi, Charles; Bassi, Harpreet; DeForge, Ryan T; Schnarr, Karin

    2015-09-01

    Patient engagement is a challenge many leaders are facing, as consumer expectations of health services demand a more personalized approach to care. This article examines consumer trends that are influencing patient engagement and empowerment relative to the use of digital technologies. Informed by consumer and population health trends that can personalize health services, three strategies leaders can engage to strengthen patient experience include placing greater focus on personal health and wellness, shifting towards personalized rather than standardized healthcare, and facilitating the democratization of healthcare information. PMID:26135292

  1. Health 2.0-Lessons Learned: Social Networking With Patients for Health Promotion.

    PubMed

    Sharma, Suparna; Kilian, Reena; Leung, Fok-Han

    2014-07-01

    The advent of social networking as a major platform for human interaction has introduced a new dimension into the physician-patient relationship, known as Health 2.0. The concept of Health 2.0 is young and evolving; so far, it has meant the use of social media by health professionals and patients to personalize health care and promote health education. Social networking sites like Facebook and Twitter offer promising platforms for health care providers to engage patients. Despite the vast potential of Health 2.0, usage by health providers remains relatively low. Using a pilot study as an example, this commentary reviews the ways in which physicians can effectively harness the power of social networking to meaningfully engage their patients in primary prevention. PMID:24522931

  2. Evaluating health interest profiles extracted from patient-generated data.

    PubMed

    Hartzler, Andrea L; McDonald, David W; Park, Albert; Huh, Jina; Weaver, Charles; Pratt, Wanda

    2014-01-01

    Patient-generated health data (PGHD) offers a promising resource for shaping patient care, self-management, population health, and health policy. Although emerging technologies bolster opportunities to extract PGHD and profile the needs and experiences of patients, few efforts examine the validity and use of such profiles from the patient's perspective. To address this gap, we explore health interest profiles built automatically from online community posts. Through a user evaluation with community members, we found that extracted profiles not only align with members' stated health interests, but also expand upon those manually entered interests with little user effort. Community members express positive attitudes toward the use and expansion of profiles to connect with peers for support. Despite this promising approach, findings also point to improvements required of biomedical text processing tools to effectively process PGHD. Findings demonstrate opportunities to leverage the wealth of unstructured PGHD available in emerging technologies that patients regularly use. PMID:25954368

  3. Characteristics of Active Tuberculosis Patients Requiring Intensive Care Monitoring and Factors Affecting Mortality

    PubMed Central

    Levent, Dalar; Emel, Eryüksel; Pelin, Uysal; Turkay, Akbaş; Aybüke, Kekeçoğlu

    2016-01-01

    Background One to three percent of cases of acute tuberculosis (TB) require monitoring in the intensive care unit (ICU). The purpose of this study is to establish and determine the mortality rate and discuss the causes of high mortality in these cases, and to evaluate the clinical and laboratory findings of TB patients admitted to the pulmonary ICU. Methods The data of patients admitted to the ICU of Yedikule Chest Diseases and Chest Surgery Education and Research Hospital due to active TB were retrospectively evaluated. Demographic characteristics, medical history, and clinical and laboratory findings were evaluated. Results Thirty-five TB patients (27 males) with a median age of 47 years were included, of whom 20 died within 30 days (57%). The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were significantly higher, and albumin and PaO2/FIO2 levels were significantly lower, and shock, multiple organ failure, the need for invasive mechanical ventilation and drug resistance were more common in the patients who died. The mortality risk was 7.58 times higher in the patients requiring invasive mechanical ventilation. The SOFA score alone was a significant risk factor affecting survival. Conclusion The survival rate is low in cases of tuberculosis treated in an ICU. The predictors of mortality include the requirement of invasive mechanical ventilation and multiple organ failure. Another factor specific to TB patients is the presence of drug resistance, which should be taken seriously in countries where there is a high incidence of the disease. Finding new variables that can be established with new prospective studies may help to decrease the high mortality rate. PMID:27433176

  4. Patient Activation and Mental Health Care Experiences Among Women Veterans.

    PubMed

    Kimerling, Rachel; Pavao, Joanne; Wong, Ava

    2016-07-01

    We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose-response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-only groups as often as desired). Results add to the growing literature documenting better health care experiences among more activated patients, and suggest that patient activation may play an important role in promoting engagement with mental health care. PMID:25917224

  5. Patient Activation and Mental Health Care Experiences Among Women Veterans

    PubMed Central

    Pavao, Joanne; Wong, Ava

    2016-01-01

    We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose–response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-only groups as often as desired). Results add to the growing literature documenting better health care experiences among more activated patients, and suggest that patient activation may play an important role in promoting engagement with mental health care. PMID:25917224

  6. Patient-Centered Care and Population Health: Establishing Their Role in the Orthopaedic Practice.

    PubMed

    Harwood, Jared L; Butler, Craig A; Page, Alexandra E

    2016-05-18

    As health care increasingly emphasizes high value, the terms "population health" and "patient-centered care" have become common, but their application is less clear. Patient-centered care encourages using data to optimize care for an individual. Population health offers a framework to consider how to efficiently and effectively manage a condition for a population, how prevention affects large groups, and the specific distribution of a given disorder. Integrating both concepts into practice can facilitate required outcome-measure reporting and potentially improve patient outcomes. Clinical practice guidelines and appropriate use criteria are examples of reconciliation of these topics. By embracing attempts to decrease variation in treating musculoskeletal disorders while personalizing delivery to individual patients, surgeons may benefit from the improvement of both efficiency and patient experience. PMID:27194502

  7. [Health Literacy and patient education in medical rehabilitation].

    PubMed

    Bitzer, Eva Maria; Spörhase, U

    2015-09-01

    Medical rehabilitation in Germany has a long tradition. It is covered by the statutory sickness funds and pension schemes, and is aimed at the prevention of work disability and need for nursing care due to chronic conditions. Chronically ill but health-literate patients - patients capable of making good health-related decisions, or of participating strongly in this decision making - have better health outcomes. To enhance health literacy and participation, medical rehabilitation relies heavily on patient education. This article describes health literacy from the perspective of educational research, outlines the basics of learning principles, and draws conclusions for developing patient education programmes in medical rehabilitation. Implementing a constructivist learning paradigm promotes changes within the trainer team and within the rehabilitation institution - turning it into a health-literate health care organisation. Health literacy in medical rehabilitation is aimed at neither turning the patient into a physician nor replacing evidence-based recommendations through subjective preferences. Medical rehabilitation reaches patients best by using modern health education programmes based on findings from education research, theoretically founded and directed towards building competencies. Furthermore, an educationally qualified training team and a rehabilitation institution are essential in enabling formal and informal learning processes. PMID:26153473

  8. Do patients with mild cognitive impairment understand numerical health information?

    PubMed

    Pertl, Marie-Theres; Benke, Thomas; Zamarian, Laura; Martini, Caroline; Bodner, Thomas; Karner, Elfriede; Delazer, Margarete

    2014-01-01

    Patients with mild cognitive impairment (MCI) are by definition still autonomous in daily life and therefore make their own decisions, for example, concerning their own or their partners' health care. Health care information typically contains complex mathematical constructs like proportions, probabilities, and survival rates. The purpose of this study was to investigate whether patients with MCI have difficulties with understanding health numeracy questions and to explore the impact of declining cognitive functions. The performance of 25 patients with MCI in a health numeracy questionnaire was compared with the performance of a control sample including 164 healthy older adults, matched in age and educational level. Participants were asked to convert percentages, assess different probabilities, or understand the dosage of a short patient information leaflet. Additionally, neuropsychological background tests were administered. Patients with MCI answered fewer items correctly than controls in the health numeracy questionnaire. A correlation analysis showed statistically significant associations between performance in the health numeracy task and mental arithmetic, executive functions (psychomotor speed, conceptualization), and global cognitive status, respectively. Patients with MCI show problems in understanding numerical information concerning health care. Since patients with MCI are confronted with several health care decisions, special attention has to be paid to presenting information in an easily understandable way, to make additional sources of information available, and to provide adequate support. PMID:24473188

  9. Interventions to Improve Care for Patients with Limited Health Literacy

    PubMed Central

    Sudore, Rebecca L.; Schillinger, Dean

    2009-01-01

    Objective To propose a framework and describe best practices for improving care for patients with limited health literacy (LHL). Methods Review of the literature. Results Approximately half of the U.S. adult population has LHL. Because LHL is associated with poor health outcomes and contributes to health disparities, the adoption of evidence-based best practices is imperative. Feasible interventions at the clinician-patient level (eg, patient-centered communication, clear communication techniques, teach-to-goal methods, and reinforcement), at the system-patient level (eg, clear health education materials, visual aids, clear medication labeling, self-management support programs, and shame-free clinical environments), and at the community-patient level (eg, adult education referrals, lay health educators, and harnessing the mass media) can improve health outcomes for patients with LHL. Conclusion Because LHL is prevalent, and because the recommended communication strategies can benefit patients of all literacy levels, clinicians, health system planners, and health policy leaders should promote the uptake of these strategies into routine care. PMID:20046798

  10. High-quality Health Information Provision for Stroke Patients

    PubMed Central

    Du, Hong-Sheng; Ma, Jing-Jian; Li, Mu

    2016-01-01

    Objective: High-quality information provision can allow stroke patients to effectively participate in healthcare decision-making, better manage the stroke, and make a good recovery. In this study, we reviewed information needs of stroke patients, methods for providing information to patients, and considerations needed by the information providers. Data Sources: The literature concerning or including information provision for patients with stroke in English was collected from PubMed published from 1990 to 2015. Study Selection: We included all the relevant articles on information provision for stroke patients in English, with no limitation of study design. Results: Stroke is a major public health concern worldwide. High-quality and effective health information provision plays an essential role in helping patients to actively take part in decision-making and healthcare, and empowering them to effectively self-manage their long-standing chronic conditions. Different methods for providing information to patients have their relative merits and suitability, and as a result, the effective strategies taken by health professionals may include providing high-quality information, meeting patients’ individual needs, using suitable methods in providing information, and maintaining active involvement of patients. Conclusions: It is suggested that to enable stroke patients to access high-quality health information, greater efforts need to be made to ensure patients to receive accurate and current evidence-based information which meets their individual needs. Health professionals should use suitable information delivery methods, and actively involve stroke patients in information provision. PMID:27569241

  11. How Do Health Policies Affect My Health?: A Performance Task for High School

    ERIC Educational Resources Information Center

    Wycoff-Horn, Marcie R.; Caravella, Tracy J.

    2011-01-01

    It is well known that chronic diseases are the most common, costly, and preventable of all health issues in the United States. Chronic diseases continue to be a major health concern. Of the top 10 leading causes of mortality, 7 are identified as chronic. More recently, the prevalence of these chronic conditions has increased among the adolescent…

  12. Health identities: from expert patient to resisting consumer.

    PubMed

    Fox, Nick; Ward, Katie

    2006-10-01

    This article explores the formation of 'health identities': embodied subjectivities that emerge out of complex psychosocial contexts of reflexive modernity, in relation to data on health and illness practices among groups of people and patients using medical technologies including weight-loss drugs and the erectile dysfunction drug sildenafil (Viagra). We examine a range of health identities, from the 'expert patient'--a person who broadly adopts a biomedical model of health and illness, to a 'resisting consumer', who fabricates a health identity around lay experiential models of health and the body. The understanding of health identities is developed within a theoretical framework drawing on previous work on body/self and the work of Deleuze and Guattari. It is concluded that the constellation of health identities reflects the diversity of relations in an industrialized, technology-driven, consumer-oriented and media-saturated society. PMID:16973681

  13. 77 FR 11120 - Patient Safety Organizations: Voluntary Relinquishment From UAB Health System Patient Safety...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-24

    ... analyze confidential information regarding the quality and safety of health care delivery. The Patient... mission and primary activity is to conduct activities to improve patient safety and the quality of health... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  14. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Child Health Patient Safety...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-17

    ... confidential information regarding the quality and safety of health care delivery. The Patient Safety and... conduct activities to improve patient safety and the quality of health care delivery. HHS issued the... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  15. Patient neglect in 21st century health-care institutions: a community health psychology perspective.

    PubMed

    Reader, Tom W; Gillespie, Alex; Mannell, Jenevieve

    2014-01-01

    Despite the technological and organisational advances of 21st century health-care systems, care scandals and burgeoning complaints from patients have raised concerns about patient neglect in hospitals. This article reviews the concept of patient neglect and the role of community health psychology in understanding its occurrence. Patient neglect has previously been conceptualised as a problem associated with hospital staff attitudes and behaviours, with regulation and training cited as solutions. Yet, a community health psychology perspective shows that the wider symbolic, material and relational aspects of care are crucial for understanding why patient neglect occurs and for outlining new solutions to augment existing interventions. PMID:24058107

  16. Similarities and differences between asthma health care professional and patient views regarding medication adherence

    PubMed Central

    Peláez, Sandra; Bacon, Simon L; Aulls, Mark W; Lacoste, Guillaume; Lavoie, Kim L

    2014-01-01

    BACKGROUND: The recent literature has reported disparate views between patients and health care professionals regarding the roles of various factors affecting medication adherence. OBJECTIVE: To examine the perspectives of asthma patients, physicians and allied health professionals regarding adherence to asthma medication. METHODOLOGY: A qualitative, multiple, collective case study design with six focus-group interviews including 38 participants (13 asthma patients, 13 pulmonologist physicians and 12 allied health professionals involved in treating asthma patients) was conducted. RESULTS: Patients, physicians and allied health professionals understood adherence to be an active process. In addition, all participants believed they had a role in treatment adherence, and agreed that the cost of medication was high and that access to the health care system was restricted. Major disagreements regarding patient-related barriers to medication adherence were identified among the groups. For example, all groups referred to side effects; however, while patients expressed their legitimate concerns, health care professionals believed that patients’ opinions of medication side effects were based on inadequate perceptions. CONCLUSION: Differences regarding medication adherence and barriers to adherence among the groups examined in the present study will provide insight into how disagreements may be translated to overcome barriers to optimal asthma adherence. Furthermore, when designing an intervention to enhance medication adherence, it is important to acknowledge that perceptual gaps exist and must be addressed. PMID:24712015

  17. Change in patient affect/defense ratio from early to late sessions in brief psychotherapy.

    PubMed

    Taurke, E A; Flegenheimer, W; McCullough, L; Winston, A; Pollack, J; Trujillo, M

    1990-09-01

    The current study examined changes in the ratio of patients' affective and defensive behaviors during the course of brief psychodynamic psychotherapy. Treatments of 16 patients were videotaped. For each patient, four sessions were evaluated with a minute-by-minute coding system of process variables. When patients were grouped according to outcome scores, significant differences between the high outcome and the average-to-low outcome groups emerged. During the early phase of treatment, patients in both groups showed an average of one affective response per five defensive responses. By the late phase of treatment, the high outcome patients showed a marked shift to one affective response per two defensive responses, while the low outcome patients remained the same. An incidental finding was a negative correlation between good outcome and the ratio of defensive behavior to total patient activity. PMID:2246376

  18. The Nurse's Role in Health Literacy of Patients With Cancer.

    PubMed

    Ballard, Deborah; Hill, Jill

    2016-06-01

    Patients with cancer are often faced with complex diagnoses that require decision making in a highly stressful environment. The role of the healthcare team is to ensure that patients have the information, tools, and resources needed to make informed decisions. However, low health literacy is a common and undervalued factor in the outcomes of patients, particularly those with cancer. PMID:27206288

  19. Communication and Information Barriers to Health Assistance for Deaf Patients

    ERIC Educational Resources Information Center

    Pereira, Patricia Cristina Andrade; Fortes, Paulo Antonio de Carvalho

    2010-01-01

    In Brazil, recent regulations require changes in private and public health systems to make special services available to deaf patients. In the present article, the researchers analyze the perceptions of 25 sign language-using patients regarding this assistance. The researchers found communication difficulties between these patients and health…

  20. Physician, Patient and Contextual Factors Affecting Treatment Decisions in Older Adults with Cancer: A Literature Review

    PubMed Central

    Tariman, J. D.; Berry, D. L.; Cochrane, B.; Doorenbos, A.; Schepp, K.

    2010-01-01

    Purpose/Objectives To review physician, patient, and contextual factors that affect treatment decision-making in older adults diagnosed with cancer and relate these factors to theoretical models of decision-making. Data Sources PubMed (1966-April 2010), PsycINFO (1967-April 2010) and CINAHL (1982-April 2010) databases were searched to access relevant medical, psychological and nursing literature. Data Synthesis Physician factors in treatment decisions include physician personal beliefs and values, expertise, practice type, perception of lowered life expectancy, medical factors, power, and communication style. Patient factors include personal beliefs and values, ethnicity, decisional control preferences, previous health-related experience, perception of the decision-making process, and personal factors. Contextual factors include availability of caregiver, lack of insurance, poor financial status, and geographical barrier. The interplay of physician, patient, and contextual factors are not well understood. Existing models of decision-making are not sufficient to explicate TDM process in older adults diagnosed with cancer. Conclusions Clinical studies in older adult patient population using a longitudinal and prospective design are needed to examine real-time interplay of patient, physician, and contextual factors and to better understand how these divergent factors influenced actual treatment decisions. Implications for Nursing Oncology nurses can advocate for a patient’s autonomy during TDM by coaching them to seek evidence-based discussion of various treatment options, benefits and risks assessments, and truthful discussion of the probability of success for each treatment option from their physicians. Oncology nurses must promote an informed treatment decisions that are consistent with a patient’s personal preference and values within the limits of the patient’s personal contexts. PMID:22201670

  1. Tufted hair folliculitis in a patient affected by pachydermoperiostosis: case report and videodermoscopic features.

    PubMed

    Baroni, Adone; Romano, Francesca

    2011-01-01

    A 25-year-old man presented with Touraine-Solente-Golé syndrome (primary pachydermoperiostosis), with an area of inflammatory dermatosis (12-month evolution) of the scalp at the cranial vertex. The patient presented with arthropathy, clubbing of the digits, diffuse periostosis, pachydermia of the hands and feet, and periosteal hyperostosis of the knee. Facial seborrhea and sebaceous gland hyperplasia were evident (Figure 1A and 1B and Figure 2A and 2B). Examination of the scalp revealed an erythematous pruritic plaque with erosions, crusts, and pustules, on which multiple tufts of 10 to 20 normal-looking hairs emerged from single follicular openings (Figure 3A). Slight pressure on the perifollicular areas resulted in the discharge of purulent material through the dilated follicular openings. Cervical and occipital lymph nodes were not enlarged, and the patient was in generally good health. Routine laboratory findings were normal. Immunologic studies, including a screening for antinuclear antibody, complement, and immunoglobulins, were normal. Both potassium hydroxide staining and fungal culture were negative. Bacteriologic culture of purulent material taken from the affected area was positive for Staphylococcus aureus. Videodermoscopy of the lesion showed rarefied interfollicular twisted red loops centered around actively affected follicles and white dots with absence of normal vascular pattern (Figure 3B). These dermoscopy patterns are markers for folliculitis decalvans, of which tufted hair folliculitis (THF) is a clinical variant. Histologic examination showed hair plugging, a dense perifollicular infiltrate of plasma cells, lymphocytes, neutrophils, and large areas of scarring and fibrosis, which would confirm suspected THE THF was diagnosed on the grounds of clinical, microbiologic, histologic, and videodermoscopy data. The patient was treated with amoxicillin 875 mg plus clavulanic acid 125 mg twice daily and topical nadifloxacin 1% twice daily for 20 days

  2. The new role of patients in future health settings.

    PubMed

    Ruotsalainen, Pekka; Blobel, Bernd

    2015-01-01

    Health is wide concept covering a person's physical, mental and social well-being. Traditionally, regulated healthcare has been the main source for curative and preventive service offered to patients. Healthcare is in transition, however. Paradigms such as patient empowerment and patient in the centre as well as in-home care service are changing processes and locations healthcare services are offered. Parallel to healthcare, new service models such as pHealth, ubiquitous healthcare, and digital medicine are developing. In the near future, technology enables the creation of a personal digital health dossier (e.g. digital patient and virtual patient model) for any individual. This dossier is stored and used in the unsecure information space. This all means that the traditional paternalistic patient model where patient is a passive object for regulated healthcare services will not work in future pHealth and digital health anymore. Instead, the new patient role (e.g. pHealth user or health consumer role) is dynamic, context-aware and participatory. The pHealth user can also have many roles at the same time, such as the role of informed chooser, decision maker, and personal health coordinator. This requires that the pHealth user can make information-based meaningful decisions before starting to use health services, and that he or she can trust on service providers by having evidence-based and reliable information about the quality and health impact of the services offered. A big challenge is that pHealth and digital health take place in unsecure information space where current healthcare specific laws, regulations, and medical ethics are insufficient to guarantee users' autonomy and privacy as well as the application of fair information and ethical principles when processing personal health information. A new ethical, legal and technical framework is needed. One of the prerequisites successful pHealth and digital health has to meet is the possibility to create

  3. Impairment in cognitive and affective empathy in patients with brain lesions: anatomical and cognitive correlates.

    PubMed

    Shamay-Tsoory, S G; Tomer, R; Goldsher, D; Berger, B D; Aharon-Peretz, J

    2004-11-01

    The present study was designed to examine the degree of impairment in cognitive and affective empathy among patients with focal brain lesions, and the contribution of specific cognitive abilities (such as cognitive flexibility and processing of emotional information), to empathy. The cognitive and affective empathic response of patients with localized prefrontal lesions (n=36) was compared to responses of patients with parietal lesions (n=15) and healthy control subjects (n=19). Results indicate that patients with prefrontal lesions (especially those with lesions involving the orbitoprefrontal and medial regions) were significantly impaired in both cognitive and affective empathy as compared to parietal patients and healthy controls. When the damage was restricted to the prefrontal cortex, either left- or right-hemisphere lesions resulted in impaired empathy. However, when the lesion involved the right hemisphere, patients with parietal lesions were also impaired. The pattern of relationships between cognitive performance and empathy suggested dissociation between the cognitive correlates of affective and cognitive empathy. PMID:15590464

  4. Infobutton usage in Patient Portal MyHealth

    PubMed Central

    Long, Jie; Hulse, Nathan C.; Tao, Cui

    2015-01-01

    Infobuttons have proven to be an important element in modern electronic health records (EHR), providing educational materials to both providers and patients. However, the usage of infobuttons in personalized health records (PHR) is only lightly documented in the literature. Patient-facing infobuttons pose a new challenge because patients have different questions and educational levels than professional users in EHRs. In this paper, we present usage data for patient-facing infobuttons that have recently been integrated in Intermountain Healthcare’s patient portal MyHealth. We summarize use patterns by usage classified in modules, electronic resources (eResource), and infobutton sessions. Based on the analysis, we propose further enhancements to the current implementation of infobuttons in MyHealth. PMID:26306251

  5. Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

    PubMed Central

    Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

    2012-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools – accountability measures and payment designs – to improve access to and quality of care for patients with behavioral health needs. PMID:23188486

  6. Development of the Patient Activation Measure for mental health.

    PubMed

    Green, Carla A; Perrin, Nancy A; Polen, Michael R; Leo, Michael C; Hibbard, Judith H; Tusler, Martin

    2010-07-01

    Our objective was to adapt the physical health Patient Activation Measure (PAM) for use among people with mental health conditions (PAM-MH). Data came from three studies among people with chronic mental health conditions and were combined in Rasch analyses. The PAM-MH's psychometric properties equal those of the original 13-item PAM. Test-retest reliability and concurrent validity were good, and the PAM-MH showed sensitivity to change. The PAM-MH appears to be a reliable and valid measure of patient activation among individuals with mental health problems. It appears to have potential for use in assessing change in activation. PMID:19728074

  7. Patient engagement and the design of digital health

    PubMed Central

    Birnbaum, Faith; Lewis, Dana M.; Rosen, Rochelle; Ranney, Megan L.

    2015-01-01

    Digital health is an area of growing interest for physicians, patients, and technology companies alike. It promises the ability to engage patients in their care, before, during, and after an emergency department visit. Current efforts to create, study, and disseminate digital health have been limited by lack of user engagement. In this commentary, we outline the imperative for engaging end-users in each phase of digital health design, as well as a few techniques to facilitate better digital health design and implementation. PMID:25997375

  8. Creating a Patient-Centered Health Care Delivery System: A Systematic Review of Health Care Quality From the Patient Perspective.

    PubMed

    Mohammed, Khaled; Nolan, Margaret B; Rajjo, Tamim; Shah, Nilay D; Prokop, Larry J; Varkey, Prathibha; Murad, Mohammad H

    2016-01-01

    Patient experience is one of key domains of value-based purchasing that can serve as a measure of quality and be used to improve the delivery of health services. The aims of this study are to explore patient perceptions of quality of health care and to understand how perceptions may differ by settings and condition. A systematic review of multiple databases was conducted for studies targeting patient perceptions of quality of care. Two reviewers screened and extracted data independently. Data synthesis was performed following a meta-narrative approach. A total of 36 studies were included that identified 10 quality dimensions perceived by patients: communication, access, shared decision making, provider knowledge and skills, physical environment, patient education, electronic medical record, pain control, discharge process, and preventive services. These dimensions can be used in planning and evaluating health care delivery. Future research should evaluate the effect of interventions targeting patient experience on patient outcomes. PMID:25082873

  9. Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions

    PubMed Central

    Lam, Chun Nok; Arora, Sanjay; Menchine, Michael

    2016-01-01

    Introduction Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED) as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This study assessed the impact of homelessness on 30-day ED revisits and hospital readmissions among patients presenting with mental health conditions in an urban, safety-net hospital. Methods We conducted a secondary analysis of administrative data on all adult ED visits in 2012 in an urban safety-net hospital. Patient demographics, mental health status, homelessness, insurance coverage, level of acuity, and ED disposition per ED visit were analyzed using multilevel modeling to control for multiple visits nested within patients. We performed multivariate logistic regressions to evaluate if homelessness moderated the likelihood of mental health patients’ 30-day ED revisits and hospital readmissions. Results Study included 139,414 adult ED visits from 92,307 unique patients (43.5±15.1 years, 51.3% male, 68.2% Hispanic/Latino). Nearly 8% of patients presented with mental health conditions, while 4.6% were homeless at any time during the study period. Among patients with mental health conditions, being homeless contributed to an additional 28.0% increase in likelihood (4.28 to 5.48 odds) of 30-day ED revisits and 38.2% increase in likelihood (2.04 to 2.82 odds) of hospital readmission, compared to non-homeless, non-mental health (NHNM) patients as the base category. Adjusted predicted probabilities showed that homeless patients presenting with mental health conditions have a 31.1% chance of returning to the ED within 30-day post discharge and a 3.7% chance of hospital

  10. Oral health of patients with severe rheumatic heart disease.

    PubMed

    Maharaj, Breminand; Vayej, Ahmed C

    2012-07-01

    In order to determine whether adequate attention is paid to the maintenance of good oral health in patients at risk of developing infective endocarditis, we studied 44 black patients with severe rheumatic heart disease before they had cardiac surgery. Plaque and gingival index scores were calculated and panoramic radiographs were done in all patients. There were 17 males and 27 females (mean age: 30.6 years). The plaque and gingival index scores were classified as poor in 31.8 and 54.6% of patients, respectively. Panoramic radiographic findings included caries in 56.8% of patients, peri-apical pathology in 18.1% and retained roots in 22.7% of patients. This study demonstrates that inadequate attention is paid to the maintenance of good oral health in patients with severe rheumatic heart disease. The oral and dental care of patients at risk of developing infective endocarditis needs to be improved. PMID:22836156

  11. Ensuring optimal health care for LGBT patients.

    PubMed

    Glasper, Alan

    2016-07-14

    Emeritus Professor Alan Glasper, from the University of Southampton, discusses a Royal College of Nursing policy that highlights the complexities of providing high-quality and non-discriminatory health care. PMID:27409790

  12. The Ratio between Positive and Negative Affect and Flourishing Mental Health across Adulthood

    PubMed Central

    Diehl, Manfred; Hay, Elizabeth L.; Berg, Kathleen M.

    2011-01-01

    Using data from a 30-day diary study with 239 adults (81 young, 81 middle-aged, and 77 older adults) this study examined whether a specific ratio between positive and negative affect distinguished individuals with different mental health status and especially flourishing from non-flourishing individuals. In addition, the study addressed whether there were age differences in the positivity ratio when daily affect data were used, and whether the proposed critical positivity ratio of 2.9 discriminated equally well between individuals with different mental health status across the adult lifespan. Findings showed that the ratio of positive to negative affect differed across adulthood such that age was associated with an increasing preponderance of positive to negative affect. The positivity ratio was also associated with mental health status in the hypothesized direction; higher positivity ratios were associated with better mental health. Finally, although the data supported the notion of a positivity ratio of 2.9 as a “critical value” in young adulthood, this value did not equally well discriminate the mental health status of middle-aged and older adults. PMID:21562989

  13. The ratio between positive and negative affect and flourishing mental health across adulthood.

    PubMed

    Diehl, Manfred; Hay, Elizabeth L; Berg, Kathleen M

    2011-09-01

    Using data from a 30-day diary study with 239 adults (81 young, 81 middle-aged, and 77 older adults), this study examined whether a specific ratio between positive and negative affect distinguished individuals with different mental health status and especially flourishing from non-flourishing individuals. In addition, the study addressed whether there were age differences in the positivity ratio when daily affect data were used, and whether the proposed critical positivity ratio of 2.9 discriminated equally well between individuals with different mental health status across the adult lifespan. Findings showed that the ratio of positive to negative affect differed across adulthood such that age was associated with an increasing preponderance of positive to negative affect. The positivity ratio was also associated with mental health status in the hypothesized direction; higher positivity ratios were associated with better mental health. Finally, although the data supported the notion of a positivity ratio of 2.9 as a 'critical value' in young adulthood, this value did not equally well discriminate the mental health status of middle-aged and older adults. PMID:21562989

  14. Health Literacy, Education Levels, and Patient Portal Usage During Hospitalizations

    PubMed Central

    Davis, Sharon E.; Osborn, Chandra Y.; Kripalani, Sunil; Goggins, Kathryn M.; Jackson, Gretchen Purcell

    2015-01-01

    Patient portal adoption has rapidly increased, and portal usage has been associated with patients’ sociodemographics, health literacy, and education. Research on patient portals has primarily focused on the outpatient setting. We explored whether health literacy and education were associated with portal usage in an inpatient population. Among 60,159 admissions in 2012–2013, 23.3% of patients reported limited health literacy; 50.4% reported some post-secondary education; 34.4% were registered for the portal; and 23.4% of registered patients used the portal during hospitalization. Probability of registration and inpatient portal use increased with educational attainment. Health literacy was associated with registration but not inpatient use. Among admissions with inpatient use, educational attainment was associated with viewing health record data, and health literacy was associated use of appointment and health education tools. The inpatient setting may provide an opportunity to overcome barriers to patient portal adoption and reduce disparities in use of health information technologies. PMID:26958286

  15. Measurement of cancer health literacy and identification of patients with limited cancer health literacy.

    PubMed

    Dumenci, Levent; Matsuyama, Robin; Riddle, Daniel L; Cartwright, Laura A; Perera, Robert A; Chung, Harold; Siminoff, Laura A

    2014-01-01

    Health literacy is related to a broad range of health outcomes. This study was designed to develop a psychometrically sound instrument designed to measure cancer health literacy along a continuum (CHLT-30), to develop another instrument designed to determine whether a patient has limited cancer health literacy (CHLT-6), and to estimate the prevalence of limited cancer health literacy. The Cancer Health Literacy Study involving 1,306 Black and White cancer patients was conducted between April 2011 and April 2013 in the Virginia Commonwealth University Massey Cancer Center and surrounding oncology clinics. A continuous latent variable modeling framework was adopted to dimensionally represent cancer health literacy, whereas discrete latent variable modeling was used to estimate the prevalence rates of limited cancer health literacy. Self confidence about engaging in health decisions was used as the primary outcome in external validation of new instruments. Results from a comprehensive analysis strongly supported the construct validity and reliability of the CHLT-30 and CHLT-6. For both instruments, measurement invariance tests ruled out item/test bias to explain gender and race/ethnicity differences in test scores. The limited cancer health literacy rate was 18%, a subpopulation consisting of overrepresented Black, undereducated, and low-income cancer patients. Overall, the results supported the conclusion that the CHLT-30 accurately measures cancer health literacy along a continuum and that the CHLT-6 efficiently identifies patients with limited cancer health literacy with high accuracy. PMID:25315594

  16. Socio-Economic and Health Status of Leprosy Affected Person: A Study in Jharkhand.

    PubMed

    Majumder, N

    2015-01-01

    The study has been conducted in the Potka Block of East Singhbhum district of the state of Jharkhand. The district is mainly dominated by indigenous tribes, such as, Santhal, Munda, Ho, Bhumiz, Kharia, and Sabar. The unit of analysis of the study was an individual. The objectives were to: a) Understand the socio-economic and health status of LAP, b) Know the health seeking behavior and problems faced by the LAP, c) Assess the utilization of the programs related to Leprosy eradication in the study area and d), Suggest various measures for improving the socio-economic and health status of LAP. Fifty Leprosy affected persons (LAP) from the Potka block; comprising of 20% of LAP of that area have been selected as the study sample by using the method of Multi-Stage Random Sampling, with equal representation of men and women. The LAPs included leprosy patients, leprosy treated people and their family members. 39/50 (78%) of the respondents are illiterates and only 3/11 (6%) among the literate population have crossed matriculation and above. This seems to have resulted in the respondent's low level of awareness about the disease, resulting in delayed treatment. 14/25 (56%) percent of female and 13/25 (52%) of male respondents are considered untouchable by their natal families, thus forced to stay in congested leprosy colonies resulting in other social and health related issues. It was observed that leprosy cured children,and also children of LAP are being denied admission iany school, due to the social stigma attached to it. 27/50 (54%)of leprosy patients and leprosy cured people (mostly with visible deformities) were found to practice begging as their sole means of livelihood. Many LAPs are also engaged in cultivation and small scale business particularly among the rural population. An amount of gender disparity was also observed in the employment pattern among the LAPs. Among the, respondents 15/25 (60%) of the females are beggars as compared to 12/25 (48%) of the male

  17. The mental health of children affected by armed conflict: Protective processes and pathways to resilience

    PubMed Central

    Betancourt, Theresa Stichick; Khan, Kashif Tanveer

    2008-01-01

    This paper examines the concept of resilience in the context of children affected by armed conflict. Resilience has been frequently viewed as a unique quality of certain ‘invulnerable’ children. In contrast, this paper argues that a number of protective processes contribute to resilient mental health outcomes in children when considered through the lens of the child's social ecology. While available research has made important contributions to understanding risk factors for negative mental health consequences of war-related violence and loss, the focus on trauma alone has resulted in inadequate attention to factors associated with resilient mental health outcomes. This paper presents key studies in the literature that address the interplay between risk and protective processes in the mental health of war-affected children from an ecological, developmental perspective. It suggests that further research on war-affected children should pay particular attention to coping and meaning making at the individual level; the role of attachment relationships, caregiver health, resources and connection in the family, and social support available in peer and extended social networks. Cultural and community influences such as attitudes towards mental health and healing as well as the meaning given to the experience of war itself are also important aspects of the larger social ecology. PMID:18569183

  18. The mental health of children affected by armed conflict: protective processes and pathways to resilience.

    PubMed

    Betancourt, Theresa Stichick; Khan, Kashif Tanveer

    2008-06-01

    This paper examines the concept of resilience in the context of children affected by armed conflict. Resilience has been frequently viewed as a unique quality of certain 'invulnerable' children. In contrast, this paper argues that a number of protective processes contribute to resilient mental health outcomes in children when considered through the lens of the child's social ecology. While available research has made important contributions to understanding risk factors for negative mental health consequences of war-related violence and loss, the focus on trauma alone has resulted in inadequate attention to factors associated with resilient mental health outcomes. This paper presents key studies in the literature that address the interplay between risk and protective processes in the mental health of war-affected children from an ecological, developmental perspective. It suggests that further research on war-affected children should pay particular attention to coping and meaning making at the individual level; the role of attachment relationships, caregiver health, resources and connection in the family, and social support available in peer and extended social networks. Cultural and community influences such as attitudes towards mental health and healing as well as the meaning given to the experience of war itself are also important aspects of the larger social ecology. PMID:18569183

  19. Using eHealth to improve health literacy among the patient population.

    PubMed

    Landry, Kathryn E

    2015-01-01

    There is no denying the global influence of eHealth, in its various forms, on the health care system in the 21st Century. Health care professionals are often familiar with technological tools used to enhance health outcomes by assisting clinicians in meeting the needs of the patient population. In an age of social media, web-based information, and material available literally in an instant, it is crucial for nurses to use and proactively share their knowledge regarding accessing and finding credible sources of online health information with the patient population. By improving health literacy among consumers, self-sufficiency and competence can be developed and promoted to improve health outcomes, placing the patient in a participatory starring role of managing and improving his or her overall well-being. PMID:25842526

  20. Mental Health Nursing, Mechanical Restraint Measures and Patients' Legal Rights.

    PubMed

    Birkeland, Soren; Gildberg, Frederik A

    2016-01-01

    Coercive mechanical restraint (MR) in psychiatry constitutes the perhaps most extensive exception from the common health law requirement for involving patients in health care decisions and achieving their informed consent prior to treatment. Coercive measures and particularly MR seriously collide with patient autonomy principles, pose a particular challenge to psychiatric patients' legal rights, and put intensified demands on health professional performance. Legal rights principles require rationale for coercive measure use be thoroughly considered and rigorously documented. This article presents an in-principle Danish Psychiatric Complaint Board decision concerning MR use initiated by untrained staff. The case illustrates that, judicially, weight must be put on the patient perspective on course of happenings and especially when health professional documentation is scant, patients' rights call for taking notice of patient evaluations. Consequently, if it comes out that psychiatric staff failed to pay appropriate consideration for the patient's mental state, perspective, and expressions, patient response deviations are to be judicially interpreted in this light potentially rendering MR use illegitimated. While specification of law criteria might possibly improve law use and promote patients' rights, education of psychiatry professionals must address the need for, as far as possible, paying due regard to meeting patient perspectives and participation principles as well as formal law and documentation requirements. PMID:27123152

  1. Should health care providers be accountable for patients' care experiences?

    PubMed

    Anhang Price, Rebecca; Elliott, Marc N; Cleary, Paul D; Zaslavsky, Alan M; Hays, Ron D

    2015-02-01

    Measures of patients' care experiences are increasingly used as quality measures in accountability initiatives. As the prominence and financial impact of patient experience measures have increased, so too have concerns about the relevance and fairness of including them as indicators of health care quality. Using evidence from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, the most widely used patient experience measures in the United States, we address seven common critiques of patient experience measures: (1) consumers do not have the expertise needed to evaluate care quality; (2) patient "satisfaction" is subjective and thus not valid or actionable; (3) increasing emphasis on improving patient experiences encourages health care providers and plans to fulfill patient desires, leading to care that is inappropriate, ineffective, and/or inefficient; (4) there is a trade-off between providing good patient experiences and providing high-quality clinical care; (5) patient scores cannot be fairly compared across health care providers or plans due to factors beyond providers' control; (6) response rates to patient experience surveys are low, or responses reflect only patients with extreme experiences; and (7) there are faster, cheaper, and more customized ways to survey patients than the standardized approaches mandated by federal accountability initiatives. PMID:25416601

  2. Health care professional development: Working as a team to improve patient care

    PubMed Central

    Babiker, Amir; El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

    2014-01-01

    In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care. PMID:27493399

  3. Measuring and improving patient safety through health information technology: The Health IT Safety Framework.

    PubMed

    Singh, Hardeep; Sittig, Dean F

    2016-04-01

    Health information technology (health IT) has potential to improve patient safety but its implementation and use has led to unintended consequences and new safety concerns. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. In response to the fundamental conceptual and methodological gaps related to both defining and measuring health IT-related patient safety, we propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for health IT-related patient safety measurement, monitoring, and improvement. The HITS framework follows both Continuous Quality Improvement (CQI) and sociotechnical approaches and calls for new measures and measurement activities to address safety concerns in three related domains: 1) concerns that are unique and specific to technology (e.g., to address unsafe health IT related to unavailable or malfunctioning hardware or software); 2) concerns created by the failure to use health IT appropriately or by misuse of health IT (e.g. to reduce nuisance alerts in the electronic health record (EHR)), and 3) the use of health IT to monitor risks, health care processes and outcomes and identify potential safety concerns before they can harm patients (e.g. use EHR-based algorithms to identify patients at risk for medication errors or care delays). The framework proposes to integrate both retrospective and prospective measurement of HIT safety with an organization's existing clinical risk management and safety programs. It aims to facilitate organizational learning, comprehensive 360 degree assessment of HIT safety that includes vendor involvement, refinement of measurement tools and strategies, and shared responsibility to identify problems and implement solutions. A long term framework goal is to enable rigorous measurement that helps achieve the safety

  4. Measuring and improving patient safety through health information technology: The Health IT Safety Framework

    PubMed Central

    Singh, Hardeep

    2016-01-01

    Health information technology (health IT) has potential to improve patient safety but its implementation and use has led to unintended consequences and new safety concerns. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. In response to the fundamental conceptual and methodological gaps related to both defining and measuring health IT-related patient safety, we propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for health IT-related patient safety measurement, monitoring, and improvement. The HITS framework follows both Continuous Quality Improvement (CQI) and sociotechnical approaches and calls for new measures and measurement activities to address safety concerns in three related domains: 1) concerns that are unique and specific to technology (e.g., to address unsafe health IT related to unavailable or malfunctioning hardware or software); 2) concerns created by the failure to use health IT appropriately or by misuse of health IT (e.g. to reduce nuisance alerts in the electronic health record (EHR)), and 3) the use of health IT to monitor risks, health care processes and outcomes and identify potential safety concerns before they can harm patients (e.g. use EHR-based algorithms to identify patients at risk for medication errors or care delays). The framework proposes to integrate both retrospective and prospective measurement of HIT safety with an organization's existing clinical risk management and safety programs. It aims to facilitate organizational learning, comprehensive 360 degree assessment of HIT safety that includes vendor involvement, refinement of measurement tools and strategies, and shared responsibility to identify problems and implement solutions. A long term framework goal is to enable rigorous measurement that helps achieve the safety

  5. Does tramadol affect coagulation status of patients with malignancy?

    PubMed Central

    Bilir, Ayten; Akay, Meltem Olga; Ceyhan, Dilek; Andıc, Neslihan

    2014-01-01

    Aim: The study investigated the direct effects of tramadol on the coagulation status of women with gynecologic malignancies in vitro. Materials and Methods: Citrated whole-blood samples from 21 patients with gynecologic tumors were spiked ex vivo with 2 or 6 μl/ml tramadol. Thrombelastography (TEG) analysis was performed using ROTEM® to assess clotting time (CT), clot formation time (CFT) and maximum clot formation (MCF). Results: In the INTEM assay, CT (P < 0.05) and CFT (P < 0.01) were significantly prolonged with tramadol at a 6 μl/ml concentration compared with baseline. There were no significant differences in MCF values between the baseline and the tramadol-treated samples (P > 0.05). Blood medicated with tramadol (6 μl/ml) clotted slowly (increased CT and CFT). Conclusion: The changes observed by TEG demonstrated that tramadol impairs hemostasis in a concentration-dependent manner in the whole blood of women with gynecologic malignancies in vitro. PMID:25097280

  6. Direct-to-consumer advertising affects provider / patient relationship.

    PubMed

    1998-12-01

    Family planning program clients are increasingly seeking oral contraceptive pills by brand name. Direct-to-consumer ads have spurred this recent increase in brand-specific requests for prescription drugs. While print consumer pitches for prescription drugs have been around for a long time, proposed guidance issued by the US Food and Drug Administration (FDA) in August 1997 allows pharmaceutical companies to more easily broadcast product claim commercials on television and radio. Now, half of all direct-to-consumer advertising dollars spent by pharmaceutical companies during January-February 1998 were directed to television ads, almost twice the share spent upon television last year. Last year, pharmaceutical companies spent more than $1 billion on direct-to-consumer advertising. The effects of this new policy are presenting in providers' offices. Before the FDA guidance, 41% of physicians participating in a national survey observed an increase in patients' requests for brand name drugs. However, since the change, 65% surveyed to date have observed an increase in such requests. With the increase in advertising comes a potential for violations of the US Food, Drug, and Cosmetic Act, which regulates provider and consumer prescription drug advertising. 125 companies were cited for violations in 1998, 6 specifically for violations connected with contraceptive information they disseminated. PMID:12321805

  7. [Factors affecting access to health care institutions by the internally displaced population in Colombia].

    PubMed

    Mogollón-Pérez, Amparo Susana; Vázquez, María Luisa

    2008-04-01

    In Colombia, the on-going armed conflict causes displacement of thousands of persons that suffer its economic, social, and health consequences. Despite government regulatory efforts, displaced people still experience serious problems in securing access to health care. In order to analyze the institutional factors that affect access to health care by the internally displaced population, a qualitative, exploratory, and descriptive study was carried out by means of semi-structured individual interviews with a criterion sample of stakeholders (81). A narrative content analysis was performed, with mixed generation of categories and segmentation of data by themes and informants. Inadequate funding, providers' problems with reimbursement by insurers, and lack of clear definition as to coverage under the Social Security System in Health pose barriers to access to health care by the internally displaced population. Bureaucratic procedures, limited inter- and intra-sector coordination, and scarce available resources for public health service providers also affect access. Effective government action is required to ensure the right to health care for this population. PMID:18392351

  8. Factors Affecting Health-Promoting Behaviors in Nursing Students at a University in Turkey.

    PubMed

    Polat, Ülkü; Özen, Şükrü; Kahraman, Burcu Bayrak; Bostanoğlu, Hatice

    2016-07-01

    This descriptive study was carried out to determine factors affecting health-promoting behaviors in nursing students. The sample consisted of 245 students. A questionnaire about factors affecting lifestyle behavior and the Health Promotion Lifestyle Profile Scale-II were used to collect data from 245 nursing students during the spring semester of the 2012-2013 academic year. A significant difference was found between students with and without diagnosed health problems in terms of their mean scores on the Health Promotion Lifestyle Profile Scale-II subscales of health responsibility, spiritual growth, and interpersonal relations, as well as their total mean scores (p < .05). The exercise, nutrition, spiritual growth, and stress management subscale scores of those students regularly going for health checks were determined to be significantly higher than those of the students who did not obtain regular health checks. Students' healthy lifestyle behaviors were generally found to be at the medium level. This study provides evidence of the need for interventions to help nurses in Turkey. PMID:25632948

  9. Category fluency performance in patients with schizophrenia and bipolar disorder: The influence of affective categories.

    PubMed

    Rossell, Susan L

    2006-02-28

    Semantic fluency (SF) and phonological fluency (PF) were examined in large groups of schizophrenia patients, bipolar patients and controls. As well as standard SF categories (animals and food), fluency to two affective categories, happy and fear was measured, i.e. participants were asked to produce as many words as they could that resulted in or are associated with fear or happiness. Schizophrenia patients showed SF and PF deficits. Bipolar patients showed PF deficits. Thus, PF is argued to be a good cognitive marker in both disorders. Severity of delusions was related to SF performance in all patients. The patient groups showed different patterns on the affective categories compared to controls: the bipolar patients were better and produced more words, especially to the happiness category, and the schizophrenia patients were impaired and produced less words. The results suggest an interesting interaction between psychotic illnesses, fluency and emotion. PMID:16376054

  10. [Bone health in patients with anorexia nervosa].

    PubMed

    Suzuki, Mari Hotta

    2013-02-01

    Osteoporosis associated with anorexia nervosa (AN) is common, and tends to be severe, slow to recover from, and sometimes irreversible. The abnormal bone metabolism in severely emaciated AN patients involves both a reduction in bone formation and an increase in bone resorption. The annual change in lumbar bone mineral density (BMD) is significantly correlated with BMI at the entry. The critical BMI for a positive increase in BMD was 16.4±0.3 kg/m(2). Nutritional improvement with body weight gain is the most important goal of treatment for AN-related osteoporosis since it increases both serum levels of insulin-like growth factor-I, a potent osteogenic factor, and estradiol, a powerful bone resorption inhibitor. However, it is difficult for AN patients to accept weight gain. About 50% of AN patients are insufficient of vitamin D and 43% show an increase in plasma undercalboxylated osteocalcin, indicating a deficiency state of the vitamin K(2). Vitamin D(3) or vitamin K(2) (menatetrenone) can prevent further bone loss in severely emaciated AN patients. Recently, bone strength has been evaluated by both BMD and bone quality. Plasma levels of homocysteine, a marker of degradation of bone quality, have significantly positive correlation with their ages of AN patients. We must evaluate bone density as well as bone quality in AN patients. PMID:23354095

  11. Snapshots of Mixtures of Affective Experiences in a Day: Findings from the Health and Retirement Study

    PubMed Central

    Smith, Jacqui; Ryan, Lindsay H.; Queen, Tara L.; Becker, Sandra; Gonzalez, Richard

    2014-01-01

    In 2009, a representative subsample of participants in the Health and Retirement Study (HRS: N = 5333; Age 50–101) responded to a short day reconstruction self-administered questionnaire that asked about their time and experiences on seven activities the previous day. We evaluate the quality and reliability of responses to this 10-minute measure of experienced well-being and compare the properties and correlates of three intensity-based composites reflecting mixtures of activity-linked affective experiences (Mean Activity-Positive Affect, Activity-Negative Affect, and Net Affect), and a frequency-based index, Activity Affective Complexity, that summarizes the proportion of activities that include a mixture of positive and negative affective experiences regardless of intensity. On average, older adults reported that 36% of the activities in their day provided some mixture of feelings (e.g., interested and frustrated). Regression models revealed differential associations for the four constructs of affective well-being with socio-demographic factors, physical and mental health, and proximal indicators of the day’s context. We conclude that the HRS short day reconstruction measure is reliable and discuss the conceptual issues in assessing, summarizing, and interpreting the complexity of emotional experience in older adults. PMID:24729799

  12. Patient and citizen participation in health care decisions in Italy.

    PubMed

    Goss, Claudia; Renzi, Cristina

    2007-01-01

    In recent years there has been a growing recognition in Western healthcare systems of the importance of considering preferences of patients and the public in tailoring health services and treatment plans. The active collaboration between doctor and patient has recently been encouraged through the shared decision-making model. Aim of the present contribution is to describe the current state of patient and public participation in healthcare in Italy. First, we will briefly outline the organization of the Italian National Health Service; second, we will describe the governmental and institutional initiatives regarding participation; third, some examples of associations and initiatives promoting patient participation will be provided; forth, we will report on research projects on patient participation published in peer-reviewed journals; and finally, we will provide some examples on training activities promoting patient participation. The Italian National Health Plan and many regional and local health authorities in Italy explicitly recognize the importance of patient/citizen participation in healthcare decisions at the macro, meso and micro level of decision-making. However, application of a shared model is still at an early stage in Italy. The reported experiences have yielded positive results and have shown that particular attention should be dedicated to more disadvantaged subgroups of the population, involving patient organisations, enhancing patient/citizen knowledge and adopting approaches that take the specific context into account. PMID:17601178

  13. eHealth for Patient Engagement: A Systematic Review

    PubMed Central

    Barello, Serena; Triberti, Stefano; Graffigna, Guendalina; Libreri, Chiara; Serino, Silvia; Hibbard, Judith; Riva, Giuseppe

    2016-01-01

    eHealth interventions are recognized to have a tremendous potential to promote patient engagement. To date, the majority of studies examine the efficacy of eHealth in enhancing clinical outcomes without focusing on patient engagement in its specificity. This paper aimed at reviewing findings from the literature about the use of eHealth in engaging patients in their own care process. We undertook a comprehensive literature search within the peer-reviewed international literature. Eleven studies met the inclusion criteria. eHealth interventions reviewed were mainly devoted to foster only partial dimensions of patient engagement (i.e., alternatively cognitive, emotional or behavioral domains related to healthcare management), thus failing to consider the complexity of such an experience. This also led to a great heterogeneity of technologies, assessed variables and achieved outcomes. This systematic review underlines the need for a more holistic view of patient needs to actually engage them in eHealth interventions and obtaining positive outcomes. In this sense, patient engagement constitute a new frontiers for healthcare models where eHealth could maximize its potentialities. PMID:26779108

  14. Oral health status and temporomandibular disorders in multiple sclerosis patients.

    PubMed

    Kovac, Zoran; Uhac, Ivone; Buković, Dino; Cabov, Tomislav; Kovacević, Daniela; Grzić, Renata

    2005-12-01

    Multiple sclerosis (MS) is an inflammatory disease of unknown etiology involving the central nervous system. Certain clinical manifestations affect the oro-facial region. Three in particular should be of interest to the dentist: trigeminal neuralgia, sensory neuropathy of the trigeminal nerve and facial palsy. The aim of this study was to determine the oral health status, the frequency of subjective symptoms and temporomandibular disorders (TMD) subtype according to Research diagnostic criteria for temporomandibular disorders (RDC/TMD) among MS patients. Examinees in this study were 50 patients suffering from MS, who were at least once treated during their disease in the Clinic Hospital Center, Rijeka, Clinic for Neurology. All examinees had to meet the diagnostic criteria for clinically and laboratory confirmed MS, according to Poser. The results show the difference in mean DMFT (decayed, missing, filled teeth) between MS and the control group. The number of decayed and missing teeth was higher, but the number of filled teeth was significantly lower in MS group. Eighty-two per cent of the subjects with MS had a least one symptom of dysfunction compared with 24% of the subjects in the healthy control group. In the present study, pain, the pain during mouth opening, the difficulty with mouth opening and temporomandibular joint (TMJ) sounds were more commonly reported in the MS group than in the control group. This study shows a statistically significant excess of dental caries and temporomandibular disorders among MS patients compared with the control group. These results suggest that MS is a possible etiological factor in temporomandibular disorders. PMID:16417141

  15. Involving citizens and patients in health research.

    PubMed

    Venuta, Rosa; Graham, Ian D

    2010-01-01

    The Canadian Institutes of Health Research's (CIHR), Canada's premier health research funding agency, is moving forward in realizing a more systematic, ongoing integration of citizens' input in priority setting, governance and funding programs and tools. In 2008, the Canadian Institutes of Health Research (CIHR) developed a Framework for Citizen Engagement. This Framework establishes guidelines for implementing a more systematic approach to consulting and engaging citizens, such as in assessing the merit and relevance of research applications, developing strategic plans, setting research priorities and for strengthening their role on CIHR's governance committees. This paper describes the current context for public consultation in Canada's federal health care system, the new CIHR citizen engagement framework and discusses citizen engagement activities and efforts undertaken by CIHR institutes and branches. It reviews the methods used by CIHR to engage citizens in four key focus areas: 1. Representation on CIHR's Boards and Committees; 2. Corporate and Institute strategic plans, priorities, policies, and guidelines; 3. Research priority setting and integrated knowledge translation; 4. Knowledge dissemination and public outreach. In discussing CIHR's experiences, the paper identifies some of the challenges and benefits of engaging citizens in CIHR's research processes, including participating in decision making and informing strategic priorities. PMID:20539148

  16. Trends that will affect your future … a portrait of American societal health.

    PubMed

    Schwartz, Stephan A

    2011-01-01

    The SchwartzReport tracks emerging trends that will affect the world, particularly the United States. For EXPLORE, it focuses on matters of health in the broadest sense of that term, including medical issues, changes in the biosphere, technology, and policy considerations, all of which will shape our culture and our lives. PMID:21194667

  17. Vector-borne pathogens: New and emerging arboviral diseases affecting public health

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Dengue and Zika have quickly become two of the most important vector-borne diseases affecting Public health around the world. This presentation will introduce vector-borne diseases and all the vectors implicated. A focus will be made on the most important arboviral diseases (Zika and dengue) describ...

  18. Stress and Burnout among Health-Care Staff Working with People Affected by HIV.

    ERIC Educational Resources Information Center

    Miller, David

    1995-01-01

    The nature, causes, consequences, and symptoms of stress and burnout among health-care staff working with people affected by HIV are identified. The extent to which these characteristics are specific to HIV/AIDS workers is discussed. Some options for prevention and management of burnout are presented. (Author)

  19. Handgrip Strength, Positive Affect, and Perceived Health Are Prospectively Associated with Fewer Functional Limitations among Centenarians

    ERIC Educational Resources Information Center

    Franke, Warren D.; Margrett, Jennifer A.; Heinz, Melinda; Martin, Peter

    2012-01-01

    This study assessed the association between perceived health, fatigue, positive and negative affect, handgrip strength, objectively measured physical activity, body mass index, and self-reported functional limitations, assessed 6 months later, among 11 centenarians (age = 102 plus or minus 1). Activities of daily living, assessed 6 months prior to…

  20. How Does Tele-Mental Health Affect Group Therapy Process? Secondary Analysis of a Noninferiority Trial

    ERIC Educational Resources Information Center

    Greene, Carolyn J.; Morland, Leslie A.; Macdonald, Alexandra; Frueh, B. Christopher; Grubbs, Kathleen M.; Rosen, Craig S.

    2010-01-01

    Objective: Video teleconferencing (VTC) is used for mental health treatment delivery to geographically remote, underserved populations. However, few studies have examined how VTC affects individual or group psychotherapy processes. This study compares process variables such as therapeutic alliance and attrition among participants receiving anger…

  1. Trans fatty acid intake is related to emotional affect in the Adventist Health Study-2.

    PubMed

    Ford, Patricia A; Jaceldo-Siegl, Karen; Lee, Jerry W; Tonstad, Serena

    2016-06-01

    Trans fatty acids in Western diets increase health risks, and have been associated with the risk of depression. We hypothesized that intakes of trans fatty acids (primarily from margarines and baked goods) were inversely associated with positive affect and positively associated with negative affect in a longitudinal study. Church attendees residing in North America completed a food frequency questionnaire in 2002-6 as part of the Adventist Health Study-2. A subset in which we excluded participants with established cardiovascular disease (n=8,771) completed the Positive and Negative Affect Schedule (PANAS) in 2006-7. The associations between dietary intakes of fatty acids to positive and negative affect were tested with linear regression analysis controlling for age, gender, ethnicity, education, body mass index, exercise, sleep, sleep squared, Mediterranean diet, total energy intake and alcohol. Intakes of trans fatty acids were inversely associated with positive affect (β=-0.06, B=-0.27 [95% CI -0.37, -0.17], p<.001) and positively associated with negative affect (β=0.05, B=0.21 [95% CI 0.11, 0.31], p<.001). In comparison, we found no association between n-3 polyunsatured fatty acids (PUFA) intakes with affect. The n-6:n-3 PUFA ratio was inversely associated with positive affect (β=-0.03, B=-0.34 [95% CI -0.58, -0.10], p=0.006). The findings suggest that a lower dietary trans fatty acid intake has beneficial effects on emotional affect while the n-6: n-3 ratio is detrimental to positive affect. PMID:27188896

  2. Implementing the patient circle. Call on patients to help improve perceptions of health care quality.

    PubMed

    Ostasiewski, P; Fugate, D L

    1994-01-01

    Adapting the quality-circle concept to a health care setting helped one hospital solve a problem and boosted its image among patients. The "patient circle" technique is one step health care providers can take toward delivering "total customer value," a quality perception that can mean the difference between surviving and thriving in the future. PMID:10154633

  3. Perception of affective prosody in patients at an early stage of relapsing-remitting multiple sclerosis.

    PubMed

    Kraemer, Markus; Herold, Michele; Uekermann, Jennifer; Kis, Bernhard; Daum, Irene; Wiltfang, Jens; Berlit, Peter; Diehl, Rolf R; Abdel-Hamid, Mona

    2013-03-01

    Cognitive dysfunction is well known in patients suffering from multiple sclerosis (MS) and has been described for many years. Cognitive impairment, memory, and attention deficits seem to be features of advanced MS stages, whereas depression and emotional instability already occur in early stages of the disease. However, little is known about processing of affective prosody in patients in early stages of relapsing-remitting MS (RRMS). In this study, tests assessing attention, memory, and processing of affective prosody were administered to 25 adult patients with a diagnosis of RRMS at an early stage and to 25 healthy controls (HC). Early stages of the disease were defined as being diagnosed with RRMS in the last 2 years and having an Expanded Disability Status Scale (EDSS) of 2 or lower. Patients and HC were comparable in intelligence quotient (IQ), educational level, age, handedness, and gender. Patients with early stages of RRMS performed below the control group with respect to the subtests 'discrimination of affective prosody' and 'matching of affective prosody to facial expression' for the emotion 'angry' of the 'Tübingen Affect Battery'. These deficits were not related to executive performance. Our findings suggest that emotional prosody comprehension is deficient in young patients with early stages of RRMS. Deficits in discriminating affective prosody early in the disease may make misunderstandings and poor communication more likely. This might negatively influence interpersonal relationships and quality of life in patients with RRMS. PMID:23126275

  4. Positive psychological states and health behaviors in acute coronary syndrome patients: A qualitative study.

    PubMed

    Huffman, Jeff C; DuBois, Christina M; Mastromauro, Carol A; Moore, Shannon V; Suarez, Laura; Park, Elyse R

    2016-06-01

    Positive psychological states are linked to superior cardiac outcomes, possibly mediated through increased participation in health behaviors. Trained study staff conducted in-depth semi-structured interviews in the hospital and 3 months later for 34 patients diagnosed with an acute coronary syndrome. These interviews focused on positive psychological states, cardiac health behaviors, and their connection; the interviews were transcribed and independently coded using directed content analysis. Both optimism and positive affect were associated with completion of physical activity and healthy eating in a bidirectional manner. In contrast, gratitude, while common, was infrequently linked to completion of health behaviors. PMID:25114026

  5. The contributing role of health-care communication to health disparities for minority patients with asthma.

    PubMed

    Diette, Gregory B; Rand, Cynthia

    2007-11-01

    Asthma is a common, chronic illness with substantial morbidity, especially for racial and ethnic minorities in the United States. The care of the patient with asthma is complex and depends ideally on excellent communication between patients and health-care providers. Communication is essential for the patient to communicate the severity of his or her illness, as well as for the health-care provider to instruct patients on pharmacologic and nonpharmacologic care. This article describes evidence for poor provider/patient communication as a contributor to health-care disparities for minority patients with asthma. Communication problems stem from issues with patients, health-care providers, and health-care systems. It is likely that asthma disparities can be improved, in part, by improving patient/provider communication. While much is known presently about the problem of patient/provider communication in asthma, there is a need to improve and extend the evidence base on the role of effective communication of asthma care and the links to outcomes for minorities. Additional studies are needed that document the extent to which problems with doctor/patient communication lead to inadequate care and poor outcomes for minorities with asthma, as well as mechanisms by which these disparities occur. PMID:17998344

  6. How the Patient Protection and Affordable Care Act affects Texas dentists.

    PubMed

    Oneacre, Lee P

    2012-10-01

    President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law March 23, 2010 (P.L. 111-148), as arguably the most significant legislative health reform since the creation of Medicare and Medicaid in 1965 (1). Several PPACA provisions will impact dentists as both health care providers and small business owners and employers (2). Overall, the law significantly changes health care financing and facilitates competition in the health insurance market place through the creation of health insurance exchanges (HIX). PMID:23311030

  7. Patient-provider connectivity and the role of e-health.

    PubMed

    Holmes, Suzanne C; Kearns, Ellen Hope

    2003-01-01

    Patient-provider connectivity (PPC) offers innovative approaches to control costs, improve quality, and sustain a healthy workforce. The application of e-commerce to health care is one facet of PPC and provides solutions to educating, informing, and more efficiently using scarce resources to sustain the nation's health. Technology is available to provide real-time access to clinical results, medical records, health-care providers, and other time-sensitive patient information. This is the first article in a series on PPC that explores the application of e-commerce to the health-care industry from the consumers' and providers' points of view and examines and assesses trends and data from various interdisciplinary sources and studies. Two models exemplifying PPC are explored including the Science Business & Education, Inc., proof-of-concept patient demonstration project, and the emerging application of peer-to-peer (P2P) technology. PPC promises to improve efficiency, facilitate communication between physician and patient, monitor compliance with medical regimens, and positively affect the quality of health care provided and the overall health of the patient. Future articles will address the growth of telemedicine, issues of confidentiality and e-risk, and other PPC applications. PMID:12813954

  8. Ontology driven health information systems architectures enable pHealth for empowered patients.

    PubMed

    Blobel, Bernd

    2011-02-01

    The paradigm shift from organization-centered to managed care and on to personal health settings increases specialization and distribution of actors and services related to the health of patients or even citizens before becoming patients. As a consequence, extended communication and cooperation is required between all principals involved in health services such as persons, organizations, devices, systems, applications, and components. Personal health (pHealth) environments range over many disciplines, where domain experts present their knowledge by using domain-specific terminologies and ontologies. Therefore, the mapping of domain ontologies is inevitable for ensuring interoperability. The paper introduces the care paradigms and the related requirements as well as an architectural approach for meeting the business objectives. Furthermore, it discusses some theoretical challenges and practical examples of ontologies, concept and knowledge representations, starting general and then focusing on security and privacy related services. The requirements and solutions for empowering the patient or the citizen before becoming a patient are especially emphasized. PMID:21036660

  9. Health locus of control and self-care behaviors in diabetic foot patients

    PubMed Central

    Abredari, Hamid; Bolourchifard, Fariba; Rassouli, Maryam; Nasiri, Navideh; Taher, Mohammad; Abedi, Ahmadreza

    2015-01-01

    Background: Diabetic foot affects more than 25% of diabetic patients and finally up to 20% of cases result in amputation. The most important factor resulting in severe complications or even death is lack of self-care. Health locus of control has been introduced as one of health factors and predicting factors of self-care. This research was performed for analyzing the correlation between self-care behaviors and health locus of control in diabetic foot patients. Methods: In this descriptive study, 120 patients with diabetic foot were chosen using convenience sampling from endocrine clinic and wards of endocrine and vascular surgery of Teleqani Hospital of Shahid Beheshti Medical University. The data were gathered by demographic, self-care behavior, and health locus of control questionnaires. The t-test, analysis of variance (ANOVA) and spearman coefficient were used to analyze the data. Results: Results of this research showed that there is a direct and significant relation between selfcare behaviors and internal health locus of control (p<0.001), and also in contrast with chance health locus of control (p<0.001). Conclusion: We have to consider these factors’ role in nursing interventions and patient-care education programs and plans. Probably, interventions and programs that will lead to the strengthening of internal health locus of control improve and strengthen patients’ self-care behaviors and their involvement in treatment. PMID:26913246

  10. How health information is received by diabetic patients?

    PubMed Central

    Zare-Farashbandi, Firoozeh; Lalazaryan, Anasik; Rahimi, Alireza; Zadeh, Akbar Hassan

    2015-01-01

    Background: Knowledge of correct information-seeking behavior by the patients can provide health specialists and health information specialists with valuable information in improving health care. This study aimed to investigate the passive receipt and active seeking of health information by diabetic patients. Materials and Methods: A survey method was used in this research on 6426 diabetic patients of whom 362 patients were selected by a no percentage stratified random sampling. The Longo information-seeking behavior questionnaire was used to collect data and they were analyzed by SPSS 20 software. Results: The most common information source by diabetic patients was practitioners (3.12). The minimum usage among the information sources were from charity organizations and emergency phone lines with a usage of close to zero. The amount of health information gained passively from each source has the lowest average of 4.18 and usage of this information in making health decision has the highest average score of 5.83. Analysis of the data related to active seeking of information showed that knowledge of available medical information from each source has the lowest average score of 3.95 and ability in using the acquired information for making medical decisions has the highest average score of 5.28. The paired t-test showed that differences between passive information receipt (41.68) and active information seeking (39.20) considered as statistically significant (P < 0.001). Conclusion: Because diabetic patients are more passive information receivers than active information seekers, the health information must be distributed by passive means to these patients. In addition, information-seeking behavior during different time periods should be investigated; to identify more effective distribution of health information. PMID:26261828

  11. Frequency and Prioritization of Patient Health Risks from a Structured Health Risk Assessment

    PubMed Central

    Phillips, Siobhan M.; Glasgow, Russell E.; Bello, Ghalib; Ory, Marcia G.; Glenn, Beth A.; Sheinfeld-Gorin, Sherri N.; Sabo, Roy T.; Heurtin-Roberts, Suzanne; Johnson, Sallie Beth; Krist, Alex H.

    2014-01-01

    PURPOSE To describe the frequency and patient-reported readiness to change, desire to discuss, and perceived importance of 13 health risk factors in a diverse range of primary care practices. METHODS Patients (n = 1,707) in 9 primary care practices in the My Own Health Report (MOHR) trial reported general, behavioral, and psychosocial risk factors (body mass index [BMI], health status, diet, physical activity, sleep, drug use, stress, anxiety or worry, and depression). We classified responses as “at risk” or “healthy” for each factor, and patients indicated their readiness to change and/or desire to discuss identified risk factors with providers. Patients also selected 1 of the factors they were ready to change as most important. We then calculated frequencies within and across these factors and examined variation by patient characteristics and across practices. RESULTS On average, patients had 5.8 (SD = 2.12; range, 0–13) unhealthy behaviors and mental health risk factors. About 55% of patients had more than 6 risk factors. On average, patients wanted to change 1.2 and discuss 0.7 risks. The most common risks were inadequate fruit/vegetable consumption (84.5%) and overweight/obesity (79.6%). Patients were most ready to change BMI (33.3%) and depression (30.7%), and most wanted to discuss depression (41.9%) and anxiety or worry (35.2%). Overall, patients rated health status as most important. CONCLUSIONS Implementing routine comprehensive health risk assessments in primary care will likely identify a high number of behavioral and psychosocial health risks. By soliciting patient priorities, providers and patients can better manage counseling and behavior change. PMID:25384812

  12. Physician privacy concerns when disclosing patient data for public health purposes during a pandemic influenza outbreak

    PubMed Central

    2011-01-01

    Background Privacy concerns by providers have been a barrier to disclosing patient information for public health purposes. This is the case even for mandated notifiable disease reporting. In the context of a pandemic it has been argued that the public good should supersede an individual's right to privacy. The precise nature of these provider privacy concerns, and whether they are diluted in the context of a pandemic are not known. Our objective was to understand the privacy barriers which could potentially influence family physicians' reporting of patient-level surveillance data to public health agencies during the Fall 2009 pandemic H1N1 influenza outbreak. Methods Thirty seven family doctors participated in a series of five focus groups between October 29-31 2009. They also completed a survey about the data they were willing to disclose to public health units. Descriptive statistics were used to summarize the amount of patient detail the participants were willing to disclose, factors that would facilitate data disclosure, and the consensus on those factors. The analysis of the qualitative data was based on grounded theory. Results The family doctors were reluctant to disclose patient data to public health units. This was due to concerns about the extent to which public health agencies are dependable to protect health information (trusting beliefs), and the possibility of loss due to disclosing health information (risk beliefs). We identified six specific actions that public health units can take which would affect these beliefs, and potentially increase the willingness to disclose patient information for public health purposes. Conclusions The uncertainty surrounding a pandemic of a new strain of influenza has not changed the privacy concerns of physicians about disclosing patient data. It is important to address these concerns to ensure reliable reporting during future outbreaks. PMID:21658256

  13. Evaluation of body esteem and mental health in patients with breast cancer after mastectomy

    PubMed Central

    Heidari, Mohammad; Shahbazi, Sara; Ghodusi, Mansureh

    2015-01-01

    Introduction: Mastectomy in patients with breast cancer can severely affect their body esteem. It also changes the emotions and attitudes of patients toward their body and causes psychological reactions such as depression, anxiety, and stress. Aims: This study was conducted with the aim of assessing correlation between body esteem and mental health in patients with breast cancer after mastectomy. Materials and Methods: This study is a descriptive study. One hundred patients with breast cancer after mastectomy were selected by convenience sampling from Seyed Al Shohada Hospital in Isfahan. Data gathering tools were questionnaires of body esteem and SCL-25 mental health and were analyzed by SPSS-PC (v.17). Results: According to the score of body esteem (2.80) and the overall average score for body esteem (36.46), patients had low body esteem. About dimensions of the mental health, the highest average was associated with depressive disorders. According to the results of the Spearman correlation coefficient, there was a direct linear relationship between body esteem and mental health. Conclusion: Considering the impact of mastectomy on body esteem and mental health and the relationship between the variables, nurses take steps for identifying and referring patients to the counseling centers to prevent psychological disorder aspects. PMID:26903758

  14. The Impact of Patient-to-Patient Interaction in Health Facility Waiting Rooms on Their Perception of Health Professionals.

    PubMed

    Willis, William Kent; Ozturk, Ahmet Ozzie; Chandra, Ashish

    2015-01-01

    Patients have to wait in waiting rooms prior to seeing the physician. But there are few studies that demonstrate what they are actually doing in the waiting room. This exploratory study was designed to investigate the types of discussions that patients in the waiting room typically engage in with other patients and how the conversations affected their opinion on general reputation of the clinic, injections/blocks as treatment procedures, waiting time, time spent with the caregiver, overall patient satisfaction, and the pain medication usage policy. The study demonstrates that patient interaction in the waiting room has a positive effect on patient opinion of the pain clinic and the caregivers. PMID:25839351

  15. Patient satisfaction with emergency oral health care in rural Tanzania.

    PubMed

    Ntabaye, M K; Scheutz, F; Poulsen, S

    1998-10-01

    Emergency oral health care, as conceived in Tanzania, is an on-demand service provided at a rural health center or dispensary by a Rural Medical Aide. The service includes: simple tooth extraction under local anesthesia, draining of abscesses, control of acute oral infection with appropriate drug therapy, first aid for maxillo-facial trauma, and recognition of oral conditions requiring patient referral for further care at the district or regional hospital dental clinic. The objective of the present study was to describe patient satisfaction with emergency oral health care services in rural Tanzania and determine the relative importance of factors influencing patient satisfaction. The study was carried out as a cross-sectional interview survey between April 1993 and May 1994 using a patient satisfaction questionnaire in rural villages in the Rungwe district of Tanzania. It included 206 patients aged 18 years or more who had received emergency oral health care between April 1993 and March 1994. Overall, 92.7% of the respondents reported that they were satisfied with the service. Patients who were married, had no formal education and lived more than 3 km from the dispensary were more likely to be satisfied with treatment. In a logistic regression model, a good working atmosphere at the dispensary, a good relationship between care provider and patients (art of care) and absence of post-treatment complications significantly influenced patient satisfaction with odds ratios of 10.3, 17.4 and 6.2, respectively. PMID:9792119

  16. Community health insurance schemes & patient satisfaction - evidence from India

    PubMed Central

    Devadasan, N.; Criel, Bart; Damme, Wim Van; Lefevre, Pierre; Manoharan, S.; der Stuyft, Patrick Van

    2011-01-01

    Background & objectives: Quality of care is an important determinant for utilizing health services. In India, the quality of care in most health services is poor. The government recognizes this and has been working on both supply and demand aspects. In particular, it is promoting community health insurance (CHI) schemes, so that patients can access quality services. This observational study was undertaken to measure the level of satisfaction among insured and uninsured patients in two CHI schemes in India. Methods: Patient satisfaction was measured, which is an outcome of good quality care. Two CHI schemes, Action for Community Organisation, Rehabilitation and Development (ACCORD) and Kadamalai Kalanjiam Vattara Sangam (KKVS), were chosen. Randomly selected, insured and uninsured households were interviewed. The household where a patient was admitted to a hospital was interviewed in depth about the health seeking behaviour, the cost of treatment and the satisfaction levels. Results: It was found that at both ACCORD and KKVS, there was no significant difference in the levels of satisfaction between the insured and uninsured patients. The main reasons for satisfaction were the availability of doctors and medicines and the recovery by the patient. Interpretation & conclusions: Our study showed that insured hospitalized patients did not have significantly higher levels of satisfaction compared to uninsured hospitalized patients. If CHI schemes want to improve the quality of care for their clients, so that they adhere to the scheme, the scheme managers need to negotiate actively for better quality of care with empanelled providers. PMID:21321418

  17. Health Care Professionals' Views about Supporting Patients' Self-Management

    ERIC Educational Resources Information Center

    Mikkonen, Irma; Hynynen, Marja-Anneli

    2012-01-01

    Purpose: The aim of this study was to describe nurses' and other health care professionals' views about their patient education skills and how to develop them. Design/methodology/approach: The data for the study were collected from the participants of the online education course on patient education. The data were analyzed using qualitative…

  18. Mobile Health: empowering patients and driving change.

    PubMed

    Bradway, Meghan; Årsand, Eirik; Grøttland, Astrid

    2015-03-01

    Diabetes is a global epidemic, with insufficient medical management capacity. It is becoming increasingly relevant to develop sustainable methods of self-management and collaboration between clinical personnel and those living with diabetes. While there have been favorable advances in mobile self-management tools for the disease, few have been validated and acknowledged. Health policies are not being established as quickly as these tools are becoming available, and the public has taken action into their own hands. PMID:25727462

  19. Improving health outcomes with better patient understanding and education.

    PubMed

    Adams, Robert John

    2010-01-01

    A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual's competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been

  20. Cognitive Function in Adolescent Patients with Anorexia Nervosa and Unipolar Affective Disorders.

    PubMed

    Sarrar, Lea; Holzhausen, Martin; Warschburger, Petra; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Schneider, Nora

    2016-05-01

    Studies have shown impairments in cognitive function among adult patients with anorexia nervosa (AN) and affective disorders (AD). The association between cognitive dysfunctions, AN and AD as well as the specificity for these psychiatric diagnoses remains unclear. Therefore, we examined cognitive flexibility and processing speed in 47 female adolescent patients with AN, 21 female adolescent patients with unipolar affective disorders and 48 female healthy adolescents. All participants completed a neuropsychological test battery. There were no significant group differences regarding cognitive function, except for psychomotor processing speed with poorer performance in patients with AN. A further analysis revealed that all groups performed with the normal range, although patients with AN were over represented in the poorest performing quartile. We found no severe cognitive impairments in either patient group. Nevertheless, belonging to the AN group contributed significantly to poor performances in neuropsychological tasks. Therefore, we conclude that the risk for cognitive impairments is slightly higher for patients with AN. PMID:26695683

  1. Targeting low literacy patients pays off for health system.

    PubMed

    2015-11-01

    Ochsner Health, with headquarters in New Orleans, targets patients with low health literacy, along with other readmission reduction programs. When patients are readmitted, the case managers administer the Rapid Estimate of Adult Literacy in Medicine (REALM) tool, developed by the Agency for Healthcare Research and Quality (AHRQ) to identify patients who need extra help in understanding their discharge instructions. When case managers make post-discharge follow-up calls to at-risk patients, they ask a series of questions that determine if the patient can understand written instructions. - The staff uses pictographs and videos to educate patients identified as having low literacy and make sure the caregivers understand the discharge instructions. PMID:26521642

  2. Patient Access to Their Health Record Using Open Source EHR.

    PubMed

    Chelsom, John; Dogar, Naveed

    2015-01-01

    In both Europe and North America, patients are beginning to gain access to their health records in electronic form. Using the open source cityEHR as an example, we have focussed on the needs of clinical users to gather requirements for patient access and have implemented these requirements in a new application called cityEHR-PA. The development of a separate application for patient access was necessary to address requirements for security and ease of use. The use of open standards throughout the design of the EHR allows the possibility of third parties to develop applications for patient access, consuming the individual patient record extracted from the full EHR. PMID:25676956

  3. Patient mobility in European Union: health spas in Ischia, Italy.

    PubMed

    den Exter, André

    2005-04-01

    In a new case on patients seeking medical services abroad, the Leichtle case, the European Court of Justice (ECJ) confirmed its previous rulings on patient mobility. According to the Court, patients in the European Union have a (conditional) right to receive health care abroad, whereas the sickness fund should reimburse the costs of treatment and travel expenditures. As such, the Court has strengthened patient mobility in the European Union, based on the free movement principles. Now, it is up to the European Commission to develop a communal strategy aimed at further strengthening patients' rights in the Union. PMID:15849839

  4. [Health education in transplant patients and their families in an intensive care unit].

    PubMed

    Pueyo-Garrigues, M; San Martín Loyola, Á; Caparrós Leal, M C; Jiménez Muñoz, C

    2016-01-01

    Health Education (HE) is extremely important in transplant patients and their families in order to promote suitable self-care in this new stage of life. Intensive Care Units offer various opportunities by nurses in order to improve their Health Education. This process could start in this unit where the interaction between nurse and family is constant. The HE of transplant patient includes three dimensions: Knowledge: information about self-care in order to have a healthy way of life, and getting some information on how to reduce anxiety in patients and their families; Skills: as regards the abilities to properly apply the Health Education, where the families are really important; and finally Attitudes: ambivalent attitudes that are experienced by transplant patients. The objective is to describe the level of development of HE for critical transplant patients and their families from Intensive Care Units. A non-systematic literature review was performed in Pubmed and CINHAL data bases. In conclusion, it is emphasised that the skill of the HE nurse in an Intensive Care Units is important to promote lifestyles appropriate to the cognitive, affective, and psychomotor needs of transplant patients. Its implementation entails positive effects on clinical outcomes of the patient, decreased morbidity and mortality, costs, and health resources. PMID:26810953

  5. Prescription drug insurance coverage and patient health outcomes: a systematic review.

    PubMed

    Kesselheim, Aaron S; Huybrechts, Krista F; Choudhry, Niteesh K; Fulchino, Lisa A; Isaman, Danielle L; Kowal, Mary K; Brennan, Troyen A

    2015-02-01

    Previous reviews have shown that changes in prescription drug insurance benefits can affect medication use and adherence. We conducted a systematic review of the literature to identify studies addressing the association between prescription drug coverage and health outcomes. Studies were included if they collected empirical data on expansions or restrictions of prescription drug coverage and if they reported clinical outcomes. We found 23 studies demonstrating that broader prescription drug insurance reduces use of other health care services and has a positive impact on patient outcomes. Coverage gaps or caps on drug insurance generally led to worse outcomes. States should consider implementing the Affordable Care Act expansions in drug coverage to improve the health of low-income patients receiving state-based health insurance. PMID:25521879

  6. Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care.

    PubMed

    Lavallee, Danielle C; Chenok, Kate E; Love, Rebecca M; Petersen, Carolyn; Holve, Erin; Segal, Courtney D; Franklin, Patricia D

    2016-04-01

    The provision of patient-centered care requires a health care environment that fosters engagement between patients and their health care team. One way to encourage patient-centered care is to incorporate patient-reported outcomes into clinical settings. Collecting these outcomes in routine care ensures that important information only the patient can provide is captured. This provides insights into patients' experiences of symptoms, quality of life, and functioning; values and preferences; and goals for health care. Previously embraced in the research realm, patient-reported outcomes have started to play a role in successful shared decision making, which can enhance the safe and effective delivery of health care. We examine the opportunities for using patient-reported outcomes to enhance care delivery and outcomes as health care information needs and technology platforms change. We highlight emerging practices in which patient-reported outcomes provide value to patients and clinicians and improve care delivery. Finally, we examine present and future challenges to maximizing the use of patient-reported outcomes in the clinic. PMID:27044954

  7. Issues in Health Care of Middle Eastern Patients

    PubMed Central

    Lipson, Juliene G.; Meleis, Afaf I.

    1983-01-01

    Relationships between Middle Eastern patients and Western health care professionals are often troubled by mutual misunderstanding of culturally influenced values and communication styles. Although Middle Easterners vary ethnically, they do share a core of common values and behavior that include the importance of affiliation and family, time and space orientations, interactional style and attitudes toward health and illness. Problems in providing health care involve obtaining adequate information, “demanding behavior” by a patient's family, conflicting beliefs about planning ahead and differing patterns of communicating grave diagnoses or “bad news.” There are guidelines that will provide an understanding of the cultural characteristics of Middle Easterners and, therefore, will improve rather than impede their health care. A personal approach and continuity of care by the same health care professional help to bridge the gap between Middle Eastern cultures and Western medical culture. In addition, periodic use of cultural interpreters helps ameliorate the intensity of some cultural issues. PMID:6364575

  8. E-health: transforming the physician/patient relationship.

    PubMed

    Ball, M J; Lillis, J

    2001-04-01

    Healthcare delivery is being transformed by advances in e-health and by the empowered, computer-literate public. Ready to become partners in their own health and to take advantage of online processes, health portals, and physician web pages and e-mail, this new breed of consumer is slowly redefining the physician/patient relationship. Such changes can effect positive results like improved clinical decision-making, increased efficiency, and strengthened communication between physicians and patients. First, however, physicians and the organizations that support them must fully understand their role in the e-health revolution. Both must advance their awareness of the new consumers and their needs and define specific action items that will help them realize the benefits of e-health. Through a combination of timely research and advice, this article will aid them in fulfilling both tasks. PMID:11248599

  9. Doctor-patient communication in the e-health era

    PubMed Central

    2012-01-01

    The digital revolution will have a profound impact on how physicians and health care delivery organizations interact with patients and the community at-large. Over the coming decades, face-to-face patient/doctor contacts will become less common and exchanges between consumers and providers will increasingly be mediated by electronic devices. In highly developed health care systems like those in Israel, the United States, and Europe, most aspects of the health care and consumer health experience are becoming supported by a wide array of technology such as electronic and personal health records (EHRs and PHRs), biometric & telemedicine devices, and consumer-focused wireless and wired Internet applications. In an article in this issue, Peleg and Nazarenko report on a survey they fielded within Israel's largest integrated delivery system regarding patient views on the use of electronic communication with their doctors via direct-access mobile phones and e-mail. A previous complementary paper describes the parallel perspectives of the physician staff at the same organization. These two surveys offer useful insights to clinicians, managers, researchers, and policymakers on how best to integrate e-mail and direct-to-doctor mobile phones into their practice settings. These papers, along with several other recent Israeli studies on e-health, also provide an opportunity to step back and take stock of the dramatic impact that information & communication technology (ICT) and health information technology (HIT) will have on clinician/patient communication moving forward. The main goals of this commentary are to describe the scope of this issue and to offer a framework for understanding the potential impact that e-health tools will have on provider/patient communication. It will be essential that clinicians, managers, policymakers, and researchers gain an increased understanding of this trend so that health care systems around the globe can adapt, adopt, and embrace these

  10. Personal Health Records for Patients with Chronic Disease

    PubMed Central

    Rozenblum, R.; Park, A.; Dunn, M.; Bates, D.W.

    2014-01-01

    Summary Background Personal health records (PHRs) connected to a physician’s electronic health record system hold substantial promise for supporting and engaging patients with chronic disease. Objectives: To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations. Methods A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations. Results Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged. Conclusion This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination. PMID:25024758

  11. Women, men and public health-how the choice of normative theory affects resource allocation.

    PubMed

    Månsdotter, Anna; Lindholm, Lars; Ohman, Ann

    2004-09-01

    Women live longer than men in almost all countries, but men are more privileged in terms of power, influence, resources and probably morbidity. This investigation aims at illustrating how the choice of normative framework affects judgements about the fairness in these sex differences, and about desired societal change. The selected theories are welfare economics, health sector extra-welfarism, justice as fairness and feminist justice. By means of five Swedish proposals aiming at improving the population's health or "sex equity", facts and values are applied to resource allocation. Although we do not claim a specific ethical foundation, it seems to us that the feminist criterion has great potential in public health policy. The overall conclusion is that the normative framework must be explicitly discussed and stated in issues of women's and men's health. PMID:15276314

  12. Health care: economic impact of caring for geriatric patients.

    PubMed

    Rich, Preston B; Adams, Sasha D

    2015-02-01

    National health care expenditures constitute a continuously expanding component of the US economy. Health care resources are distributed unequally among the population, and geriatric patients are disproportionately represented. Characterizing this group of individuals that accounts for the largest percentage of US health spending may facilitate the introduction of targeted interventions in key high-impact areas. Changing demographics, an increasing incidence of chronic disease and progressive disability, rapid technological advances, and systemic market failures in the health care sector combine to drive cost. A multidisciplinary approach will become increasingly necessary to balance the delicate relationship between our constrained supply and increasing demand. PMID:25459539

  13. Spouse health status, depressed affect, and resilience in mid and late life: a longitudinal study.

    PubMed

    Bookwala, Jamila

    2014-04-01

    This study used longitudinal data to examine the effects of spousal illness on depressive symptoms among middle-aged and older married individuals and the extent to which the adverse effects of illness in a spouse were mitigated by 2 psychological resources, mastery and self-esteem. Using 1,704 married participants who were 51 years of age on average, depressive symptoms were compared in 4 groups varying in their experience of spousal health transitions: those whose spouse remained ill at T1 and T2, those whose spouse declined in health from T1 to T2, those whose spouse's health improved from T1 to T2, and those whose spouse remained healthy at both time points. Mixed analyses of covariance showed that, as hypothesized, having a spouse who became or remained ill over time was linked to greater depressed affect by T2, whereas having a spouse improve in health was associated with a decline in depressive symptomatology. Moderated regression analyses indicated that while higher mastery and self-esteem were linked to lower depressed affect in general, these resources were especially protective against depressed affect for those whose spouse remained ill at both time points. These findings are at the intersection of life course theory and the stress process model highlighting the contextual forces in and the interconnectedness of individual development as well as the plasticity and resilience evident in adaptation to stress during mid and late life. PMID:24364828

  14. Building an evidence base on mental health interventions for children affected by armed conflict

    PubMed Central

    Betancourt, Theresa S.; Williams, Timothy

    2009-01-01

    This paper reviews what is currently known from research about the effectiveness of interventions to address mental health problems in children and adolescents affected by armed conflict. The focus will be on interventions delivered in conflict affected countries either during active humanitarian emergencies or during the post conflict period. The paper will discuss two main paradigms of intervention dominating the field: psychosocial approaches and clinical/psychiatric approaches. The paper reviews some of the basic literature, theories and issues involved in assessment, programme planning, monitoring and evaluation of both approaches. In order to explore these issues in depth, the paper will draw from the author’s field experiences with research in the Russian Federation and in northern Uganda. The paper also presents a brief review of a handful of other published evaluations of mental health interventions for war affected children. We will close with a discussion of what future research is needed to build an evidence base regarding mental health interventions for children affected by armed conflict as well as the ethical and feasibility issues associated with carrying out this work. PMID:19997531

  15. Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care

    PubMed Central

    Betancourt, Theresa S.; Meyers-Ohki, Sarah E.; Charrow, Alexandra P.; Tol, Wietse A.

    2014-01-01

    Background Children and adolescents exposed to armed conflict are at high risk of developing mental health problems. To date, a range of psychosocial approaches and clinical/psychiatric interventions has been used to address mental health needs in these groups. Aims To provide an overview of peer-reviewed psychosocial and mental health interventions designed to address mental health needs of conflict-affected children, and to highlight areas in which policy and research need strengthening. Methods We used standard review methodology to identify interventions aimed at improving or treating mental health problems in conflict-affected youth. An ecological lens was used to organize studies according to the individual, family, peer/school, and community factors targeted by each intervention. Interventions were also evaluated for their orientation toward prevention, treatment, or maintenance, and for the strength of the scientific evidence of reported effects. Results Of 2305 studies returned from online searches of the literature and 21 sources identified through bibliography mining, 58 qualified for full review, with 40 peer-reviewed studies included in the final narrative synthesis. Overall, the peer-reviewed literature focused largely on school-based interventions. Very few family and community-based interventions have been empirically evaluated. Only two studies assessed multilevel or stepped-care packages. Conclusions The evidence base on effective and efficacious interventions for conflict-affected youth requires strengthening. Postconflict development agendas must be retooled to target the vulnerabilities characterizing conflict-affected youth, and these approaches must be collaborative across bodies responsible for the care of youth and families. PMID:23656831

  16. A multicenter cross-sectional study of mental and physical health depression in MHD patients.

    PubMed

    Vettath, R E; Reddy, Y N V; Reddy, Y N V; Dutta, S; Singh, Z; Mathew, M; Abraham, G

    2012-07-01

    Depression is ranked fourth among the disabling diseases affecting people worldwide and is the most common psychological problem in patients with End Stage Renal Disease (ESRD). The aim of this study is to assess the physical and emotional health status of renal dialysis patients, based on the SF-36 scale in relation to their economic status. Sixty maintenance hemodialysis patients, with a mean age of 40±13 years were included in this cross-sectional study using the SF-36 scale. It comprises 36 questions regarding physical and mental functions, body pain, vitality, etc. An SF-36 score of 50 or less was considered as moderate to severe depression and 51-100 as mild depression to good health. 56.81% of the patients who are below poverty line under dialysis had moderate to severe depression with regard to their health status. A physical health score of up to 50 was seen in 63.63% of patients below poverty line 63.63% (P= 0.16). A mental health score of 0-50 was observed in 61.63% of the cohort studied (P = 0.22). Among the patient with diabetes (28.33%) 55.56% had depression. Dialysis duration was directly associated with deteriorating physical health status and inversely proportional to their mental health status (P<0.05). There are problems in other regular activities due to depressed physical and mental health. The factors that were identified in this study that influence depression such as poverty status, increasing age, vintage and frequency of dialysis and treatment with erythropoietin dosage should be addressed and treated accordingly to improve the quality of life. Improving self-esteem with fruitful employment opportunities, concerted rehabilitation by professionals and easing of economic burden by private-public partnership is an achievable goal. PMID:23162267

  17. Foreclosure and Health in Southern Europe: Results from the Platform for People Affected by Mortgages.

    PubMed

    Vásquez-Vera, Hugo; Rodríguez-Sanz, Maica; Palència, Laia; Borrell, Carme

    2016-04-01

    Housing instability has been shown to be related to poorer health outcomes in various studies, mainly in the USA and UK. Affected individuals are more prone to psychiatric (e.g., major depression, anxiety) and physical disorders (e.g., hypertension). This situation has deteriorated with the onset of the economic crisis. One of the most affected countries is Spain, which has high rates of foreclosure and eviction that continue to rise. In response, a civil movement, The Platform for People Affected by Mortgages (PAH), works to provide solutions to its members affected by foreclosure and advocates for the right to decent housing. The aims of this study ware to describe and compare the health status of PAH members from Catalonia to a sample of the general population and to analyze the association between health status and mortgage status, foreclosure stage, and other socioeconomic variables, among members of the PAH. We conducted a cross-sectional study using a self-administered online questionnaire (2014) administered to 905 PAH members in Catalonia (>18 years; 559 women and 346 men). Results were compared with health indicators from The Health Survey of Catalonia 2013 (n = 4830). The dependent variables were poor mental health (GHQ 12 ≥ 3), and poor self-reported health (fair or poor). All analyses were stratified by sex. We computed age-standardized prevalence and prevalence ratios of poor mental and self-reported health in both samples. We also analyzed health outcomes among PAH members according to mortgage status (mortgage holders or guarantors), stage of foreclosure, and other socioeconomic variables by computing prevalence ratios from robust Poisson regression models. The prevalence of poor mental health among PAH members was 90.6 % in women and 84.4 % in men, and 15.5 and 10.2 % in the general population, respectively. The prevalence of poor self-reported health was 55.6 % in women and 39.4 % in men from the PAH, and 19.2 and 16.1 % in the general

  18. Factors Affecting Job Motivation among Health Workers: A Study From Iran

    PubMed Central

    Daneshkohan, Abbas; Zarei, Ehsan; Mansouri, Tahere; Maajani, Khadije; Ghasemi, Mehri Siyahat; Rezaeian, Mohsen

    2015-01-01

    Objective: Human resources are the most vital resource of any organizations which determine how other resources are used to accomplish organizational goals. This research aimed to identity factors affecting health workers’ motivation in Shahid Beheshti University of Medical Sciences (SBUMS). Method: This is a cross-sectional survey conducted with participation of 212 health workers of Tehran health centers in November and December 2011. The data collection tool was a researcher-developed questionnaire that included 17 motivating factors and 6 demotivating factors and 8 questions to assess the current status of some factors. Validity and reliability of the tool were confirmed. Data were analyzed with descriptive and analytical statistical tests. Results: The main motivating factors for health workers were good management, supervisors and managers’ support and good working relationship with colleagues. On the other hand, unfair treatment, poor management and lack of appreciation were the main demotivating factors. Furthermore, 47.2% of health workers believed that existing schemes for supervision were unhelpful in improving their performance. Conclusion: Strengthening management capacities in health services can increase job motivation and improve health workers’ performance. The findings suggests that special attention should be paid to some aspects such as management competencies, social support in the workplace, treating employees fairly and performance management practices, especially supervision and performance appraisal. PMID:25948438

  19. LEGAL BASES FOR DISCLOSING CONFIDENTIAL PATIENT INFORMATION FOR PUBLIC HEALTH: DISTINGUISHING BETWEEN HEALTH PROTECTION AND HEALTH IMPROVEMENT

    PubMed Central

    Taylor, Mark J.

    2015-01-01

    The disclosure of confidential patient data without an individual's explicit consent should be for purposes that persons have reason to both expect and accept. We do not currently have the required level of clarity or consistency in understanding regarding the disclosure of confidential patient information for public health purposes to support effective public dialogue. The Health Service (Control of Patient Information) Regulations 2002 establish a legal basis in England and Wales for data to be disclosed for public health purposes without patient consent. Under the Regulations, there is more than one potential route towards lawful processing: Data may be processed for public health purposes under both Regulations 3 and 5. The alternatives have different safeguards and conditions attached, and their respective applicability to processing for purposes of public health improvement is currently unclear and subject to review. Beyond the need for clarity regarding the safeguards applicable to processing for particular public health purposes, there are reasons to prefer recognition that Regulation 5 is the most appropriate legal basis for disclosure when the purpose is public health improvement rather than public health protection. Where health improvement, rather than protection, is the aim, there is no justification for discarding the additional safeguards associated with processing under Regulation 5. PMID:25995294

  20. LEGAL BASES FOR DISCLOSING CONFIDENTIAL PATIENT INFORMATION FOR PUBLIC HEALTH: DISTINGUISHING BETWEEN HEALTH PROTECTION AND HEALTH IMPROVEMENT.

    PubMed

    Taylor, Mark J

    2015-01-01

    The disclosure of confidential patient data without an individual's explicit consent should be for purposes that persons have reason to both expect and accept. We do not currently have the required level of clarity or consistency in understanding regarding the disclosure of confidential patient information for public health purposes to support effective public dialogue. The Health Service (Control of Patient Information) Regulations 2002 establish a legal basis in England and Wales for data to be disclosed for public health purposes without patient consent. Under the Regulations, there is more than one potential route towards lawful processing: Data may be processed for public health purposes under both Regulations 3 and 5. The alternatives have different safeguards and conditions attached, and their respective applicability to processing for purposes of public health improvement is currently unclear and subject to review. Beyond the need for clarity regarding the safeguards applicable to processing for particular public health purposes, there are reasons to prefer recognition that Regulation 5 is the most appropriate legal basis for disclosure when the purpose is public health improvement rather than public health protection. Where health improvement, rather than protection, is the aim, there is no justification for discarding the additional safeguards associated with processing under Regulation 5. PMID:25995294

  1. Oral health-related quality of life in patients with removable dentures.

    PubMed

    Pistorius, Jutta; Horn, Jan G; Pistorius, Alexander; Kraft, Joachim

    2013-01-01

    The purpose of this study was to determine factors that affected oral health-related quality of life (Oral Health Related Quality of Life = OHRQoL) in patients with removable dentures (RD). Quality of life was evaluated by using the Geriatric Oral Health Assessment Index (GOHAI). We analysed data of 250 patients aged 63 ± 11.6 years. After excluding patients lacking relevant analysis data, 243 patients remained in the study, including 129 males and 114 females. Relevant parameters for good OHRQoL were: patient satisfaction with their RD (r = -0.317), higher age (r = 0.222), greater number of remaining teeth (r = 0.357), higher income (r = 0.175), higher frequency of dental visits (r = -0.212), tobacco abstinence (r = -0.181), and residence in a rural area (r = -0.420). Also, marital status had an impact on OHRQoL. Widowed and married patients showed the highest values and unmarried patients the lowest. Frequently mentioned problem areas considered within the survey were: the patient's fear of further tooth loss, concerns about functional aspects such as the decrease in chewing efficiency and dissatisfaction with the aesthetics of the dental prostheses. The results showed that the OHRQoL is apparently not only influenced by dental factors, but also by psychosocial and economic factors, the relevance of which would have to be shown in further studies. PMID:24420442

  2. [A sociological study of factors affecting reproductive health of female teenagers and young women].

    PubMed

    Nizamov, I G; Chechulina, O V

    2003-01-01

    The reproductive health of teenagers deserves a special attention and must be regarded from the viewpoint of their future prospects as well as their social and cultural media. The mentioned social-and-cultural factors affecting the teenagers' attitude towards sexuality and preconditioning their access to information and services of healthcare have an impact on the status of their reproductive health and on their general well-being, including the ability of teenagers to avoid an undesired pregnancy or sexually transmitted diseases. PMID:12882120

  3. Identity Theft in Community Mental Health Patients

    PubMed Central

    Klopp, Jonathon; Konrad, Shane; Yanofski, Jason

    2007-01-01

    Identity theft is a serious problem in the United States, and persons with enduring mental illnesses may be particularly vulnerable to becoming victims of this crime. Victims of identity theft experience a variety of consequences that include financial loss and serious emotional distress. Little is known about the impact of identity theft on individuals with mental illnesses. The two cases from a community mental health center presented in this article demonstrate many of the facets that may be associated with an increased risk for becoming the victim of identity theft. A summary of preventive steps as well as steps involved in resolving the crime once one has become a victim are presented. PMID:20806029

  4. Lack of health maintenance examinations and risk in myeloma patients.

    PubMed

    Tariman, Joseph D; Gleason, Charise; Faiman, Beth; Doss, Deborah; Catamero, Donna; Bishop-Royse, Jessica; Katz, Mike; Kurtin, Sandra; Moran, Diane; Lonial, Sagar

    2016-07-01

    Health maintenance (HM) practices are essential to prevent illness, promote well-being, and maximize health. Patients with multiple myeloma (MM) are at increased risk for cardiovascular disease and cancers, yet, research on HM practices and preventative care of MM survivors has limited report. The study comprised a descriptive, correlational, and cross-sectional online survey design. Survey of patients with MM was carried out through the International Myeloma Foundation (IMF) and the Association of Cancer Online Resources (ACOR) e-mail list services. The members of the IMF and ACOR e-mail list services were surveyed, of which 237 patients responded. The modified Medical Expenditure Preventive Survey-Preventive Care questionnaire was used; it included items that ask patients regarding their healthcare practices that relate to dental care, cancer prevention, addiction, lifestyles, sensory screening, immunizations, cardiovascular, endocrine, psychosocial, and bone health. Descriptive statistics, Pearson's chi-square, and Spearman's rho correlation coefficient were obtained. In this study, men had statistically significant inferior global health maintenance scores than women (P = 0.002). Being employed (P = 0.054) and married or partnered (P = 0.017) were significantly correlated with better health maintenance patterns among male respondents. In contrast, no statistically significant correlations between sociodemographic factors and health maintenance patterns were found in women. Patients with MM, particularly men, require continued education and close monitoring of health maintenance practices. These findings are consistent with publications looking at gender disparities in healthcare utilization in the United States. Studies show that men, in general, are less likely to seek preventative healthcare screenings. Healthcare providers must incorporate health maintenance promotion during clinic visits. PMID:27119422

  5. Mental health professionals’ attitudes toward patients with PTSD and depression

    PubMed Central

    Maier, Thomas; Moergeli, Hanspeter; Kohler, Michaela; Carraro, Giovanni E.; Schnyder, Ulrich

    2015-01-01

    Background To date, mental health professionals’ attitudes toward posttraumatic stress disorder (PTSD), compared to other psychiatric disorders such as schizophrenia or depression, have rarely been studied. Objective We assessed mental health professionals’ attitudes toward patients with PTSD compared to patients suffering from depression. Method Case vignettes of a patient with either PTSD or depression were presented to two samples of mental health professionals: attendees of a conference on posttraumatic stress (N=226) or of a lecture for psychiatry residents (N=112). Participants subsequently completed a questionnaire that assessed their attitude reactions to the presented case. Results Participants showed similarly positive attitudes toward depression and PTSD. PTSD elicited a more favorable attitude with regard to prosocial reactions, estimated dependency, attributed responsibility, and interest in the case, particularly in mental health professionals specializing in psychotraumatology. Across diagnoses, higher age and longer professional experience were associated with more positive attitudes toward patients. Conclusions Mental health professionals’ positive attitudes toward patients with depression and PTSD correlate with their specific knowledge about the disorder, their level of professional training, and their years of professional experience. Limitations The instruments used, although based on established theoretical concepts in attitude research, were not validated in their present versions. PMID:26507340

  6. General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

    PubMed Central

    2011-01-01

    Background Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. Method Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men) and 10 district nurses (7 women, 3 men) from 19 primary health care centres within a well-defined area of Sweden. Results Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. Conclusions Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and profession differences in this

  7. How nurses and their work environment affect patient experiences of the quality of care: a qualitative study

    PubMed Central

    2014-01-01

    Background Healthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences. Methods A descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis. Results The nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care. Conclusions According to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and

  8. Patient-Centered Culturally Sensitive Health Care: Trend or Major Thrust in Health Care Delivery?

    ERIC Educational Resources Information Center

    Killion, Cheryl M.

    2007-01-01

    In this reaction article to the Major Contribution, the merits and challenges of implementing patient-centered culturally sensitive health care, or cultural competence plus, are explicated. Three themes are addressed: separate but equal?, factoring in mental health, and sharing the load. The need to refine the conceptualization of the two…

  9. Survey: Hospitalization Access for Patients of Migrant Health Centers and Combined Migrant and Community Health Centers.

    ERIC Educational Resources Information Center

    Smith, David R.; And Others

    1987-01-01

    A study of migrant health centers' access to hospitals uncovered financial barriers to private hospital care when the patient was indigent or without health insurance. This may be exacerbated as private hospitals expand in states with many migrants. Cooperative efforts between public and private institutions are in order. (VM)

  10. The formal mental health care burden among recently deinstitutionalized patients.

    PubMed

    Deb, P; Holmes, A M

    1998-08-01

    This article examines the extent to which the costs of formal health care are shifted from third-party payers to the patient and his or her family, especially during the transition to the community after discharge from a state hospital. Findings indicate that patients residing in the community are as likely to receive some care as their counterparts in institutions, but are at higher risk for uncovered care. Uncovered care is more likely to manifest as an unmet need for patients who have been recently discharged, especially for racial minorities, and as an out-of-pocket expense for patients who are established in the community. PMID:9685753

  11. Are school-based mental health interventions for war-affected children effective and harmless?

    PubMed

    Ertl, Verena; Neuner, Frank

    2014-01-01

    In recent years, different approaches to large-scale mental health service provision for children in war-affected, mainly low- and middle-income, countries have been developed. Some school-based programs aiming at both strengthening resilience and reducing symptoms of trauma-related distress have been evaluated. In an article published in BMC Medicine, Tol and colleagues integrate their findings of the efficacy of universal school-based intervention across four countries and do not recommend classroom-based intervention as a treatment of trauma-related symptoms, since no consistent positive effects were found. On the contrary, for some children this type of universal intervention may impair recovery. Since universal school-based programs similar to the one evaluated here are widely implemented, Tol et al.'s results are highly relevant to inform the field of mental health service provision in war-affected countries. PMID:24885265

  12. Offering Mental Health Services in a Conflict Affected Region of Pakistan: Who Comes, and Why?

    PubMed Central

    Shah, Safieh; Van den Bergh, Rafael; Van Bellinghen, Benedicte; Severy, Nathalie; Sadiq, Sana; Afridi, Sher Ali; Akhtar, Asma; Maïkére, Jacob; Van Overloop, Catherine; Saeed-ur-Rehman; Khilji, Tahir Bashir-ud-Din; Saleem-ur-Rehman; van Griensven, Johan; Schneider, Serge; Bosman, Philippe; Guillergan, Erwin Lloyd D.; Dazzi, Francesca; Zachariah, Rony

    2014-01-01

    Background North West Pakistan is an area ravaged by conflict and population displacement for over three decades. Recently, drone attacks and military operations have aggravated underlying mental disorders, while access to care is limited. Among patients attending a mental health clinic integrated in district hospital conducted by psychologists; we describe service utilization, patient characteristics, presenting complaints, morbidity patterns, and follow-up details. Methodology/Principal Findings A retrospective study using routinely collected programme data was conducted from February to December 2012. A total of 1545 consultations were conducted for 928 patients (86% females). There were 71(8%) children and adolescents. An increase was observed from February to July, followed by a decline. 163 new patients (18%) were on psychotropic medication at presentation. The most common morbidity in females (36%) were symptoms of adjustment disorders and acute reactions. Depression and anxiety were common in both genders while post traumatic disorder was frequent in males (21%). Out of the 928 new patients, 639(69%) had a follow up visit planned with their psychologist, but only 220(34%) new patients returned for a follow up visit. Conclusion In a district hospital, mental health services managed by psychologists were well attended. There is a need to consider widening the current package of care to cater to the diversity of mental health disorders, gender difference, children and adolescents. Standardized diagnostic and monitoring tools would also need to be adapted accordingly and to assess patient progress. Innovative approaches to tackle the problem of the low return rate are needed. PMID:24963793

  13. The neuroanatomical basis of affective mentalizing in schizophrenia: comparison of patients with schizophrenia and patients with localized prefrontal lesions.

    PubMed

    Shamay-Tsoory, Simone G; Aharon-Peretz, Judith; Levkovitz, Yechiel

    2007-02-01

    Patients with schizophrenia show impaired emotional and social behavior, such as misinterpretation of social situations and lack of Theory of Mind (ToM). However, the neuroanatomical basis of impaired ToM and its nature in schizophrenia is still largely unknown. Based on previous findings, the present study suggests that impaired social cognition observed in schizophrenic patients may be similar to that observed in patients with prefrontal (PFC) damage due to impaired 'affective ToM' abilities, rather than to a general impairment in ToM. We examined the behavioral and neural mechanisms that underlie the social and communicative impairments observed in patients with schizophrenia and with PFC damage, by looking at differential patterns of ToM impairment in these individuals. The performance of 24 patients with schizophrenia was compared to the responses of patients with localized lesions in the ventromedial (VM) or dorsolateral PFC, patients with non-frontal lesions, and healthy control subjects. Patients with schizophrenia and those with VM lesions were impaired on 'affective ToM' tasks but not in cognitive ToM conditions. It was concluded that the pattern of mentalizing impairments in schizophrenia resembled those seen in patients with lesions of the frontal lobe, particularly with VM damage, providing support for the notion of a disturbance of the fronto-limbic circuits in schizophrenia. PMID:17182218

  14. A novel SMARCAL1 missense mutation that affects splicing in a severely affected Schimke immunoosseous dysplasia patient.

    PubMed

    Barraza-García, Jimena; Rivera-Pedroza, Carlos I; Belinchón, Alberta; Fernández-Camblor, Carlota; Valenciano-Fuente, Blanca; Lapunzina, Pablo; Heath, Karen E

    2016-08-01

    Schimke immunoosseous dysplasia (SIOD) is an autosomal recessive disease characterized by skeletal dysplasia, focal segmental glomerulosclerosis, renal failure and immunodeficiency. In this work, we report the molecular studies undertaken in a severely affected SIOD patient that died at six years old due to nephropathy. The patient was screened for mutations using a targeted skeletal dysplasias panel. A homozygous novel missense mutation was identified, c.1615C > G (p.[Leu539Val]) that was predicted as mildly pathogenic by in silico pathogenicity prediction tools. However, splicing prediction software suggested that this variant may create a new splicing donor site in exon 9, which was subsequently confirmed using a minigene assay in HEK293 cells. Thus, the splicing alteration, c.1615C > G; r.1615c > g, 1615_1644del; (p.[Leu539_Ile548del]), results in the loss of 10 amino acids of the HARP-ATPase catalytic domain and the RPA-binding domain. Several studies have demonstrated a weak genotype-phenotype correlation among such patients. Thus, the molecular characterization has helped us to understand why a predicted weakly pathogenic missense mutation results in severe SIOD and should be considered in similar scenarios. PMID:27282802

  15. Fostering Innovation, Advancing Patient Safety: The Kidney Health Initiative

    PubMed Central

    Archdeacon, Patrick; Winkelmayer, Wolfgang C.; Falk, Ronald J.; Roy-Chaudhury, Prabir

    2013-01-01

    Summary To respond to the serious and underrecognized epidemic of kidney disease in the United States, the US Food and Drug Administration and the American Society of Nephrology have founded the Kidney Health Initiative—a public–private partnership designed to create a collaborative environment in which the US Food and Drug Administration and the greater kidney community can interact to optimize the evaluation of drugs, devices, biologics, and food products. The Kidney Health Initiative will bring together all the necessary stakeholders, including patients, regulators, industry, health care providers, academics, and other governmental agencies, to improve patient safety and foster innovation. This initiative is intended to enable the kidney community as a whole to provide the right drug, device, or biologic for administration to the right patient at the right time by fostering partnerships that will facilitate development and delivery of those products and addressing challenges that currently impede these goals. PMID:23744001

  16. Fostering innovation, advancing patient safety: the kidney health initiative.

    PubMed

    Archdeacon, Patrick; Shaffer, Rachel N; Winkelmayer, Wolfgang C; Falk, Ronald J; Roy-Chaudhury, Prabir

    2013-09-01

    To respond to the serious and underrecognized epidemic of kidney disease in the United States, the US Food and Drug Administration and the American Society of Nephrology have founded the Kidney Health Initiative-a public-private partnership designed to create a collaborative environment in which the US Food and Drug Administration and the greater kidney community can interact to optimize the evaluation of drugs, devices, biologics, and food products. The Kidney Health Initiative will bring together all the necessary stakeholders, including patients, regulators, industry, health care providers, academics, and other governmental agencies, to improve patient safety and foster innovation. This initiative is intended to enable the kidney community as a whole to provide the right drug, device, or biologic for administration to the right patient at the right time by fostering partnerships that will facilitate development and delivery of those products and addressing challenges that currently impede these goals. PMID:23744001

  17. Using health psychology to help patients: theories of behaviour change.

    PubMed

    Barley, Elizabeth; Lawson, Victoria

    2016-09-01

    Behaviour change theories and related research evidence highlight the complexity of making and sticking to health-related behaviour changes. These theories make explicit factors that influence behaviour change, such as health beliefs, past behaviour, intention, social influences, perceived control and the context of the behaviour. Nurses can use this information to understand why a particular patient may find making recommended health behaviour changes difficult and to determine factors that may help them. This article outlines five well-established theories of behaviour change: the health belief model, the theory of planned behaviour, the stages of change model, self-determination theory, and temporal self-regulation theory. The evidence for interventions that are informed by these theories is then explored and appraised. The extent and quality of evidence varies depending on the type of behaviour and patients targeted, but evidence from randomised controlled trials indicates that interventions informed by theory can result in behaviour change. PMID:27615529

  18. A Study of Predictive Factors Affecting Health: Promoting Behaviors of North Korean Adolescent Refugees

    PubMed Central

    Noh, Jin-Won; Yun, Hyo-Young; Park, Hyunchun; Yu, Shi-Eun

    2015-01-01

    Objectives: The present study aimed to analyze the factors that could affect the health-promoting behaviors of North Korean adolescent refugees residing in South Korea. Methods: Questions about their sociodemographic variables, subjective health status, healthy living habits, and health-promoting behaviors were asked. Results: Statistically significant differences were found in religion (t=2.30, p<0.05), having family members in South Korea (t=2.02, p<0.05), and subjective health status (t=4.96, p<0.01). Scores on health-responsible behaviors were higher with higher age (t=2.90, p<0.01) and for subjects without family or friends (t=2.43, p<0.05). Higher physical-activity behaviors were observed in males (t=3.32, p<0.01), in those with better subjective health status (t=3.46, p<0.05) and lower body mas index (t=3.48, p<0.05), and in smokers (t=3.17, p<0.01). Nutritional behaviors were higher in those who followed a religion (t=2.17, p<0.05). Spiritual growth behaviors were higher in those who followed a religion (t=4.21, p<0.001), had no family in South Korea (t=2.04, p<0.05), and had higher subjective health status (t=5.74, p<0.01). Scores on interpersonal relationships and stress-management behaviors were higher for those with higher subjective health status. A multiple regression analysis showed greater effects on health-promoting behaviors when subjective health status was better. Older people and non-smokers exhibited more health-responsible behaviors, while more physical-activity behaviors and spiritual growth activities were observed when subjective health status was better. Interpersonal relationship behaviors had positive effects on those with good subjective heath status and on non-smokers. Conclusions: Based on the results of the current study, an alternative was suggested for promoting health in North Korean adolescent refugees. PMID:26429289

  19. External built residential environment characteristics that affect mental health of adults.

    PubMed

    Ochodo, Charles; Ndetei, D M; Moturi, W N; Otieno, J O

    2014-10-01

    External built residential environment characteristics include aspects of building design such as types of walls, doors and windows, green spaces, density of houses per unit area, and waste disposal facilities. Neighborhoods that are characterized by poor quality external built environment can contribute to psychosocial stress and increase the likelihood of mental health disorders. This study investigated the relationship between characteristics of external built residential environment and mental health disorders in selected residences of Nakuru Municipality, Kenya. External built residential environment characteristics were investigated for 544 residents living in different residential areas that were categorized by their socioeconomic status. Medically validated interview schedules were used to determine mental health of residents in the respective neighborhoods. The relationship between characteristics of the external built residential environment and mental health of residents was determined by multivariable logistic regression analyses and chi-square tests. The results show that walling materials used on buildings, density of dwelling units, state of street lighting, types of doors, states of roofs, and states of windows are some built external residential environment characteristics that affect mental health of adult males and females. Urban residential areas that are characterized by poor quality external built environment substantially expose the population to daily stressors and inconveniences that increase the likelihood of developing mental health disorders. PMID:24464242

  20. Affective personality as cognitive-emotional presymptom profiles regulatory for self-reported health predispositions.

    PubMed

    Archer, T; Adolfsson, B; Karlsson, E

    2008-08-01

    Three studies that examined the links between affective personality, as constructed from responses to the Positive Affect (PA) and Negative Affect (NA) Scale (PANAS), and individuals' self-report of self-esteem, intrinsic motivation and Beck's Depression Inventory (BDI) depression in high school students and persons in working occupations are described. Self-report estimations of several other neuropsychiatric and psychosocial variables including, the Uppsala Sleep Inventory (USI), the Hospital Anxiety and Depression (HAD) test, Dispositional optimism, Locus of control, the Subjective Stress Experience test (SSE) and the Stress-Energy (SE) test, were also derived. Marked effects due to affective personality type upon somatic and psychological stress, anxiety and depression, self-esteem, internal and external locus of control, optimism, stress and energy, intrinsic motivation, external regulation, identified regulation, major sleep problems, problems falling asleep, and psychophysiological problems were observed; levels of self-esteem, self-motivation and BDI-depression all produced substantial effects on health and well-being. Regression analyses indicated PA was predicted by dispositional optimism (thrice), energy (thrice), and intrinsic motivation, and counter predicted by depression (twice) and stress (twice); and NA by anxiety (twice), stress (twice), psychological stress, identified regulation, BDI depression and psychophysiological problems, and counter predicted by internal locus of control and self-esteem. BDI-depression was predicted by negative affect, major sleep problems and psychophysiological problems (Study III), self-esteem by dispositional optimism and energy, and counter predicted by anxiety, depression and stress (Study I), and intrinsic motivation by dispositional optimism, energy, PA and self-esteem (Study II). These convergent findings are interpreted from a perspective of the cognitive-emotional expressions underlying behavioural or

  1. Patients as partners: a qualitative study of patients' engagement in their health care.

    PubMed

    Pomey, Marie-Pascale; Ghadiri, Djahanchah P; Karazivan, Philippe; Fernandez, Nicolas; Clavel, Nathalie

    2015-01-01

    To advocate for patients to be more actively involved with the healthcare services they receive, particularly patients living with chronic illness, the Faculty of Medicine of the University of Montreal and its affiliated hospitals developed the Patients as Partners concept where the patient is considered a full-fledged partner of the health care delivery team and the patient's experiential knowledge is recognized. This study aims to show how patients view their engagement with healthcare professionals regarding their direct care. Using theoretical sampling, 16 semi-structured interviews were conducted with patients with chronic illness who were familiar with the concept of Patients as Partners. Data analysis followed a constructivist grounded theory approach. Patients describe themselves as proactively engaging in three types of practice, regardless of health professionals' openness to their role as partners. The first is a process of continuous learning that allows them to acquire experiential knowledge about their health, as well as scientific information and technical know-how. The second involves their assessment of the healthcare they receive, in terms of its quality and how it aligns with their personal preferences. It includes their assessment of the quality of their relationship with the health professional and of the latter's scientific knowledge and technical know-how. The third type, adaptation practices, builds on patients' learning and assessments to compensate for and adapt to what has been perceived as optimal or non-optimal health or healthcare circumstances. Patients appear to play a more active and less docile role in their own direct care than suggested so far in the literature, regardless of the degree of reciprocity of the partnership or the degree to which the health professional seeks to encourage patient engagement. PMID:25856569

  2. 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

  3. How patients' review sites will change health care.

    PubMed

    Hotopf, Max

    2013-10-01

    TripAdvisor has changed how the travel industry treats customers. Is the same likely to happen to health services? Review sites are growing fast across Europe, propelled by expansions in patient choice. What impact will they have on the medical profession and on providers, both public and private? How will they change the nature of health care? To address these questions, those at the forefront of developing review sites in Europe were interviewed. PMID:23904237

  4. Assessing patients' health behaviours. Essential steps for motivating patients to adopt and maintain behaviours conducive to oral health.

    PubMed

    Freeman, Ruth; Ismail, Amid

    2009-01-01

    This chapter provides a summary of various approaches to behaviour change in oral health. The current research evidence does not support the practice of giving 'instructions' or 'advice' to patients as a means of modifying their attitudes or changing their health behaviours. A number of explanatory models are described which address both the complexity and the factors that influence and predict an individual's health behaviour. A practical guide of what should be assessed and professional assumptions which may be made to assist patients change and maintain their health behaviours are provided. The potential for difficulty during this assessment period is raised since this awareness will allow for flexibility when negotiating with patients to help them develop strategies to modify, change and maintain their health behaviours. Thus, the last part of the chapter describes new approaches that rely on multiple models that focus on patients' or recipients' beliefs, desired goals and readiness to change which are preferable to the traditional patient education approaches in dentistry. PMID:19494679

  5. Health Numeracy: Perspectives About Using Numbers in Health Management from African American Patients Receiving Dialysis

    PubMed Central

    Wright Nunes, Julie A.; Osborn, Chandra Y.; Ikizler, T. Alp; Cavanaugh, Kerri L.

    2015-01-01

    Background Health numeracy is linked to important clinical outcomes. Kidney disease management relies heavily on patient numeracy skills across the continuum of kidney disease care. Little data is available eliciting stakeholder perspectives from patients receiving dialysis about the construct of health numeracy. Methods Using focus groups we asked patients receiving hemodialysis open-ended questions to identify facilitators and barriers to their understanding, interpreting, and applying numeric information in kidney care. Transcripts were analyzed using content analysis. Results Twelve patients participated with a mean (SD) age of 56 (12) years. All were African American, 50% were female and 83% with an annual income < $20,000/year. Although patients felt numbers were critical to every aspect in life, they noted several barriers to understanding, interpreting and applying quantitative information specifically to manage their health. Low patient self-efficacy related to health numeracy and limited patient-provider communication about quantitatively based feedback, were emphasized as key barriers. Conclusions Through focus groups of key patient stakeholders we identified important modifiable barriers to effective kidney care. Additional research is needed to develop tools that support numeracy sensitive education and communication interventions in dialysis. PMID:25358522

  6. Survivorship health information counseling for patients with prostate cancer.

    PubMed

    Colella, Joan; Gejerman, Glen

    2013-01-01

    Cancer survivorship has been recognized in recent years as a critical variable in the cancer care continuum. The Institute of Medicine issued a special report in 2006 addressing cancer survivorship issues. One intervention within these reports is cancer survivorship education about chronic effects following cancer treatment. This evidence-based practice (EBP) project provided a survivorship discharge health information counseling program for patients with localized prostate cancer who were treated with external beam radiation. The results of this pilot program resulted in improved patient satisfaction with survivorship discharge health information for cancel care. PMID:24592520

  7. Some effects of a health educational film on cardiac patients.

    PubMed

    Kliment, P; Palát, M; Riecanský, I; Fejfar, Z

    1982-01-01

    A health educational film on the psychosocial problems of their illness and recovery was viewed by 51 male patients with myocardial infarction. The attractiveness of the topic was tested and found to be high. Reactions elicited by separate messages of the film during the performance were recorded: their rate rose significantly after statements concerning mostly psychosocial aspects of recovery. On behalf of 13 criteria the film was evaluated by the patients medium positively with differences depending on their education. Viewing of the film changed the kind and structure of expressed demands for more health information and made them more concrete. PMID:7183112

  8. Prehension Kinematics, Grasping Forces, and Independent Finger Control in Mildly Affected Patients with Essential Tremor.

    PubMed

    Solbach, Kasja; Mumm, Mareike; Brandauer, Barbara; Kronenbürger, Martin; Hermsdörfer, Joachim; Timmann, Dagmar

    2016-08-01

    Although the pathophysiology of essential tremor (ET), one of the most common movement disorders, is not fully understood, evidence increasingly points to cerebellar involvement. To confirm this connection, we assessed the everyday hand and finger movements of patients with ET, as these movements are known to be affected in cerebellar diseases. In 26 mildly affected patients with ET (compared to age- and gender-matched controls), kinematic and finger force parameters were assessed in a precision grip. In a second task, independent finger movements were recorded. The active finger had to press and release against a force-sensitive keypad while the other fingers stayed inactive. Finally, control of grip force to movement-induced, self-generated load changes was studied. Transport and shaping components during prehension were significantly impaired in patients with ET compared to controls. No significant group differences were observed in independent finger movements and grip force adjustments to self-generated load force changes. However, in the latter two tasks, more severely affected ET patients performed worse than less affected. Although observed deficits in hand and finger movement tasks were small, they are consistent with cerebellar dysfunction in ET. Findings need to be confirmed in future studies examining more severely affected ET patients. PMID:26310449

  9. Promoting oral health practice among patients with diabetes attending primary health care clinics

    PubMed Central

    Aljaber, Abeer; Al-Surimi, Khaled

    2015-01-01

    The oral public health program for patients with diabetes was initiated by Saudi Arabia Ministry of Health (MoH) based on international quality standard to control the severity of oral disease in patients with diabetes through improving the accessibility of patients to dental clinics in primary health care centers (PHCC). This program intends to deliver oral health care (OHC) for each patient with diabetes at least one visit every six months. However, we found that more than 90% of patients with diabetes that visited prince Mohammed bin Saud PHCC in Riyadh do not get their regular dental check up every six months. We developed a quality improvement project (QIP) using the quality improvement model to activate MoH oral health program for patients with diabetes visiting prince Mohamed bin Saud PHCC. The aim of our QIP was to increase number of patients with diabetes receiving their regular oral health check up during the PHC visit. The quality team tested two simple improvement ideas. The first idea was having the dentist signature on appointment request. The testing of the first idea led to the second idea, that both physician and dentist should sign the referral form. After running several PDSA cycles to test these interventions ideas, we found the number of patients with diabetes seen in dental clinic had increased dramatically compared with the baseline assessment. We conclude that the idea of signing the referral form by both physician and dentist is a practical and simple strategy to be executed and has a direct impact on the patient clinical flow between clinics. PMID:26734427

  10. Promoting oral health practice among patients with diabetes attending primary health care clinics.

    PubMed

    Aljaber, Abeer; Al-Surimi, Khaled

    2015-01-01

    The oral public health program for patients with diabetes was initiated by Saudi Arabia Ministry of Health (MoH) based on international quality standard to control the severity of oral disease in patients with diabetes through improving the accessibility of patients to dental clinics in primary health care centers (PHCC). This program intends to deliver oral health care (OHC) for each patient with diabetes at least one visit every six months. However, we found that more than 90% of patients with diabetes that visited prince Mohammed bin Saud PHCC in Riyadh do not get their regular dental check up every six months. We developed a quality improvement project (QIP) using the quality improvement model to activate MoH oral health program for patients with diabetes visiting prince Mohamed bin Saud PHCC. The aim of our QIP was to increase number of patients with diabetes receiving their regular oral health check up during the PHC visit. The quality team tested two simple improvement ideas. The first idea was having the dentist signature on appointment request. The testing of the first idea led to the second idea, that both physician and dentist should sign the referral form. After running several PDSA cycles to test these interventions ideas, we found the number of patients with diabetes seen in dental clinic had increased dramatically compared with the baseline assessment. We conclude that the idea of signing the referral form by both physician and dentist is a practical and simple strategy to be executed and has a direct impact on the patient clinical flow between clinics. PMID:26734427

  11. Oral health related quality of life among imprisoned Dutch forensic psychiatric patients.

    PubMed

    Buunk-Werkhoven, Yvonne A B; Dijkstra, Arie; Schaub, Rob M H; van der Schans, Cees P; Spreen, Marinus

    2010-01-01

    Because dental health and oral pathology may affect forensic psychiatric patients' well being, it is important to be able to assess oral health related quality of life (OH-QoL) in these patients. Two studies were conducted among Dutch forensic psychiatric male patients to assess the psychometric properties and some potential predictors of the Oral Health Impact Profile-14 (OHIP-14) as a measure of OH-QoL. Study 1 involved 40 patients who completed the OHIP-14 before receiving professional dental care and were retested 3 months later. The internal consistency was good, the test-retest correlations were fair, and over the 3 months follow-up no significant changes in OH-QoL were observed. Study 2 consisted of 39 patients who completed an improved version of the original OHIP-14, as well as measures to validate of the OHIP. Dental anxiety and unhealthy dentition jointly explained 26.7% of the variance in OH-QoL, and the better patients performed their oral hygiene behavior, the better their OH-QoL. It is concluded that the Dutch OHIP-14 is a useful instrument, and that nurses, especially in forensic nursing, should pay particularly attention to dental anxiety when encouraging patients to visit OH professionals and to perform adequate oral hygiene self-care. PMID:21175534

  12. An investigation on pharmacy functions and services affecting satisfaction of patients with prescriptions in community pharmacies.

    PubMed

    Sakurai, Hidehiko; Nakajima, Fumio; Tada, Yuichirou; Yoshikawa, Emi; Iwahashi, Yoshiki; Fujita, Kenji; Hayase, Yukitoshi

    2009-05-01

    Various functions expected by patient expects are needed with progress in the system for separation of dispensing and prescribing functions. In this investigation, the relationship between patient satisfaction and pharmacy function were analyzed quantitatively. A questionnaire survey was conducted in 178 community pharmacies. Questions on pharmacy functions and services totaled 87 items concerning information service, amenities, safety, personnel training, etc. The questionnaires for patients had five-grade scales and composed 11 items (observed variables). Based on the results, "the percentage of satisfied patients" was determined. Multivariate analysis was performed to investigate the relationship between patient satisfaction and pharmacy functions or services provided, to confirm patient's evaluation of the pharmacy, and how factors affected comprehensive satisfaction. In correlation analysis, "the number of pharmacists" and "comprehensive satisfaction" had a negative correlation. Other interesting results were obtained. As a results of factor analysis, three latent factors were obtained: the "human factor," "patients' convenience," and "environmental factor," Multiple regression analysis showed that the "human factor" affected "comprehensive satisfaction" the most. Various pharmacy functions and services influence patient satisfaction, and improvement in their quality increases patient satisfaction. This will result in the practice of patient-centered medicine. PMID:19420889

  13. Famine-affected, refugee, and displaced populations: recommendations for public health issues.

    PubMed

    1992-07-24

    During the past three decades, the most common emergencies affecting the health of large populations in developing countries have involved famine and forced migrations. The public health consequences of mass population displacement have been extensively documented. On some occasions, these migrations have resulted in extremely high rates of mortality, morbidity, and malnutrition. The most severe consequences of population displacement have occurred during the acute emergency phase, when relief efforts are in the early stage. During this phase, deaths--in some cases--were 60 times the crude mortality rate (CMR) among non-refugee populations in the country of origin (1). Although the quality of international disaster response efforts has steadily improved, the human cost of forced migration remains high. Since the early 1960s, most emergencies involving refugees and displaced persons have taken place in less developed countries where local resources have been insufficient for providing prompt and adequate assistance. The international community's response to the health needs of these populations has been at times inappropriate, relying on teams of foreign medical personnel with little or no training. Hospitals, clinics, and feeding centers have been set up without assessment of preliminary needs, and essential prevention programs have been neglected. More recent relief programs, however, emphasize a primary health care (PHC) approach, focusing on preventive programs such as immunization and oral rehydration therapy (ORT), promoting involvement by the refugee community in the provision of health services, and stressing more effective coordination and information gathering. The PHC approach offers long-term advantages, not only for the directly affected population, but also for the country hosting the refugees. A PHC strategy is sustainable and strengthens the national health development program. PMID:1326713

  14. Patient Age Influences Perceptions About Health Care Communication

    PubMed Central

    DeVoe, Jennifer E.; Wallace, Lorraine S.; Fryer, George E.

    2016-01-01

    Objective The study’s objective was to determine if a patient’s age is independently associated with how he/she perceives interactions with health care providers Methods We used a secondary, cross-sectional analysis of nationally representative data from the 2002 Medical Expenditure Panel Survey (MEPS). We measured the independent association between patient age and six outcomes pertaining to communication and decision-making autonomy, while simultaneously controlling for gender, race, ethnicity, family income, educational attainment, census region, rural residence, insurance status, and usual source of care. Results Compared to patients ≥ 65 years, patients ages 18–64 were less likely to report that their provider “always” listened to them, “always” showed respect for what they had to say, and “always” spent enough time with them. Discussion Patient perceptions of health care interactions vary by age. A better understanding of how and why age is associated with patient-provider communication could be useful to design practice-level interventions that enhance services and also to develop national policies that improve health care delivery and health outcomes. PMID:19184691

  15. Health Literacy and Education as Mediators of Racial Disparities in Patient Activation Within an Elderly Patient Cohort.

    PubMed

    Eneanya, Nwamaka D; Winter, Michael; Cabral, Howard; Waite, Katherine; Henault, Lori; Bickmore, Timothy; Hanchate, Amresh; Wolf, Michael; Paasche-Orlow, Michael K

    2016-01-01

    The Patient Activation Measure (PAM) assesses facets of patient engagement to identify proactive health behaviors and is an important predictor of health outcomes. Health literacy and education are also important for patient participation and successful navigation of the health care system. Because health literacy, education, and patient activation are associated with racial disparities, we sought to investigate whether health literacy and education would mediate racial differences in patient activation. Participants were 265 older adults who participated in a computer-based exercise interventional study. Health literacy was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Of 210 eligible participants, 72% self-identified as Black and 28% as White. In adjusted analyses, education and health literacy each significantly reduced racial differences in patient activation. These findings are especially important when considering emerging data on the significance of patient activation and new strategies to increase patient engagement. PMID:27524777

  16. Intimate Partner Violence and Its Health Impact on Disproportionately Affected Populations, Including Minorities and Impoverished Groups

    PubMed Central

    Hayashi, Hitomi; Campbell, Jacquelyn C.

    2015-01-01

    Abstract In the United States, intimate partner violence (IPV) against women disproportionately affects ethnic minorities. Further, disparities related to socioeconomic and foreign-born status impact the adverse physical and mental health outcomes as a result of IPV, further exacerbating these health consequences. This article reviews 36 U.S. studies on the physical (e.g., multiple injuries, disordered eating patterns), mental (e.g., depression, post-traumatic stress disorder), and sexual and reproductive health conditions (e.g., HIV/STIs, unintended pregnancy) resulting from IPV victimization among ethnic minority (i.e., Black/African American, Hispanic/Latina, Native American/Alaska Native, Asian American) women, some of whom are immigrants. Most studies either did not have a sufficient sample size of ethnic minority women or did not use adequate statistical techniques to examine differences among different racial/ethnic groups. Few studies focused on Native American/Alaska Native and immigrant ethnic minority women and many of the intra-ethnic group studies have confounded race/ethnicity with income and other social determinants of health. Nonetheless, of the available data, there is evidence of health inequities associated with both minority ethnicity and IPV. To appropriately respond to the health needs of these groups of women, it is necessary to consider social, cultural, structural, and political barriers (e.g., medical mistrust, historical racism and trauma, perceived discrimination, immigration status) to patient–provider communication and help-seeking behaviors related to IPV, which can influence health outcomes. This comprehensive approach will mitigate the racial/ethnic and socioeconomic disparities related to IPV and associated health outcomes and behaviors. PMID:25551432

  17. FACTORS ASSOCIATED WITH PATIENT's CARE DURING CONSULTATION IN MINISTRY OF HEALTH FACILITIES, JEDDAH CITY, SAUDI ARABIA

    PubMed Central

    Balbaid, Omar M.; Al-Dawood, Kasim M.

    1997-01-01

    Objective: To assess the factors affecting health care and patient's satisfaction during the consultation. Design: A cross-sectional study was conducted using a structured questionnaire form on a random sample of outpatient clinic attendants. Setting: The Outpatient Department clinics at King Fahad and King Abdulaziz Hospital in addition to eleven Primary Health Care Centers (PHCCs) in Jeddah. Subjects: A sample of 340 subjects attending clinics of two hospitals and eleven PHCCs. Methods: Direct interviewing of subjects using a structured questionnaire was carried out. Information collected was basic demographic data regarding satisfaction with aspects of outpatient health care. Results: The rate of patients’ satisfaction in all facilities was 76.5% with no significant variation between hospitals and Primary Health Care Centers. The study showed aspects of poor patient care, such as short consultation time and incomplete physical examination of patients. Other factors correlated with mean consultation time and completeness of physical examination were stressed. Conclusion: There was a low rate of patients’ satisfaction in all Ministry of Health (MOH) facilities studied. Aspects related to patient care need to be improved. Practical recommendations on this were stressed PMID:23008565

  18. Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients.

    PubMed

    de Oliveira, Claire; Cheng, Joyce; Vigod, Simone; Rehm, Jürgen; Kurdyak, Paul

    2016-01-01

    A small proportion of health care users, called high-cost patients, account for a disproportionately large share of health care costs. Most literature on these patients has focused on the entire population. However, high-cost patients whose use of mental health care services is substantial are likely to differ from other members of the population. We defined a mental health high-cost patient as someone for whom mental health-related services accounted for at least 50 percent of total health care costs. We examined these patients' health care utilization and costs in Ontario, Canada. We found that their average cost for health care, in 2012 Canadian dollars, was $31,611. In contrast, the cost was $23,681 for other high-cost patients. Mental health high-cost patients were younger, lived in poorer neighborhoods, and had different health care utilization patterns, compared to other high-cost patients. These findings should be considered when implementing policies or interventions to address quality of care for mental health patients so as to ensure that mental health high-cost patients receive appropriate care in a cost-effective manner. Furthermore, efforts to manage mental health patients' health care use should address their complex profile through integrated multidisciplinary health care delivery. PMID:26733699

  19. Patient health information materials in waiting rooms of family physicians: do patients care?

    PubMed Central

    Moerenhout, Tania; Borgermans, Liesbeth; Schol, Sandrina; Vansintejan, Johan; Van De Vijver, Erwin; Devroey, Dirk

    2013-01-01

    Background Patient health information materials (PHIMs), such as leaflets and posters are widely used by family physicians to reinforce or illustrate information, and to remind people of information received previously. This facilitates improved health-related knowledge and self-management by patients. Objective This study assesses the use of PHIMs by patient. It also addresses their perception of the quality and the impact of PHIMs on the interaction with their physician, along with changes in health-related knowledge and self-management. Methods Questionnaire survey among patients of family practices of one town in Belgium, assessing: (1) the extent to which patients read PHIMs in waiting rooms (leaflets and posters) and take them home, (2) the patients’ perception of the impact of PHIMs on interaction with their physician, their change in health-related knowledge and self-management, and (3) the patients judgment of the quality of PHIMs. Results We included 903 questionnaires taken from ten practices. Ninety-four percent of respondents stated they read PHIMs (leaflets), 45% took the leaflets home, and 78% indicated they understood the content of the leaflets. Nineteen percent of respondents reportedly discussed the content of the leaflets with their physician and 26% indicated that leaflets allowed them to ask fewer questions of their physician. Thirty-four percent indicated that leaflets had previously helped them to improve their health-related knowledge and self-management. Forty-two percent reportedly discussed the content of the leaflets with others. Patient characteristics are of significant influence on the perceived impact of PHIMS in physician interaction, health-related knowledge, and self-management. Conclusion This study suggests that patients value health information materials in the waiting rooms of family physicians and that they perceive such materials as being helpful in improving patient–physician interaction, health-related knowledge, and

  20. Holistic health assessment tool for patients on maintenance hemodialysis.

    PubMed

    Singhania, P R; Mandalika, S

    2012-07-01

    The recent emphasis on assessment of the psychological status, availability of newer and better methods of interpreting the anthropometric measurements of renal patients on dialysis therapy prompted the authors to develop the "Holistic Health Assessment Tool for dialysis patients (HHAT-D)." A total of 30 subjects (25-65 years), enrolled from dialysis centers in Mumbai were administered the HHAT-D tool to assess anthropometric, biochemical, functional, and psychological status (knowledge, needs, that coping strategies) along with dietary intake. The results showed that majority of the patients (73.3%) were mild to moderately malnourished. A highly significant negative correlation of anthropometric measurements (BMI, lean body mass, mid arm circumference, arm muscle area, bicep skin fold thickness, % usual body weight, and % standard body weight) with the HHAT-D scores (P<0.01) confirmed the validity of the tool in assessing the degree of malnutrition. The poor health status of the patients was further confirmed by the average (40%) to poor (36.6%) flexibility status and poor dietary nutrient intake. Moderate (36.6%) to high (60%) coping effectiveness was recorded in the patients as assessed using the "coping effectiveness inventory." A high degree of interitem correlation (Cronbach's coefficient alpha-test value 0.836) also proved the reliability of the HHAT-D tool. Thus, the HHAT-D was found to be a specific and reliable tool for assessment of holistic health status of patients on maintenance hemodialysis to improve quality of life and facilitate faster recovery. PMID:23162270

  1. Patients’ report on how endometriosis affects health, work, and daily life

    PubMed Central

    Fourquet, Jessica; Gao, Xin; Zavala, Diego; Orengo, Juan C.; Abac, Sonia; Ruiz, Abigail; Laboy, Joaquín; Flores, Idhaliz

    2009-01-01

    NARRATIVE ABSTRACT The objective of this study was to assess the burden of endometriosis by obtaining Patient Reported Outcome (PRO) data describing the experience of living with this disease. Survey data from one hundred and seven women with self-reported, surgically diagnosed endometriosis showed that living with this disease may be characterized by physical limitations that disrupt health, work and daily life. PMID:19926084

  2. Context matters: Community characteristics and mental health among war-affected youth in Sierra Leone

    PubMed Central

    Betancourt, Theresa S.; McBain, Ryan; Newnham, Elizabeth A.; Brennan, Robert T.

    2013-01-01

    Background Worldwide, over one billion children and adolescents live in war-affected settings. At present, only limited research has investigated linkages between disrupted social ecology and adverse mental health outcomes among war-affected youth. In this study, we examine three community-level characteristics—social disorder and collective efficacy within the community, as reported by caregivers, and perceived stigma as reported by youth—in relation to externalizing behaviors and internalizing symptoms among male and female former child soldiers in post-conflict Sierra Leone. Methods 243 former child soldiers (30% female, mean age at baseline: 16.6 years) and their primary caregivers participated in interviews in 2004 and 2008, as part of a larger prospective cohort study of war-affected youth in Sierra Leone. Two-point growth models were estimated to examine the relationship between community-level characteristics and externalizing and internalizing outcomes across the time points. Results Both social disorder within the community, reported by caregivers, and perceived stigma, reported by youth, positively co-varied with youths’ externalizing and internalizing scores—indicating that higher levels of each at baseline and follow-up were associated with higher levels of mental health problems at both time points (p<0.05). The relationship between collective efficacy and mental health outcomes was non-significant (p>0.05). Conclusions This study offers a rare glimpse into the role that the post-conflict social context plays in shaping mental health among former child soldiers. Results indicate that both social disorder and perceived stigma within the community demonstrate an important relationship to externalizing and internalizing problems among adolescent ex-combatants. Moreover, these relationships persisted over a four-year period of follow up. These results underscore the importance of the post-conflict social environment and the need to develop post

  3. Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study

    PubMed Central

    Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

    2015-01-01

    Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. PMID:27227131

  4. Children affected by HIV/AIDS: SAFE, a model for promoting their security, health, and development.

    PubMed

    Betancourt, Theresa S; Fawzi, Mary K S; Bruderlein, Claude; Desmond, Chris; Kim, Jim Y

    2010-05-01

    A human security framework posits that individuals are the focus of strategies that protect the safety and integrity of people by proactively promoting children's well being, placing particular emphasis on prevention efforts and health promotion. This article applies this framework to a rights-based approach in order to examine the health and human rights of children affected by HIV/AIDS. The SAFE model describes sources of insecurity faced by children across four fundamental dimensions of child well-being and the survival strategies that children and families may employ in response. The SAFE model includes: Safety/protection; Access to health care and basic physiological needs; Family/connection to others; and Education/livelihoods. We argue that it is critical to examine the situation of children through an integrated lens that effectively looks at human security and children's rights through a holistic approach to treatment and care rather than artificially limiting our scope of work to survival-oriented interventions for children affected by HIV/AIDS. Interventions targeted narrowly at children, in isolation of their social and communal environment as outlined in the SAFE model, may in fact undermine protective resources in operation in families and communities and present additional threats to children's basic security. An integrated approach to the basic security and care of children has implications for the prospects of millions of children directly infected or indirectly affected by HIV/AIDS around the world. The survival strategies that young people and their families engage in must be recognized as a roadmap for improving their protection and promoting healthy development. Although applied to children affected by HIV/AIDS in the present analysis, the SAFE model has implications for guiding the care and protection of children and families facing adversity due to an array of circumstances from armed conflict and displacement to situations of extreme poverty

  5. Factors affecting decision-making of patients choosing acupuncture in a public hospital

    PubMed Central

    Koh, Thean Howe Bryan; Kong, Keng He; Low, Yin Peng

    2015-01-01

    Background With increasing evidence to support its practice, acupuncture has been integrated within many hospitals around the world. The purpose of this study is to understand the factors affecting decision making of patients as they select acupuncture treatment for their medical conditions and symptoms within a public hospital. Methods A qualitative study consisting of in depth interviews with 14 patients was conducted. All patients attended an acupuncture clinic within a public hospital. Data collected was analysed via thematic analysis. Results Four main factor groups affecting decision making of patients were identified- factors affecting the level and value of patient-centric care, the confidence and trust patients place within the acupuncture service, the presence of collaborative efforts between acupuncturists and Western medicine practitioners, and the knowledge, culture and belief society has regarding the role of acupuncture and Western medicine. All participants interviewed had more than one factor group present as enablers toward their eventual selection of acupuncture for ailment management. It was also noted that although the majority of participants had sufficient knowledge regarding acupuncture, there were a select few who had misperceptions or no knowledge regarding certain aspects of acupuncture. Conclusions There may be certain patterns in the way patients choose to utilise acupuncture services in public hospitals. Further studies should also be carried out in other public hospitals to analyse the factor groups identified further. PMID:26697443

  6. Impairments of attention and effort among patients with major affective disorders.

    PubMed

    Cohen, R; Lohr, I; Paul, R; Boland, R

    2001-01-01

    Impairments of attention are common among people with major affective disorders, yet the influence of effortful task demands on attentional performance in unipolar and bipolar illness has been little studied. The authors compared psychiatric inpatients with primary diagnoses of unipolar or bipolar affective disorder (n=27) and age-matched normal control subjects (n=20) on a battery of eight neuropsychological tasks designed to measure different attentional functions. There were low-effort and high-effort versions of each task. Significant group differences were consistently observed on tasks demanding sustained and focused attention, but not on tasks requiring visual selective attention. Although affective disorder patients showed impairments on most tasks regardless of level of task effort, group differences were greatest on high-effort conditions. Results indicate that patients with major affective disorders show significant attentional impairments on most measures of effortful attention, and the magnitude of these impairments increases as the effortful demands of the task increase. PMID:11514646

  7. Effect of Nasal Calcitonin on the Health-Related Quality of Life in Postmenopause Women Affected With Low Bone Density

    PubMed Central

    Shohrati, Majid; Bayat, Noushin; Saburi, Amin; Abbasi, Zahra

    2015-01-01

    Background: Physical activity and mental health could be affected by osteoporosis and various therapeutic options such as calcitonin may influence Quality Of Life (QOL) of these patients with Low Bone Density (LBD). Objectives: This study aimed to evaluate the effect of nasal calcitonin on QOL in post menopause women with LBD. Patients and Methods: This clinical trial study was performed on one hundred and fifteen menopause women with LBD less than 1 SD in Bone Mineral Densitometry (BMD) referred to Baqiyatallah Hospital in Tehran, Iran, during 2009 - 2010. They were assigned to receive 200 IU calcitonin nasal spray along with calcium (1000 mg) and vitamin D (400 IU) for 6 months. Quality of life was assessed by Short-Form 36 (SF-36) questionnaire (Persian-validated version). Results: The mean age (± SD) of the participants was 58.75 ± 8.15 years. Intranasal spray of calcitonin increased QOL scores significantly (88.05 ± 15.63 vs. 92.15 ± 13.22, P value = 0.000). Bone mineral density of spine was increased from 0.834 ± 0.11 to 0.12 ± 0.852 and this difference in BMD of lumbar spine was statistically significant (P value: 0.003) but not significant in femur’s BMD (P value = 0.061). In comparison with BMD indexes, The QOL scores especially Mental Health domain changes had only a significant correlation with the changes of total T score in BMD (P = 0.031, Coefficient Correlation = 0.248). Conclusions: It seems that nasal spray of calcitonin can effectively improve QOL of women with LBD and QOL changes were not influenced by clinical or para-clinical alteration. Mental health domain must be more considered in further studies as a predicting domain for Health-Related Quality of Life (HR-QOL) changes. PMID:26421180

  8. Patient-Provider Communication: Understanding the Role of Patient Activation for Latinos in Mental Health Treatment

    ERIC Educational Resources Information Center

    Cortes, Dharma E.; Mulvaney-Day, Norah; Fortuna, Lisa; Reinfeld, Sarah; Alegria, Margarita

    2009-01-01

    This article highlights results from the Right Question Project-Mental Health (RQP-MH), an intervention designed to teach skills in question formulation and to increase patients' participation in decisions about mental health treatment. Of participants in the RQP-MH intervention, 83% were from a Latino background, and 75% of the interviews were…

  9. Patient-Centered Mental Health Care for Female Veterans

    PubMed Central

    Kimerling, Rachel; Bastian, Lori A.; Bean-Mayberry, Bevanne A.; Bucossi, Meggan M.; Carney, Diane V.; Goldstein, Karen M.; Phibbs, Ciaran S.; Pomernacki, Alyssa; Sadler, Anne G.; Yano, Elizabeth M.; Frayne, Susan M.

    2016-01-01

    Objective Mental health services for women vary widely across the Veterans Health Administration (VHA) system, without consensus on the need for, or organization of, specialized services for women. Understanding women’s needs and priorities is essential to guide the implementation of patient-centered behavioral health services. Methods In a cross-sectional, multisite survey of female veterans using primary care, potential stakeholders were identified for VHA mental health services by assessing perceived or observed need for mental health services. These stakeholders (N=484) ranked priorities for mental health care among a wide range of possible services. The investigators then quantified the importance of having designated women’s mental health services for each of the mental health services that emerged as key priorities. Results Treatment for depression, pain management, coping with chronic general medical conditions, sleep problems, weight management, and posttraumatic stress disorder (PTSD) emerged as women’s key priorities. Having mental health services specialized for women was rated as extremely important to substantial proportions of women for each of the six prioritized services. Preference for primary care colocation was strongly associated with higher importance ratings for designated women’s mental health services. For specific types of services, race, ethnicity, sexual orientation, PTSD symptoms, and psychiatric comorbidity were also associated with higher importance ratings for designated women’s services. Conclusions Female veterans are a diverse population whose needs and preferences for mental health services vary along demographic and clinical factors. These stakeholder perspectives can help prioritize structural and clinical aspects of designated women’s mental health care in the VHA. PMID:25642611

  10. Mild eczema affects self-perceived health among pre-adolescent girls.

    PubMed

    Ballardini, Natalia; Östblom, Eva; Wahlgren, Carl-Fredrik; Kull, Inger

    2014-05-01

    The aim was to assess the impact of eczema on health-related quality of life in the population-based birth cohort BAMSE with 2,756 pre-adolescent children. All answered the following questions on self-perceived health; "How are you feeling?", "How healthy do you consider yourself to be?" and "How happy are you with your life right now?". Children with ongoing eczema answered the "Children's Dermatology Life Quality Index (CDLQI)" questionnaire. In total, 350 (12.7%) of the children had eczema. Girls with eczema reported impaired self-perceived health as evaluated in the 3 questions; adjusted OR 1.72 (95% CI 1.16-2.55), 1.89 (95% CI 1.29-2.76) and 1.69 (95% CI 1.18-2.42). Eczema among boys was not associated with impairment of self-perceived health. The mean CDLQI score was 3.98 (95% CI 3.37-4.58). Since eczema affects up to 20% of pre-adolescent girls, the findings have implications both for health care providers and for society as a whole. PMID:24158408

  11. An Analysis of the Structural Factors Affecting the Public Participation in Health Promotion

    PubMed Central

    Ghaumi, Raheleh; Aminee, Tayebe; Aminaee, Akram; Dastoury, Mojgan

    2016-01-01

    The present study focuses on analyzing national and international Community-Based Participatory Research (CBPR) studies published from 2000 to 2012 in order to identify and categorize the possible factors that affect social participation for improving the public health. Clearly, improving the public health necessitates a combination of the participation and responsibility by the social members and the attempts by public health policy-makers and planners. CBPR studies are selected as the corpus since they seek to encourage active and informed participation of the social members in fulfilling the health related goals. The present study is conducted through meta-synthesis within a qualitative framework. The results revealed a set of factors within the structural capacities which were employed by the CBPR researchers for achieving the health promotion goals. The structural capacities employed in the interventions could be considered on the cultural and social grounds. The cultural grounds were divided into scientific and religious attempts. For the scientific attempts, the results highlighted the participation of higher education institutes including universities and research centers as well as educational institutes such as schools and the relevant institutions. And regarding the religious attempts, the results indicated that the cooptation of religious centers played the greatest role in enhancing the public participation. PMID:27045401

  12. Beneficial mycorrhizal symbionts affecting the production of health-promoting phytochemicals.

    PubMed

    Sbrana, Cristiana; Avio, Luciano; Giovannetti, Manuela

    2014-06-01

    Fresh fruits and vegetables are largely investigated for their content in vitamins, mineral nutrients, dietary fibers, and plant secondary metabolites, collectively called phytochemicals, which play a beneficial role in human health. Quantity and quality of phytochemicals may be detected by using different analytical techniques, providing accurate quantification and identification of single molecules, along with their molecular structures, and allowing metabolome analyses of plant-based foods. Phytochemicals concentration and profiles are affected by biotic and abiotic factors linked to plant genotype, crop management, harvest season, soil quality, available nutrients, light, and water. Soil health and biological fertility play a key role in the production of safe plant foods, as a result of the action of beneficial soil microorganisms, in particular of the root symbionts arbuscular mycorrhizal fungi. They improve plant nutrition and health and induce changes in secondary metabolism leading to enhanced biosynthesis of health-promoting phytochemicals, such as polyphenols, carotenoids, flavonoids, phytoestrogens, and to a higher activity of antioxidant enzymes. In this review we discuss reports on health-promoting phytochemicals and analytical methods used for their identification and quantification in plants, and on arbuscular mycorrhizal fungi impact on fruits and vegetables nutritional and nutraceutical value. PMID:25025092

  13. Using photovoice to examine community level barriers affecting maternal health in rural Wakiso district, Uganda.

    PubMed

    Musoke, David; Ekirapa-Kiracho, Elizabeth; Ndejjo, Rawlance; George, Asha

    2015-05-01

    Uganda continues to have poor maternal health indicators including a high maternal mortality ratio. This paper explores community level barriers affecting maternal health in rural Wakiso district, Uganda. Using photovoice, a community-based participatory research approach, over a five-month period, ten young community members aged 18-29 years took photographs and analysed them, developing an understanding of the emerging issues and engaging in community dialogue on them. From the study, known health systems problems including inadequate transport, long distance to health facilities, long waiting times at facilities and poor quality of care were confirmed, but other aspects that needed to be addressed were also established. These included key gender-related determinants of maternal health, such as domestic violence, low contraceptive use and early teenage pregnancy, as well as problems of unclean water, poor sanitation and women's lack of income. Community members appreciated learning about the research findings precisely hence designing and implementing appropriate solutions to the problems identified because they could see photographs from their own local area. Photovoice's strength is in generating evidence by community members in ways that articulate their perspectives, support local action and allow direct communication with stakeholders. PMID:26278841

  14. An Analysis of the Structural Factors Affecting the Public Participation in Health Promotion.

    PubMed

    Ghaumi, Raheleh; Aminee, Tayebe; Aminaee, Akram; Dastoury, Mojgan

    2016-01-01

    The present study focuses on analyzing national and international Community-Based Participatory Research (CBPR) studies published from 2000 to 2010 in order to identify and categorize the possible factors that affect social participation for improving the public health. Clearly, improving the public health necessitates a combination of the participation and responsibility by the social members and the attempts by public health policy-makers and planners. CBPR studies are selected as the corpus since they seek to encourage active and informed participation of the social members in fulfilling the health related goals. The present study is conducted through meta-synthesis within a qualitative framework. The results revealed a set of factors within the structural capacities which were employed by the CBPR researchers for achieving the health promotion goals. The structural capacities employed in the interventions could be considered on the cultural and social grounds. The cultural grounds were divided into scientific and religious attempts. For the scientific attempts, the results highlighted the participation of higher education institutes including universities and research centers as well as educational institutes such as schools and the relevant institutions. And regarding the religious attempts, the results indicated that the cooptation of religious centers played the greatest role in enhancing the public participation. PMID:27045401

  15. Commentary: issues and perspectives affecting CRNA practice. Regulation of health professionals, Part 1: Telepractice.

    PubMed

    Gunn, I P

    1999-05-01

    Although the requirement to protect the public welfare and safety is a right guaranteed to the states by the US Constitution's 10th amendment, which grants states the "police powers" of government, it is not an absolute power. The Commerce clause of the Constitution limits the power of states in creating barriers to intrastate commerce. Changes in the health care delivery system of the US, such as the use of corporate models such as managed care entities and health maintenance organizations, as well as health insurers' development of utilization reviews before approval of reimbursable procedures in individual cases, has prompted concerns with regard to the care of patients occurring outside the state in which the patient resides, by health care professionals not licensed in that state. Many states have considered such decision making an "unauthorized practice of medicine, or other practice" creating the necessity for some providers to obtain an many as 20 licenses to cover their practice. The practice of telemedicine (or telenursing or telehealth) falls into this quagmire, and thus efforts are ongoing to try to find ways to permit such practices while maintaining quality control, with or without additional state licenses. PMID:10504915

  16. Seasonal difference in brain serotonin transporter binding predicts symptom severity in patients with seasonal affective disorder.

    PubMed

    Mc Mahon, Brenda; Andersen, Sofie B; Madsen, Martin K; Hjordt, Liv V; Hageman, Ida; Dam, Henrik; Svarer, Claus; da Cunha-Bang, Sofi; Baaré, William; Madsen, Jacob; Hasholt, Lis; Holst, Klaus; Frokjaer, Vibe G; Knudsen, Gitte M

    2016-05-01

    Cross-sectional neuroimaging studies in non-depressed individuals have demonstrated an inverse relationship between daylight minutes and cerebral serotonin transporter; this relationship is modified by serotonin-transporter-linked polymorphic region short allele carrier status. We here present data from the first longitudinal investigation of seasonal serotonin transporter fluctuations in both patients with seasonal affective disorder and in healthy individuals. Eighty (11)C-DASB positron emission tomography scans were conducted to quantify cerebral serotonin transporter binding; 23 healthy controls with low seasonality scores and 17 patients diagnosed with seasonal affective disorder were scanned in both summer and winter to investigate differences in cerebral serotonin transporter binding across groups and across seasons. The two groups had similar cerebral serotonin transporter binding in the summer but in their symptomatic phase during winter, patients with seasonal affective disorder had higher serotonin transporter than the healthy control subjects (P = 0.01). Compared to the healthy controls, patients with seasonal affective disorder changed their serotonin transporter significantly less between summer and winter (P < 0.001). Further, the change in serotonin transporter was sex- (P = 0.02) and genotype- (P = 0.04) dependent. In the patients with seasonal affective disorder, the seasonal change in serotonin transporter binding was positively associated with change in depressive symptom severity, as indexed by Hamilton Rating Scale for Depression - Seasonal Affective Disorder version scores (P = 0.01). Our findings suggest that the development of depressive symptoms in winter is associated with a failure to downregulate serotonin transporter levels appropriately during exposure to the environmental stress of winter, especially in individuals with high predisposition to affective disorders.media-1vid110.1093/brain/aww043_video_abstractaww043_video

  17. The Effect of Community Pharmacy–Based Interventions on Patient Health Outcomes: A Systematic Review

    PubMed Central

    Blalock, Susan J.; Roberts, Andrew W.; Lauffenburger, Julie C.; Thompson, Trey; O'Connor, Shanna K.

    2016-01-01

    Many studies have demonstrated the beneficial effects that pharmacist-provided patient care services can have on patient health outcomes. However, the effectiveness of patient care services delivered by pharmacists in community pharmacy settings, where organizational barriers may affect service implementation or limit effectiveness, remains unclear. The authors systematically reviewed the literature on the effectiveness of pharmacist-delivered patient care services in community pharmacy settings in the United States. Of the 749 articles retrieved, 21 were eligible for inclusion in the review. Information concerning 134 outcomes was extracted from the included articles. Of these, 50 (37.3%) demonstrated statistically significant, beneficial intervention effects. The percentage of studies reporting favorable findings ranged from 50% for blood pressure to 0% for lipids, safety outcomes, and quality of life. Our findings suggest that evidence supporting the effectiveness of pharmacist-provided direct patient care services delivered in the community pharmacy setting is more limited than in other settings. PMID:23035056

  18. Impaired oculo-motor behaviour affects both reading and scene perception in neglect patients.

    PubMed

    Primativo, Silvia; Arduino, Lisa S; Daini, Roberta; De Luca, Maria; Toneatto, Carlo; Martelli, Marialuisa

    2015-04-01

    Unilateral spatial neglect (USN) is a common neuropsychological disorder following a right-sided brain lesion. Although USN is mostly characterized by symptoms involving the left hemispace, other symptoms are not left lateralized. Recently, it was shown that patients with neglect dyslexia, a reading disturbance that affects about 40% of USN patients, manifest a non-lateralized impairment of eye movement behaviour in association with their reading deficit when they read aloud and perform non-verbal saccadic tasks (Primativo et al., 2013). In the present paper, we aimed to demonstrate that the eye movement impairment shown by some USN patients reflects a more general oculo-motor disorder that is not confined to orthographic material, the horizontal axis or constrained saccadic tasks. We conjectured that inaccurate oculo-motor behaviour in USN patients indicates the presence of a reading deficit. With this aim we evaluated 20 patients, i.e., 10 right-sided brain-damaged patients without neglect and 10 patients affected by USN. On the basis of the patients' eye movement patterns during a scene exploration task, we found that 4 out of the 10 USN patients presented an abnormal oculo-motor pattern. These same four patients (but not the others) also failed in performing 5 different saccadic tasks and produced neglect dyslexia reading errors in both single words and texts. First, we show that a large proportion of USN patients have inaccurate eye movement behaviour in non-reading tasks. Second, we demonstrate that this exploratory deficit is predictive of the reading impairment. Thus, we conclude that the eye movement deficit prevents reading and impairs the performance on many other perceptual tests, including scene exploration. The large percentage of patients with impaired eye-movement pattern suggests that particular attention should be paid to eye movement behaviour during the diagnostic phase in order to program the best rehabilitation strategy for each patient. PMID

  19. Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

    PubMed Central

    Krist, Alex H.; Woolf, Steven H.; Bello, Ghalib A.; Sabo, Roy T.; Longo, Daniel R.; Kashiri, Paulette; Etz, Rebecca S.; Loomis, John; Rothemich, Stephen F.; Peele, J. Eric; Cohn, Jeffrey

    2014-01-01

    PURPOSE Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. METHODS We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively. RESULTS A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake. CONCLUSIONS By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems. PMID:25354405

  20. The MRC dyspnoea scale by telephone interview to monitor health status in elderly COPD patients.

    PubMed

    Paladini, Luciana; Hodder, Rick; Cecchini, Isabella; Bellia, Vincenzo; Incalzi, Raffaele Antonelli

    2010-07-01

    Dyspnoea is the most common symptom associated with poor quality of life in patients affected by Chronic Obstructive Pulmonary Disease (COPD). While COPD severity is commonly staged by lung function, the Medical Research Council (MRC) dyspnoea scale has been proposed as a more clinically meaningful method of quantifying disease severity in COPD. We wished to assess whether this scale might also be useful during telephone surveys as a simple surrogate marker of perceived health status in elderly patients with COPD. We conducted a comprehensive health status assessment by telephone survey of 200 elderly patients who had a physician diagnosis of COPD. The telephone survey contained 71 items and explored such domains as educational level, financial status, living arrangements and social contacts, co-morbid illness, and the severity and the impact of COPD on health status. Patients were categorized according to the reported MRC score: mild dyspnoea (MRC scale of 1), moderate dyspnoea (MRC scale of 2 and 3), or severe dyspnoea (MRC of 4 and 5). Deterioration in most of the recorded indicators of health status correlated with an increasingly severe MRC score. This was most evident for instrumental activities of daily living (IADL), perceived health and emotional status, pain-related limitations, limitations in social life, hospital admissions in preceding year and prevalence of most co-morbidities. The MRC dyspnoea scale is a reliable index of disease severity and health status in elderly COPD patients which should prove useful for remote monitoring of COPD and for rating health status for epidemiological purposes. PMID:20116231

  1. A review of health outcomes in patients with psoriasis.

    PubMed

    Li, Kai; Armstrong, April W

    2012-01-01

    Psoriasis, a chronic inflammatory skin condition, is a complex disease in terms of its significant comorbidities and impact on patients' quality of life. The objective of this article is to elucidate the health outcomes of the disease, including its economic and psychosocial burden on the patient. Current treatments options and the economic considerations of treatment costs are reviewed. Psoriasis is a multidimensional disease, so patients benefit from having a multidisciplinary team of dermatologists and other physicians for management of it and of associated comorbid conditions. PMID:22117868

  2. What can virtual patient simulation offer mental health nursing education?

    PubMed

    Guise, V; Chambers, M; Välimäki, M

    2012-06-01

    This paper discusses the use of simulation in nursing education and training, including potential benefits and barriers associated with its use. In particular, it addresses the hitherto scant application of diverse simulation devices and dedicated simulation scenarios in psychiatric and mental health nursing. It goes on to describe a low-cost, narrative-based virtual patient simulation technique which has the potential for wide application within health and social care education. An example of the implementation of this technology in a web-based pilot course for acute mental health nurses is given. This particular virtual patient technique is a simulation type ideally suited to promoting essential mental health nursing skills such as critical thinking, communication and decision making. Furthermore, it is argued that it is particularly amenable to e-learning and blended learning environments, as well as being an apt tool where multilingual simulations are required. The continued development, implementation and evaluation of narrative virtual patient simulations across a variety of health and social care programmes would help ascertain their success as an educational tool. PMID:22070549

  3. Reproductive health and the environment: Counseling patients about risks.

    PubMed

    Haruty, Bella; Friedman, Julie; Hopp, Stephanie; Daniels, Ryane; Pregler, Janet

    2016-05-01

    Endocrine-disrupting chemicals (EDCs) are associated with reproductive complications such as infertility, pregnancy complications, poor birth outcomes, and child developmental abnormalities, although not all chemicals of concern are EDCs. Pregnant patients and women of childbearing age need reasonable advice about environmental contaminants and reproductive health. PMID:27168513

  4. When Residents Need Health Care: Stigma of the Patient Role

    ERIC Educational Resources Information Center

    Moutier, Christine; Cornette, Michelle; Lehrmann, Jon; Geppert, Cynthia; Tsao, Carol; DeBoard, Renee; Hammond, Katherine Green; Roberts, Laura Weiss

    2009-01-01

    Objective: Whether and under what circumstances medical residents seek personal health care is a growing concern that has important implications for medical education and patient welfare, but has not been thoroughly investigated. Barriers to obtaining care have been previously documented, but very little empirical work has focused on trainees who…

  5. Michigan health system launches integrated campaign using patient testimonials.

    PubMed

    2006-01-01

    Spectrum Health System in Michigan recently launched The Right Decision campaign, which totes the system's heart center and cancer facilities. The effort is underway with aggressive print ads, television and radio spots, and Web site promotion. The 1,000-bed, acute-care system hopes to raise awareness of the heart and cancer centers through real-life patient testimonials. PMID:16813347

  6. Computerized knowledge bases in primary health care: a curse or a blessing for health promotion, prevention and patient quality?.

    PubMed

    Alendahl, K; Timpka, T; Sjöberg, C

    1995-01-01

    This paper presents a future scenario analysis of how the introduction of computerized knowledge bases (KBs) can come to affect primary care practice. For the collection and analysis of data, a two-level video method was applied. First, four consultations where a computerized KB was used were video-recorded. A search workshop was then carried out by letting a multi-disciplinary panel comment on the video recordings. The comments were categorized with regard to content and perspective. Analyses of the comments showed a concern for a disregard of patients' health beliefs and for difficulties in portioning out the acquired medical knowledge to the patient during the consultation. Furthermore, the computerized KB was found to easily break the natural flow of the consultation and be perceived as a third party. The conclusion is that the most critical aspects for using computerized KBs in a reformed primary health care concern the integration of the systems into the consultation process. Health promotion, prevention, and patient quality are central here, and the introduction of KB technology must not lead the consultation away from these issues. PMID:8591587

  7. The Influence of Health Literacy and Patient Activation on Patient Information Seeking and Sharing.

    PubMed

    Ledford, Christy J W; Cafferty, Lauren A; Russell, Travis C

    2015-01-01

    This study provided an assessment of how patients looked for information to prepare for a clinical appointment and whether they shared those findings with their provider. A cross-sectional survey allowed insight into patient attitudes, motivations, and behavior in clinical real time. At two hospital-based clinics, 243 patients completed surveys before and after clinical appointments. Younger patients with higher communicative and critical health literacy prepared for clinical appointments with information searches. The predicted association of health literacy and patient activation with information sharing was not supported. This study shows that patients with higher patient activation perceived that their providers responded more positively to patient-obtained medical information. The role of critical health literacy may show that individuals choosing to seek information are considering not just their ability to conduct the search but also their ability to synthesize and critically analyze the results of the information search. An implication for providers is to become skilled in directly asking or passively surveying what outside information sources the patient has engaged with, no matter if the patient does or does not introduce the information. PMID:26513034

  8. Measuring patient engagement: development and psychometric properties of the Patient Health Engagement (PHE) Scale

    PubMed Central

    Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea; Lozza, Edoardo

    2015-01-01

    Beyond the rhetorical call for increasing patients' engagement, policy makers recognize the urgency to have an evidence-based measure of patients' engagement and capture its effect when planning and implementing initiatives aimed at sustaining the engagement of consumers in their health. In this paper, authors describe the Patient Health Engagement Scale (PHE-scale), a measure of patient engagement that is grounded in rigorous conceptualization and appropriate psychometric methods. The scale was developed based on our previous conceptualization of patient engagement (the PHE-model). In particular, the items of the PHE-scale were developed based on the findings from the literature review and from interviews with chronic patients. Initial psychometric analysis was performed to pilot test a preliminary version of the items. The items were then refined and administered to a national sample of chronic patients (N = 382) to assess the measure's psychometric performance. A final phase of test-retest reliability was performed. The analysis showed that the PHE Scale has good psychometric properties with good correlation with concurrent measures and solid reliability. Having a valid and reliable measure to assess patient engagement is the first step in understanding patient engagement and its role in health care quality, outcomes, and cost containment. The PHE Scale shows a promising clinical relevance, indicating that it can be used to tailor intervention and assess changes after patient engagement interventions. PMID:25870566

  9. Preventive strategies in oral health for special needs patients

    PubMed Central

    Vozza, Iole; Cavallè, Edoardo; Corridore, Denise; Ripari, Francesca; Spota, Andrea; Brugnoletti, Orlando; Guerra, Fabrizio

    2015-01-01

    Summary As regards to the most common oral disease in pediatric patients, intellectual disability is not a risk factor for caries disease itself, but it rather reduces the individual capability to self-care and therefore to his own oral care. Children suffering of systemic pathologies and/or with different stages of disability are to be considered at high risk for dental caries development. According to recent guidelines for oral health prevention in childhood, individual additional strategies for a preventive care should be applied for these patients. All the health providers, family and caregivers should be involved with the aim of being aware, motivated and informed on oral health issues, and a better access system to the dental care structure, both logistic, professional and economical should be assured. PMID:26941896

  10. Pretesting mHealth: Implications for Campaigns among Underserved Patients

    PubMed Central

    Kumar, Disha; Arya, Monisha

    2016-01-01

    Background For health campaigns, pretesting the channel of message delivery and process evaluation is important to eventual campaign effectiveness. We conducted a pilot study to pretest text messaging as a mHealth channel for traditionally underserved patients. Aims The primary objectives of the research were to assess 1) successful recruitment of these patients for a text message study and 2) whether recruited patients would engage in a process evaluation after receiving the text message. Methods Recruited patients were sent a text message and then called a few hours later to assess whether they had received, read, and remembered the sent text message. Results We approached twenty patients, of whom fifteen consented to participate. Of these consented participants, ten (67%) engaged in the process evaluation and eight (53%) were confirmed as receiving, reading, and remembering the text message. Conclusion We found that traditionally underserved and under-researched patients can be recruited to participate in a text message study, and that recruited patients would engage in a process evaluation after receiving the text message. PMID:27540419

  11. Social marketing meets health literacy: Innovative improvement of health care providers’ comfort with patient interaction

    PubMed Central

    Primack, Brian A.; Bui, Thuy; Fertman, Carl I.

    2010-01-01

    Objective It is essential to train health care providers to deliver care sensitive to the needs of diverse individuals with varying degrees of health literacy. We aimed to evaluate an innovative, theory-based, educational intervention involving social marketing and health literacy. Methods In 2006 at a large medical school, all first-year students were exposed to the intervention. They completed pre- and post-test anonymous surveys including demographic data, covariates, and key outcome variables. Paired t-tests and multiple linear regression were used to evaluate the intervention and to determine independent associations among the key outcome variables. Results Post-intervention scores were significantly higher than pre-intervention scores for social marketing (3.31 versus 1.90, p < 0.001), health literacy (3.41 versus 2.98, p < 0.001), and comfort in brochure development (3.11 versus 2.52, p < 0.001) (N = 83). After controlling for demographic and covariate data, health literacy and comfort in brochure development were independent predictors of comfort interacting with diverse populations. Conclusion A brief intervention involving social marketing and health literacy can improve skills that improve medical students’ comfort with patients of diverse backgrounds. Practice implications Health care providers can be taught educational principles and skills involved in developing effective patient education materials. These skills may improve providers’ comfort with direct patient interaction. PMID:17418522

  12. Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya

    PubMed Central

    2014-01-01

    Background The World Health Organization (WHO) and the Government of Kenya alike identify a well-performing health workforce as key to attaining better health. Nevertheless, the motivation and retention of health care workers (HCWs) persist as challenges. This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi. Methods A cross-sectional cluster sample design was used to select 59 health facilities that yielded interviews with 404 health care workers, grouped into 10 different types of service providers. Data were collected in November 2011 using structured questionnaires and a Focus Group Discussion guide. Findings were analyzed using bivariate and multivariate methods of the associations and determinants of health worker motivation and retention. Results The levels of education and gender factors were lowest in Turkana with female HCWs representing only 30% of the workers against a national average of 53%. A smaller proportion of HCWs in Turkana feel that they have adequate training for their jobs. Overall, 13% of the HCWs indicated that they had changed their job in the last 12 months and 20% indicated that they could leave their current job within the next two years. In terms of work environment, inadequate access to electricity, equipment, transport, housing, and the physical state of the health facility were cited as most critical, particularly in Turkana. The working environment is rated as better in private facilities. Adequate training, job security, salary, supervisor support, and manageable workload were identified as critical satisfaction factors. Family health care, salary, and terminal benefits were rated as important compensatory factors. Conclusions There are distinct motivational and retention factors that affect

  13. Integrating cognitive and affective dimensions of pain experience into health professions education

    PubMed Central

    Murinson, Beth B; Mezei, Lina; Nenortas, Elizabeth

    2011-01-01

    Pain is prevalent in clinical settings, and yet it is relatively under-represented in the education of most students in the health professions. Because pain includes both sensory-discriminative and affective features, teaching students about pain presents unique challenges and opportunities. The present article describes the evolution of a new blueprint for clinical excellence that, among other competencies, incorporates a need for the emotional development of clinical trainees. The framework has been applied to the development and implementation of two new courses in pain. The first course is designed to provide a comprehensive foundation of medical knowledge regarding pain, while integratively introducing students to the affective dimensions of pain. The second course is designed to enhance students’ appreciation for the protean effects of pain through use of the humanities to represent medical experience. It is concluded that, to be most effective, fostering the emotional development of trainees in the health professions necessitates the incorporation of affect-focused learning objectives, educational tasks and assessment methods. PMID:22184551

  14. Cryosurvival of in vitro produced embryos as affected by health status effect of oocyte donor cow.

    PubMed

    Hosseini, S M; Hajian, M; Asgari, V; Forouzanfar, M; Ostadhosseini, S; Moulavi, F; Abedi, P; Kiani, M; Vash N, N T; Safahani-Langroodi, M; Nasr-Esfahani, M H

    2013-01-01

    In vitro embryo production and embryo vitrification of genetically superior cows that culled inevitably due to health problems can accelerate genetic progress. This study was carried out to investigate whether maternal age and health status effects of high genetic merit cows affect cryosurvival and developmental competence of IVP embryos. In this sense, the effects of ageing and four common culling causes of dairy cows [repeat breeding (RPB), udder problems (UPM), chronic endometritis (CRE), and lameness (LAM)] on in vitro embryo development, and in vivo developmental competence after embryo vitrification were evaluated. The mean number of oocytes obtained per cow did not vary significantly between donors indifferent groups. Cleavage rates in RPB (86.0+/-4.2%), SEN (81.3+/-2.5%) and CRE (77.6+/-6.3%) cows which were comparable to control (95.9+/-1.5%) but were significantly higher than the related rate of UPM donors (50.6+/-2.6%). Importantly, there was no significant difference between the blastocyst rates of different groups. Mean overall survival rate was not different between the groups and was not affected by the blastocyst production rate. There was no significant difference between pregnancy rates of different groups. The results of the present study indicated that in cattle, neither ageing, nor these four diseases affect ovarian potential in terms of the yield and quality of in vitro embryo development. PMID:24441373

  15. Meeting the health information needs of prostate cancer patients using personal health records

    PubMed Central

    Pai, H.H.; Lau, F.; Barnett, J.; Jones, S.

    2013-01-01

    Background There is interest in the use of health information technology in the form of personal health record (phr) systems to support patient needs for health information, care, and decision-making, particularly for patients with distressing, chronic diseases such as prostate cancer (pca). We sought feedback from pca patients who used a phr. Methods For 6 months, 22 pca patients in various phases of care at the BC Cancer Agency (bcca) were given access to a secure Web-based phr called provider, which they could use to view their medical records and use a set of support tools. Feedback was obtained using an end-of-study survey on usability, satisfaction, and concerns with provider. Site activity was recorded to assess usage patterns. Results Of the 17 patients who completed the study, 29% encountered some minor difficulties using provider. No security breaches were known to have occurred. The two most commonly accessed medical records were laboratory test results and transcribed doctor’s notes. Of survey respondents, 94% were satisfied with the access to their medical records, 65% said that provider helped to answer their questions, 77% felt that their privacy and confidentiality were preserved, 65% felt that using provider helped them to communicate better with their physicians, 83% found new and useful information that they would not have received by talking to their health care providers, and 88% said that they would continue to use provider. Conclusions Our results support the notion that phrs can provide cancer patients with timely access to their medical records and health information, and can assist in communication with health care providers, in knowledge generation, and in patient empowerment. PMID:24311957

  16. Emerging uses of patient generated health data in clinical research.

    PubMed

    Wood, William A; Bennett, Antonia V; Basch, Ethan

    2015-05-01

    Recent advancements in consumer directed personal computing technology have led to the generation of biomedically-relevant data streams with potential health applications. This has catalyzed international interest in Patient Generated Health Data (PGHD), defined as "health-related data - including health history, symptoms, biometric data, treatment history, lifestyle choices, and other information-created, recorded, gathered, or inferred by or from patients or their designees (i.e. care partners or those who assist them) to help address a health concern."(Shapiro et al., 2012) PGHD offers several opportunities to improve the efficiency and output of clinical trials, particularly within oncology. These range from using PGHD to understand mechanisms of action of therapeutic strategies, to understanding and predicting treatment-related toxicity, to designing interventions to improve adherence and clinical outcomes. To facilitate the optimal use of PGHD, methodological research around considerations related to feasibility, validation, measure selection, and modeling of PGHD streams is needed. With successful integration, PGHD can catalyze the application of "big data" to cancer clinical research, creating both "n of 1" and population-level observations, and generating new insights into the nature of health and disease. PMID:25248998

  17. Oral Myiasis Affecting Gingiva in a Child Patient: An Uncommon Case Report.

    PubMed

    Ali, Fareedi Mukram; Patil, Kishor; Kar, Sanjay; Patil, Atulkumar A; Ahamed, Shabeer

    2016-01-01

    Certain dipteran flies larvae causing invasion of the tissues and organs of the humans or other vertebrates are called as myiasis, which feed on hosts dead or living tissues. It is well documented in the skin and hot climate regions; underdeveloped countries are affected more commonly. Oral cavity is affected rarely and it can be secondary to serious medical conditions. Poor oral hygiene, alcoholism, senility, or suppurating lesions can be associated with the oral myiasis. Inflammatory and allergic reactions are the commonest clinical manifestations of the disease. In the present case, gingiva of maxillary anterior region was affected by larval infection in a 13-year-old mentally retarded patient. PMID:26881145

  18. Oral Myiasis Affecting Gingiva in a Child Patient: An Uncommon Case Report

    PubMed Central

    Ali, Fareedi Mukram; Patil, Kishor; Kar, Sanjay; Patil, Atulkumar A.; Ahamed, Shabeer

    2016-01-01

    Certain dipteran flies larvae causing invasion of the tissues and organs of the humans or other vertebrates are called as myiasis, which feed on hosts dead or living tissues. It is well documented in the skin and hot climate regions; underdeveloped countries are affected more commonly. Oral cavity is affected rarely and it can be secondary to serious medical conditions. Poor oral hygiene, alcoholism, senility, or suppurating lesions can be associated with the oral myiasis. Inflammatory and allergic reactions are the commonest clinical manifestations of the disease. In the present case, gingiva of maxillary anterior region was affected by larval infection in a 13-year-old mentally retarded patient. PMID:26881145

  19. Assessment of health-related quality of life in Turkish patients with facial prostheses

    PubMed Central

    2013-01-01

    , localization of the defect, and age of facial prosthesis were associated with patients’ QOL. These findings may provide valuable information about the specific health needs of these patients that may affect their well-being. Further studies are needed to confirm these results. Use of the WHOQOL-BREF may provide valuable information for determining patients’ needs and priorities as well as for planning and developing comprehensive prosthetic rehabilitation programs. PMID:23351906

  20. Health Worker Opinion/perception of health services provided to patients in the Selebi Phikwe Ni-Cu Mine Area, Botswana.

    PubMed

    Ekosse, Georges; de Jager, Linda; van den Heever, Dawid J

    2006-01-01

    This study determines the prevalence of types of sicknesses and diseases affecting patients visiting health service facilities and the available health services within the Selebi Phikwe Ni-Cu mine area, Botswana. Through the administration of questionnaires and structured questions, attempts were made to establish and verify the existing human health problems at the study area by focusing on respiratory tract related symptoms of sicknesses and diseases. With the aid of statistical package for social sciences (SPSS), interpreted results from respondents indicated that all the health service providers served patients suffering from headaches, persistent coughing, chest pains, lower abdominal pains, pain when passing out urine, genital discharge and diarrhea. Seventy one percent of the health service providers indicated that their patients suffered from body weakness, 86 % indicated that they had patients who suffered from recent loss of body weight, and another 86 % pointed out that their patients had influenza/common cold. Other health complaints reported included unusual spitting, shortness of breath, palpitations, nausea/vomiting, diarrhoea, and constipation. Moreover the health service providers indicated that they had patients who suffered from significant illnesses of which some passed away. However if there are lacking facilities, patients are referred to bigger health service providers in the country. The findings of the study do not in general depict demarcating differences of health status of residents of the study area to those of the control site. A need therefore for further investigations to be conducted to establish relations of mining activities to human health at Selebi Phikwe is called for. PMID:17348749

  1. Understanding the Differences Between Oncology Patients and Oncology Health Professionals Concerning Spirituality/Religiosity: A Cross-Sectional Study.

    PubMed

    Camargos, Mayara Goulart de; Paiva, Carlos Eduardo; Barroso, Eliane Marçon; Carneseca, Estela Cristina; Paiva, Bianca Sakamoto Ribeiro

    2015-11-01

    This study investigated whether spirituality/religiosity (S/R) plays an important role in the lives of cancer patients and in the work of health professionals who provide care for these patients. The correlations between spiritual quality of life (QOL) and the other QOL domain scores of patients and health professionals were also assessed. Moreover, QOL domain scores were compared between patients and health professionals. In this cross-sectional study, 1050 participants (525 oncology patients and 525 health professionals) were interviewed. Quality of life was assessed with the World Health Organization quality of life spiritual, religious, and personal beliefs (WHOQOL-SRPB). To compare the groups with respect to the instruments' domains, a quantile regression and an analysis of covariance model were used. The WHOQOL-Bref and WHOQOL-SRPB domains were correlated by performing Pearson and partial correlation tests. It was demonstrated that 94.1% of patients considered it important that health professionals addressed their spiritual beliefs, and 99.2% of patients relied on S/R to face cancer. Approximately, 99.6% of the patients reported that S/R support is necessary during cancer treatment; 98.3% of health professionals agreed that spiritual and religious support was necessary for oncology patients. Positive correlations between spiritual QOL and the other QOL domains were observed. When compared among themselves, patients exhibited significantly higher levels of spiritual QOL. In conclusion, S/R was an important construct in the minds of cancer patients and health professionals. Both groups often use S/R resources in their daily lives, which seems to positively affect their perceptions of QOL. Further studies are needed to determine how health professionals effectively address S/R during oncology practice. PMID:26632743

  2. Health-based payment and computerized patient record systems.

    PubMed

    Hornbrook, M C; Goodman, M J; Fishman, P A; Meenan, R T

    1998-01-01

    Health care information technology is changing rapidly and dramatically. A small but growing number of clinicians, especially those in staff and group model HMOs and hospital-affiliated practices, are automating their patient medical records in response to pressure to improve quality and reduce costs. Computerized patient record systems in HMOs track risks, diagnoses, patterns of care, and outcomes across large populations. These systems provide access to large amounts of clinical information; as a result, they are very useful for risk-adjusted or health-based payment. The next stage of evolution in health-based payment is to switch from fee-for-service (claims) to HMO technology in calculating risk coefficients. This will occur when HMOs accumulate data sets containing records on provider-defined disease episodes, with every service linked to its appropriate disease episode for millions of patients. Computerized patient record systems support clinically meaningful risk-assessment models and protect patients and medical groups from the effects of adverse selection. They also offer significant potential for improving quality of care. PMID:10187225

  3. 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

  4. Patient records: from single events to elements for health planning.

    PubMed

    Pisanelli, D M; Ricci, F L

    1994-12-01

    Data collected in patient records are not only the kernel of a ward information system, but also the groundwork for planning and evaluating services in health care. The aim of this study was to analyze the problem of aggregate data generation starting from separate items in patient records. After describing the different uses of patient record data, we outline the process which generates aggregates data starting from individual records. This process leads to the definition of the "view on aggregation" as an intermediate step between patient records and aggregate data. A simplified schema is presented based on the Entity-Relationship model representing a conceptual model of the integration of aggregate data and patient record items. Finally, the role is discussed of automation in this process and the perspectives for its implementation. PMID:7869944

  5. [Effect of pharmacotherapy of affective disorders on the psycho-semantics of alcoholic patients].

    PubMed

    Krupitskiĭ, E M; Burakov, A M; Grinenko, A Ia; Borodkin, Iu S

    1995-01-01

    90 alcoholic patients (II stage of alcoholism) with secondary affective disorders (anxiety, depression) were divided into 4 groups. The patients of the first group received the GABA receptor ligand baclofen during 3 weeks. Sybazon preparation was used in the second group, while the patients of the third group were treated with amitriptyline. Placebo was applied in the forth group. The clinical psychological tests demonstrated that all drugs caused quite effective relief of affective disorders. Psychosemantic tests application showed that the pharmacotherapy caused positive changes in patients of 1-3 groups. These changes touched on both system of personal estimations and relations of personality to himself and to the world around i.e. psychosemantic sphere. Such changes in psychosemantic sphere were not observed in the 4-th group of patients (placebo). Besides it was revealed that each drug caused some specific changes in psychosemantic sphere. The result obtained were supposed to have some theoretical value in comprehension of brain-psychics relations as well as the applied significance for adequate choice of affective disorders pharmacotherapy of alcoholic patients. PMID:8788983

  6. Er:YAG Laser Dental Treatment of Patients Affected by Epidermolysis Bullosa

    PubMed Central

    Galeotti, Angela; D'Antò, Vincenzo; Gentile, Tina; Giancristoforo, Simona; Romeo, Umberto

    2014-01-01

    Aim. The purpose of this study was to evaluate the efficacy of Er:YAG laser used for treating hard dental tissue in patients with epidermolysis bullosa (EB). Methods. We report two cases of EB in which an Er:YAG laser was used for conservative treatments. In the first case, the Er:YAG laser (2,940 μm, 265 mJ, 25 Hz) was used to treat caries on a deciduous maxillary canine in an 8-year-old male patient affected by dystrophic EB. In the second case, we treated a 26-year-old female patient, affected by junctional EB, with generalized enamel hypoplasia, and an Er:YAG laser (2,940 μm, 265 mJ, 25 Hz) was used to remove the damaged enamel on maxillary incisors. Results. The use of the Er:YAG laser, with the appropriate energy, was effective in the selective removal of carious tissue and enamel hypoplasia. During dental treatment with the Er:YAG laser, patients required only a few interruptions due to the absence of pain, vibration, and noise. Conclusions. Laser treatment of hard dental tissues is a valuable choice for patients affected by EB since it is less invasive compared to conventional treatment, resulting in improved patient compliance. PMID:25431688

  7. Intermittent targeted therapies and stochastic evolution in patients affected by chronic myeloid leukemia

    NASA Astrophysics Data System (ADS)

    Pizzolato, N.; Persano Adorno, D.; Valenti, D.; Spagnolo, B.

    2016-05-01

    Front line therapy for the treatment of patients affected by chronic myeloid leukemia (CML) is based on the administration of tyrosine kinase inhibitors, namely imatinib or, more recently, axitinib. Although imatinib is highly effective and represents an example of a successful molecular targeted therapy, the appearance of resistance is observed in a proportion of patients, especially those in advanced stages. In this work, we investigate the appearance of resistance in patients affected by CML, by modeling the evolutionary dynamics of cancerous cell populations in a simulated patient treated by an intermittent targeted therapy. We simulate, with the Monte Carlo method, the stochastic evolution of initially healthy cells to leukemic clones, due to genetic mutations and changes in their reproductive behavior. We first present the model and its validation with experimental data by considering a continuous therapy. Then, we investigate how fluctuations in the number of leukemic cells affect patient response to the therapy when the drug is administered with an intermittent time scheduling. Here we show that an intermittent therapy (IT) represents a valid choice in patients with high risk of toxicity, despite an associated delay to the complete restoration of healthy cells. Moreover, a suitably tuned IT can reduce the probability of developing resistance.

  8. Carolinas HealthCare attends to patients, amenities; builds business.

    PubMed

    Rees, T

    2000-01-01

    Carolinas HealthCare System has grown into a nearly two billion dollar entity by focusing on patient needs and amenities in its health care facilities. Growth of the system, the largest in North and South Carolina, is due in large part to Harry A. Nurkin, president and CEO, who started out with a run-down hospital for indigents. With the approval of the hospital board, Nurkin launched a marketing effort that included taking a lesson from the founders of the Holiday Inn hotel chain. He remodeled and developed facilities that are pleasing to patients and visitors, moved patient parking closer to the hospitals' front doors, taught key hospital personnel the basics about marketing, aligned the system with ABA and NFL teams and conducted an aggressive advertising program. PMID:11143133

  9. PatientsLikeMe: Consumer health vocabulary as a folksonomy.

    PubMed

    Smith, Catherine Arnott; Wicks, Paul J

    2008-01-01

    PatientsLikeMe is an online social networking community. Subcommunities center on three diagnoses: Amyotrophic Lateral Sclerosis, Multiple Sclerosis and Parkinsons Disease. Community members can describe their symptoms online in natural language, resulting in folksonomic tags available for clinical analysis and for browsing by other users to find patients like me. Forty-three percent of PatientsLikeMe symptom terms are present as exact (24%) or synonymous (19%) terms in the Unified Medical Language System Metathesaurus (National Library of Medicine; 2007AC). Slightly more than half of the symptom terms either do not match the UMLS, or are unclassifiable. A clinical vocabulary, SNOMED CT, accounts for 93% of the matching terms. Analysis of the failed matches reveals challenges for online patient communication, not only with healthcare professionals, but with other patients. In a Web 2.0 environment with lowered barriers between consumers and professionals, a deficiency in knowledge representation affects not only professionals, but consumers as well. PMID:18999004

  10. Nutrient supplementation may adversely affect maternal oral health--a randomised controlled trial in rural Malawi.

    PubMed

    Harjunmaa, Ulla; Järnstedt, Jorma; Dewey, Kathryn G; Ashorn, Ulla; Maleta, Kenneth; Vosti, Stephen A; Ashorn, Per

    2016-01-01

    Nutritional supplementation during pregnancy is increasingly recommended especially in low-resource settings, but its oral health impacts have not been studied. Our aim was to examine whether supplementation with multiple micronutrients (MMN) or small-quantity lipid-based nutrient supplements affects dental caries development or periodontal health in a rural Malawian population. The study was embedded in a controlled iLiNS-DYAD trial that enrolled 1391 pregnant women <20 gestation weeks. Women were provided with one daily iron-folic acid capsule (IFA), one capsule with 18 micronutrients (MMN) or one sachet of lipid-based nutrient supplements (LNS) containing protein, carbohydrates, essential fatty acids and 21 micronutrients. Oral examination of 1024 participants was conducted and panoramic X-ray taken within 6 weeks after delivery. The supplement groups were similar at baseline in average socio-economic, nutritional and health status. At the end of the intervention, the prevalence of caries was 56.7%, 69.1% and 63.3% (P = 0.004), and periodontitis 34.9%, 29.8% and 31.2% (P = 0.338) in the IFA, MMN and LNS groups, respectively. Compared with the IFA group, women in the MMN group had 0.60 (0.18-1.02) and in the LNS group 0.59 (0.17-1.01) higher mean number of caries lesions. In the absence of baseline oral health data, firm conclusions on causality cannot be drawn. However, although not confirmatory, the findings are consistent with a possibility that provision of MMN or LNS may have increased the caries incidence in this target population. Because of the potential public health impacts, further research on the association between gestational nutrient interventions and oral health in low-income settings is needed. PMID:26194850

  11. Health care financing policy for hospitalized pediatric patients.

    PubMed

    Munoz, E; Chalfin, D; Goldstein, J; Lackner, R; Mulloy, K; Wise, L

    1989-03-01

    Prospective hospital payment systems using the federal Medicare DRG payment model are changing hospital reimbursement. Currently, many states have adopted diagnosis related group (DRG) prospective "all payer systems" using the federal model. All payer systems, whereby Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode, prevent cost shifting between payers. New York state has used an all payer system since Jan 1, 1988. This study simulated DRG all payer methods for a large sample (N = 16,084) of pediatric patients for a three-year period using the New York DRG all payer reimbursement system now in effect. Medicaid pediatric patients had (adjusted for DRG weight index) a longer hospital stay and greater total hospital cost compared with pediatric patients from Blue Cross and other commercial payers. Medicaid pediatric patients also had a greater severity of illness compared with patients from Blue Cross and other payers. Pediatric patients in all payment groups (ie, Medicaid, Blue Cross, and other commercial insurers) generated financial risk under the DRG all payer scheme. Medicaid pediatric patients generated the greatest financial risk, however. These data suggest that state and private payers may be under-reimbursing for the care of the hospitalized pediatric patient using the DRG prospective hospital payment scheme. Health care financing policy for pediatric patients may limit both access and quality of care. PMID:2492754

  12. Patient satisfaction.

    PubMed

    Prakash, Bhanu

    2010-09-01

    Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. Patient satisfaction is thus a proxy but a very effective indicator to measure the success of doctors and hospitals. This article discusses as to how to ensure patient satisfaction in dermatological practice. PMID:21430827

  13. Health-related quality of life in Moroccan patients with rheumatoid arthritis.

    PubMed

    Ibn Yacoub, Yousra; Amine, Bouchra; Laatiris, Assia; Hajjaj-Hassouni, Najia

    2012-10-01

    We aimed to assess the aspects of health-related quality of life (HRQoL) in Moroccan patients with rheumatoid arthritis (RA) and to evaluate the disease-related parameters influencing it. Two hundred fifty-five patients with RA were consecutively included. We assessed sociodemographic characteristics, cigarette smoking status, disease duration, diagnosis delay, joint pain intensity (on a 0-100-mm visual analogue scale), disease activity (by the disease activity score (DAS 28) and biological tests), structural damage (by radiographs scored using the Sharp's method as modified by Van der Heijde), functional disability (by the Health Assessment Questionnaire), extra-articular manifestations, immunological status, and treatments. The Arabic version of the Medical Outcomes Study Short Form 36 Health Survey (SF-36) was applied to assess HRQoL. All domains of SF-36 were deteriorated in a significant way comparing to the general population. The most affected subgroups of SF-36 were role limitation, role emotional, vitality, and social functioning. Women had significantly lower scores of SF-36 compared to men. Patients with decreased levels of education and low socioeconomic status had significantly lower scores of SF-36 (for all p ≤ 0.01). Current and ex-smokers had lower scores in physical domains of quality of life. Patients treated with methotrexate had better scores of mental health. Furthermore, patients receiving biologic agents had better scores of physical and social domains. Decreased scores of SF-36 were significantly correlated with disease duration, joint pain intensity, clinical and biological disease activity, functional disability, and radiographic damage. The level of antibodies against citrullinated peptides had significant correlations with the impairment of physical domains of SF-36. Physical as well as mental aspects of HRQoL in our RA patients were significantly deteriorated. Recognizing complicated relationships between HRQoL and disease

  14. The mental health of male victims and their children affected by legal and administrative partner aggression.

    PubMed

    Berger, Joshua L; Douglas, Emily M; Hines, Denise A

    2016-07-01

    The authors recently developed a psychometrically valid measure of legal and administrative (LA) intimate partner violence (IPV) victimization (Hines, Douglas, & Berger, 2014). The current article explores the impact of actual and threatened LA aggression on the mental health of male physical IPV victims and their children. In the current study, a sample of 611 men who sought help after experiencing physical IPV from their female partners completed a survey assessing the types and extent of IPV that occurred in their relationship, including LA aggression, their own mental health outcomes, and the mental health of their oldest child. A series of OLS regressions indicated that after controlling for covariates, actual LA aggression was associated with more symptoms of PTSD and depression in male victims, and that both threatened and actual LA aggression were associated with higher levels of affective and oppositional defiant symptoms in the men's school age children. The current findings suggest that it is important to screen couples for the presence of LA aggression and male partners and their children should be referred for mental health treatment if LA aggression is occurring in the relationship. Aggr. Behav. 42:346-361, 2016. © 2015 Wiley Periodicals, Inc. PMID:26522849

  15. 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

  16. Using patient management as a surrogate for patient health outcomes in diagnostic test evaluation

    PubMed Central

    2012-01-01

    Background Before a new test is introduced in clinical practice, evidence is needed to demonstrate that its use will lead to improvements in patient health outcomes. Studies reporting test accuracy may not be sufficient, and clinical trials of tests that measure patient health outcomes are rarely feasible. Therefore, the consequences of testing on patient management are often investigated as an intermediate step in the pathway. There is a lack of guidance on the interpretation of this evidence, and patient management studies often neglect a discussion of the limitations of measuring patient management as a surrogate for health outcomes. Methods We discuss the rationale for measuring patient management, describe the common study designs and provide guidance about how this evidence should be reported. Results Interpretation of patient management studies relies on the condition that patient management is a valid surrogate for downstream patient benefits. This condition presupposes two critical assumptions: the test improves diagnostic accuracy; and the measured changes in patient management improve patient health outcomes. The validity of this evidence depends on the certainty around these critical assumptions and the ability of the study design to minimise bias. Three common designs are test RCTs that measure patient management as a primary endpoint, diagnostic before-after studies that compare planned patient management before and after testing, and accuracy studies that are extended to report on the actual treatment or further tests received following a positive and negative test result. Conclusions Patient management can be measured as a surrogate outcome for test evaluation if its limitations are recognised. The potential consequences of a positive and negative test result on patient management should be pre-specified and the potential patient benefits of these management changes clearly stated. Randomised comparisons will provide higher quality evidence about

  17. Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes.

    PubMed

    Steptoe, Andrew; Wardle, Jane; Marmot, Michael

    2005-05-01

    Negative affective states such as depression are associated with premature mortality and increased risk of coronary heart disease, type 2 diabetes, and disability. It has been suggested that positive affective states are protective, but the pathways through which such effects might be mediated are poorly understood. Here we show that positive affect in middle-aged men and women is associated with reduced neuroendocrine, inflammatory, and cardiovascular activity. Positive affect was assessed by aggregating momentary experience samples of happiness over a working day and was inversely related to cortisol output over the day, independently of age, gender, socioeconomic position, body mass, and smoking. Similar patterns were observed on a leisure day. Happiness was also inversely related to heart rate assessed by using ambulatory monitoring methods over the day. Participants underwent mental stress testing in the laboratory, where plasma fibrinogen stress responses were smaller in happier individuals. These effects were independent of psychological distress, supporting the notion that positive well-being is directly related to health-relevant biological processes. PMID:15840727

  18. Factors affecting the use of antioxidant supplements in patients with late AMD

    PubMed Central

    Yu, Alice L; Paul, Tobias; Schaumberger, Markus; Welge-Lussen, Ulrich

    2014-01-01

    Background The purpose of this study was to assess the use of oral antioxidant supplements in patients with late age-related macular degeneration (AMD) and to identify influencing factors that may affect the use of such supplements. Methods The study included 47 patients with late AMD. Using a questionnaire, the patients were asked for their demographic, ophthalmologic, and systemic data, their source of recommendation of antioxidant use for AMD, and/or their reasons for nonuse. The demographic, ophthalmologic, and systemic information was correlated with use or nonuse of oral antioxidant supplements for AMD. Results Sixty-eight percent (32/47) of patients took antioxidant supplements for AMD and 32% (15/47) of patients did not. There were no statistically significant differences in demographic, ophthalmologic, and systemic parameters between patients with late AMD who used supplements and those who did not. Two thirds of patients with late AMD (66%, 31/47) reported being recommended oral antioxidant supplements for AMD by their ophthalmologist. Patients who did not use antioxidant supplements either did not obtain any recommendation or did not believe in their benefits. Conclusion This study shows that most patients with late AMD use antioxidant supplements despite the recommendation to do so being missing in the Age-Related Eye Disease Study. Our study emphasizes the importance of seeking further therapeutic options for patients with late AMD. PMID:25061269

  19. Healthy Eating for Healthy Nurses: Nutrition Basics to Promote Health for Nurses and Patients.

    PubMed

    Reed, Denise

    2014-01-01

    Nurses care for people each day in many settings such as hospitals, physician offices, schools, and public health facilities. Such positions often require nurses to work variable and long hours, exposing them to the stressors of caring for people who are ill. These stressors can support poor food choices that adversely affect the health and well-being of the nurse. Nurses are also an integral part of providing nutrition related information to patients. As such, patients may be very cognizant of the health habits of their nurses. Eating for good health is one way that nurses can reduce the impact of stressors on the body and positively influence their health, allowing them to better care for patients and themselves. This article reviews two common nutrition related areas of concern to nurses, stressors, inflammation, and nutrition and sleep and eating patterns, that can lead to obesity. Knowledge and attitudes about nutrition education are also discussed briefly. Finally, the article offers a review of nutrition basics for nurses and suggestions to avoid potential food pitfalls common for nurses. PMID:26824155

  20. Electronic retrieval of health information by healthcare providers to improve practice and patient care

    PubMed Central

    McGowan, Jessie; Grad, Roland; Pluye, Pierre; Hannes, Karin; Deane, Katherine; Labrecque, Michel; Welch, Vivian; Tugwell, Peter

    2014-01-01

    Background The movement towards evidence-based practice makes explicit the need for access to current best evidence to improve health. Advances in electronic technologies have made health information more available, but does availability affect the rate of use of evidence in practice? Objectives To assess the effectiveness of interventions intended to provide electronic retrieval (access to information) to health information by healthcare providers to improve practice and patient care. Search methods We obtained studies from computerized searches of multiple electronic bibliographic databases, supplemented by checking reference lists, and consultation with experts. Selection criteria Randomized controlled trials (RCTs) including cluster randomized trials (CRCTs), controlled clinical trials (CCT), and interrupted time series analyses (ITS) of any language publication status examining interventions of effectiveness of electronic retrieval of health information by healthcare providers. Data collection and analysis Duplicate relevancy screening of searches, data abstraction and risk of bias assessment was undertaken. Main results We found two studies that examined this question. Neither study found any changes in professional behavior following an intervention that facilitated electronic retrieval of health information. There was some evidence of improvements in knowledge about the electronic sources of information reported in one study. Neither study assessed changes in patient outcomes or the costs of provision of the electronic resource and the implementation of the recommended evidence-based practices. Authors’ conclusions Overall there was insufficient evidence to support or refute the use of electronic retrieval of healthcare information by healthcare providers to improve practice and patient care. PMID:19588361

  1. The use of health functional foods in gastrointestinal cancer patients.

    PubMed

    Kang, Hwa Pyoung; Lee, Hosun; Oh, Tak Geun; Lee, Kyong Joo; Park, Soo Jung; Chung, Moon Jae; Kim, Seung Up; Lee, Hyuk; Park, Jun Chul; Hong, Sung Pil; Park, Jun Yong; Park, Jeong Youp; Bang, Seungmin; Kim, Do Young; Cheon, Jae Hee; Ahn, Sang Hoon; Kim, Tae Il; Park, Seung Woo; Song, Si Young

    2013-01-01

    As an adjunct to cancer treatment, the use of health functional foods (HFFs) seems to be increasing. However, little is known for the use of HFFs among cancer patients in Korea. The aims of this study were to investigate the exposure rate of HFF use among gastrointestinal (GI) cancer patients and to examine the relationship of socio-demographic and disease-related characteristics with the use of HFFs. A total of 126 patients diagnosed with GI cancer participated in the study. A cross-sectional survey was conducted using a questionnaire. Over a half of all the patients surveyed (n = 67; 53.2%) used HFFs. Patients who were younger, had higher income, or longer duration of disease showed a trend to use HFFs more frequently, even though the tendency was not statistically significant. The most commonly used HFF was vitamin complex (n = 20; 16%), followed by red ginseng (n = 15; 12%), and sweet wormwood (Artemisia annua) (n = 11; 8.8%). About 26% of all responders expressed concerns for using HFFs. The primary concern was 'going against physician's recommendations' (36.8%). About 63% of respondents expressed a desire to consult with their physicians and follow their recommendations. More basic scientific data and educational materials regarding HFFs are required for both health-care professionals and cancer patients. A larger sample and size-controlled groups representing each cancer type will continue to be recruited for participation in this survey. PMID:23429665

  2. The Use of Health Functional Foods in Gastrointestinal Cancer Patients

    PubMed Central

    Kang, Hwa Pyoung; Lee, Hosun; Oh, Tak Geun; Lee, Kyong Joo; Park, Soo Jung; Kim, Seung Up; Lee, Hyuk; Park, Jun Chul; Hong, Sung Pil; Park, Jun Yong; Park, Jeong Youp; Bang, Seungmin; Kim, Do Young; Cheon, Jae Hee; Ahn, Sang Hoon; Kim, Tae Il; Park, Seung Woo; Song, Si Young

    2013-01-01

    As an adjunct to cancer treatment, the use of health functional foods (HFFs) seems to be increasing. However, little is known for the use of HFFs among cancer patients in Korea. The aims of this study were to investigate the exposure rate of HFF use among gastrointestinal (GI) cancer patients and to examine the relationship of socio-demographic and disease-related characteristics with the use of HFFs. A total of 126 patients diagnosed with GI cancer participated in the study. A cross-sectional survey was conducted using a questionnaire. Over a half of all the patients surveyed (n = 67; 53.2%) used HFFs. Patients who were younger, had higher income, or longer duration of disease showed a trend to use HFFs more frequently, even though the tendency was not statistically significant. The most commonly used HFF was vitamin complex (n = 20; 16%), followed by red ginseng (n = 15; 12%), and sweet wormwood (Artemisia annua) (n = 11; 8.8%). About 26% of all responders expressed concerns for using HFFs. The primary concern was 'going against physician's recommendations' (36.8%). About 63% of respondents expressed a desire to consult with their physicians and follow their recommendations. More basic scientific data and educational materials regarding HFFs are required for both health-care professionals and cancer patients. A larger sample and size-controlled groups representing each cancer type will continue to be recruited for participation in this survey. PMID:23429665

  3. Neuropsychological performance and affective temperaments in Euthymic patients with bipolar disorder type II.

    PubMed

    Romero, Ester; Holtzman, Jessica N; Tannenhaus, Lucila; Monchablon, Romina; Rago, Carlo Mario; Lolich, Maria; Vázquez, Gustavo H

    2016-04-30

    Affective temperament has been suggested as a potential mediator of the effect between genetic predisposition and neurocognitive functioning. As such, this report seeks to assess the extent of the correlation between affective temperament and cognitive function in a group of bipolar II subjects. 46 bipolar II outpatients [mean age 41.4 years (SD 18.2); female 58.9%] and 46 healthy controls [mean age 35.1 years (SD 18); female 56.5%] were evaluated with regard to their demographic and clinical characteristics, affective temperament, and neurocognitive performance. Crude bivariate correlation analyses and multiple linear regression models were constructed between five affective temperament subscales and eight neurocognitive domains. Significant correlations were identified in bipolar patients between hyperthymic temperament and verbal memory and premorbid IQ; cyclothymic temperament and attention; and irritable temperament, attention, and verbal fluency. In adjusting for potential confounders of the relationship between temperament and cognitive function, the strongest mediating factors among the euthymic bipolar patients were found to be residual manic and depressive symptoms. It is therefore concluded that affective temperaments may partially influence the neurocognitive performance of both healthy controls and euthymic patients with bipolar disorder type II in several specific domains. PMID:27086230

  4. Transcriptional regulation differs in affected facioscapulohumeral muscular dystrophy patients compared to asymptomatic related carriers

    PubMed Central

    Arashiro, Patricia; Eisenberg, Iris; Kho, Alvin T.; Cerqueira, Antonia M. P.; Canovas, Marta; Silva, Helga C. A.; Pavanello, Rita C. M.; Verjovski-Almeida, Sergio; Kunkel, Louis M.; Zatz, Mayana

    2009-01-01

    Facioscapulohumeral muscular dystrophy (FSHD) is a progressive muscle disorder that has been associated with a contraction of 3.3-kb repeats on chromosome 4q35. FSHD is characterized by a wide clinical inter- and intrafamilial variability, ranging from wheelchair-bound patients to asymptomatic carriers. Our study is unique in comparing the gene expression profiles from related affected, asymptomatic carrier, and control individuals. Our results suggest that the expression of genes on chromosome 4q is altered in affected and asymptomatic individuals. Remarkably, the changes seen in asymptomatic samples are largely in products of genes encoding several chemokines, whereas the changes seen in affected samples are largely in genes governing the synthesis of GPI-linked proteins and histone acetylation. Besides this, the affected patient and related asymptomatic carrier share the 4qA161 haplotype. Thus, these polymorphisms by themselves do not explain the pathogenicity of the contracted allele. Interestingly, our results also suggest that the miRNAs might mediate the regulatory network in FSHD. Together, our results support the previous evidence that FSHD may be caused by transcriptional dysregulation of multiple genes, in cis and in trans, and suggest some factors potentially important for FSHD pathogenesis. The study of the gene expression profiles from asymptomatic carriers and related affected patients is a unique approach to try to enhance our understanding of the missing link between the contraction in D4Z4 repeats and muscle disease, while minimizing the effects of differences resulting from genetic background. PMID:19339494

  5. Does Intellectual Disability Affect the Development of Dental Caries in Patients with Cerebral Palsy?

    ERIC Educational Resources Information Center

    Moreira, Rafaela Nogueira; Alcantara, Carlos Eduardo Pinto; Mota-Veloso, Isabella; Marinho, Sandra Aparecida; Ramos-Jorge, Maria L.; Oliveira-Ferreira, Fernanda

    2012-01-01

    The aim of this study was to evaluate if the severity of intellectual disability is a factor that affects the development of dental cavities in patients with cerebral palsy. This cross-sectional study was conducted on 165 individuals who were selected from a physical rehabilitation center, a special public school and a regular public school. Of…

  6. Complex treatment of trophic affections with vascular patients using monochromatic red light and hyperbaric oxygenation

    NASA Astrophysics Data System (ADS)

    Babkina, Zinaida M.; Vasilyev, Mikhail V.; Zakharov, Vyacheslav P.; Nikolayev, Viktor V.; Babkin, Vasily I.; Samoday, Valery G.; Zon, Boris A.; Pakhomov, Gennady V.; Naskidashvili, Vasily I.; Kumin, Anatoly A.

    1996-11-01

    Monochromatic red light irradiation therapy of trophic skin affections with vascular patients permits to receive positive results with small wounds. A combination of monochromatic red light and hyperbaric oxygenation is most perspective when conducting a complex therapy of trophic wounds not more than 40 mm2 and allows to diminish time of treatment almost two times.

  7. Patients struggle to access effective health care due to ongoing violence, distance, costs and health service performance in Afghanistan

    PubMed Central

    Nic Carthaigh, Niamh; De Gryse, Benoit; Esmati, Abdul Sattar; Nizar, Barak; Van Overloop, Catherine; Fricke, Renzo; Bseiso, Jehan; Baker, Corinne; Decroo, Tom; Philips, Mit

    2015-01-01

    Background The Afghan population suffers from a long standing armed conflict. We investigated patients’ experiences of their access to and use of the health services. Methods Data were collected in four clinics from different provinces. Mixed methods were applied. The questions focused on access obstacles during the current health problem and health seeking behaviour during a previous illness episode of a household member. Results To access the health facilities 71.8% (545/759) of patients experienced obstacles. The combination of long distances, high costs and the conflict deprived people of life-saving healthcare. The closest public clinics were underused due to perceptions regarding their lack of availability or quality of staff, services or medicines. For one in five people, a lack of access to health care had resulted in death among family members or close friends within the last year. Conclusions Violence continues to affect daily life and access to healthcare in Afghanistan. Moreover, healthcare provision is not adequately geared to meet medical and emergency needs. Impartial healthcare tailored to the context will be vital to increase access to basic and life-saving healthcare. PMID:25492948

  8. Influence of Sex on Suicidal Phenotypes in Affective Disorder Patients with Traumatic Childhood Experiences

    PubMed Central

    Carlberg, Laura; Swoboda, Patrick; Ludwig, Birgit; Koller, Romina; Kapusta, Nestor D.; Aigner, Martin; Haslacher, Helmuth; Schmöger, Michaela; Kasper, Siegfried; Schosser, Alexandra

    2015-01-01

    Objectives In the current study, we aimed to investigate the impact of childhood trauma on suicidal behaviour phenotypes in a group of patients with diagnosed affective disorder (unipolar or bipolar affective disorder). Patients and Methods Patients with and without a history of childhood abuse, measured by Childhood Trauma Questionnaire (CTQ), were assessed to explore risks for suicidal behaviour (including suicide attempt, self-harm and non-suicidal self-injury). The tested sample consisted of 258 patients (111 males and 147 females, in-patients and out-patients at the Department of Psychiatry and Psychotherapy, Medical University of Vienna and University Hospital Tulln, Lower Austria). Psychiatric diagnoses were derived from the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) interview. In addition, patients were administered the Lifetime Parasuicidal Count (LPC), Suicidal Behaviour Questionnaire (SBQ-R), and Viennese Suicide Risk Assessment Scale (VISURIAS) questionnaires. Results In contrast to male suicide attempters, female suicide attempters showed both significantly higher total CTQ scores (p<0.001), and higher CTQ subscores (emotional, physical and sexual abuse, as well as emotional and physical neglect) in comparison to the non-suicidal control group. Besides, females with a history of self-harming behaviour (including suicidal intention) and Non-Suicidal-Self Injury (NSSI) had significantly higher CTQ total scores (p<0.001) than the control group. Conclusion These findings suggest gender differences in suicidal behaviour after being exposed to childhood trauma. PMID:26366559

  9. Predicting self-care with patients and family members' affective states and family functioning.

    PubMed

    Musci, E C; Dodd, M J

    1990-01-01

    People with cancer manage the side effects of treatment with the assistance of their family members. This study was designed to describe self-care behaviors (SCBs) initiated by patients and their family members and to determine the relationship between patients and family members' affective states and family functioning and SCBs. Using a longitudinal design, 42 patients and 40 family members were followed during 3 cycles of chemotherapy (12-16 weeks). The patients completed measures of affective state (POMS) each cycle; patients and family members completed a family functioning measure (F-COPES) at second cycle only; and the patients reported in an SCB log on an ongoing basis. The overall pattern of SCBs corroborated previous findings. The average number of SCBs initiated was 1.4 per side effect. Depression and vigor significantly predicted SCBs at Cycle 1 only. The severity of side effects consistently predicted SCB over the 3 cycles (r 2 = -0.39 to -0.46). Patients who experienced more severe side effects were at risk of diminished self-care. PMID:2342973

  10. Pathological display of affect in patients with depression and right frontal brain damage. An alternative mechanism.

    PubMed

    Ross, E D; Stewart, R S

    1987-03-01

    Two patients are reported with the acute onset of pathological crying following right inferior frontal brain damage. Both had severe endogenous depression and neither had pseudobulbar palsy. These and other cases argue that two organic brain diseases--one structural and the other "physiopharmacological"--may interact to produce pathological display of affect that cannot be accounted for by traditional neurological explanations. A pharmacological mechanism for the rapid amelioration of pathological affect by tricyclic medications and its possible relationship to the newly discovered descending motor systems of the brain that use norepinephrine and serotonin as neurotransmitters is offered. These cases also suggest that pathological affect is a valuable clinical indicator of an underlying major depression in some brain-injured patients. PMID:3819712

  11. Symptom Interval and Patient Delay Affect Survival Outcomes in Adolescent Cancer Patients

    PubMed Central

    Jin, Song Lee; Hahn, Seung Min; Kim, Hyo Sun; Shin, Yoon Jung; Kim, Sun Hee; Lee, Yoon Sun; Lyu, Chuhl Joo

    2016-01-01

    Purpose Unique features of adolescent cancer patients include cancer types, developmental stages, and psychosocial issues. In this study, we evaluated the relationship between diagnostic delay and survival to improve adolescent cancer care. Materials and Methods A total of 592 patients aged 0–18 years with eight common cancers were grouped according to age (adolescents, ≥10 years; children, <10 years). We retrospectively reviewed their symptom intervals (SIs, between first symptom/sign of disease and diagnosis), patient delay (PD, between first symptom/sign of disease and first contact with a physician), patient delay proportion (PDP), and overall survival (OS). Results Mean SI was significantly longer in adolescents than in children (66.4 days vs. 28.4 days; p<0.001), and OS rates were higher in patients with longer SIs (p=0.001). In children with long SIs, OS did not differ according to PDP (p=0.753). In adolescents with long SIs, OS was worse when PDP was ≥0.6 (67.2%) than <0.6 (95.5%, p=0.007). In a multivariate analysis, adolescents in the long SI/PDP ≥0.6 group tended to have a higher hazard ratio (HR, 6.483; p=0.069) than those in the long SI/PDP <0.6 group (HR=1, reference). Conclusion Adolescents with a long SI/PDP ≥0.6 had lower survival rates than those with a short SI/all PDP or a long SI/PDP <0.6. They should be encouraged to seek prompt medical assistance by a physician or oncologist to lessen PDs. PMID:26996554

  12. Community Health Workers in Brazil's Unified Health System: A Framework of their Praxis and Contributions to Patient Health Behaviors

    PubMed Central

    Pinto, Rogério M.; da Silva, Sueli Bulhões; Soriano, Rafaela

    2012-01-01

    Community Health Workers (CHWs) play a pivotal role in primary care, serving as liaisons between community members and medical providers. However, the growing reliance of health care systems worldwide on CHWs has outpaced research explaining their praxis – how they combine indigenous and technical knowledge, overcome challenges and impact patient outcomes. This paper thus articulates the CHW Praxis and Patient Health Behavior Framework. Such a framework is needed to advance research on CHW impact on patient outcomes and to advance CHW training. The project that originated this framework followed Community-Based Participatory Research principles. A team of U.S.-Brazil research partners, including CHWs, worked together from conceptualization of the study to dissemination of its findings. The framework is built on an integrated conceptual foundation including learning/teaching and individual behavior theories. The empirical base of the framework comprises in-depth interviews with 30 CHWs in Brazil's Unified Health System, Mesquita, Rio de Janeiro. Data collection for the project which originated this report occurred in 2008–10. Semi-structured questions examined how CHWs used their knowledge/skills; addressed personal and environmental challenges; and how they promoted patient health behaviors. This study advances an explanation of how CHWs use self-identified strategies – i.e., empathic communication and perseverance – to help patients engage in health behaviors. Grounded in our proposed framework, survey measures can be developed and used in predictive models testing the effects of CHW praxis on health behaviors. Training for CHWs can explicitly integrate indigenous and technical knowledge in order for CHWs to overcome contextual challenges and enhance service delivery. PMID:22305469

  13. Professionalism: good for patients and health care organizations.

    PubMed

    Brennan, Michael D; Monson, Verna

    2014-05-01

    Professionalism is an indispensable element in the compact between the medical profession and society that is based on trust and putting the needs of patients above all other considerations. The resurgence of interest in professionalism dates back to the 1980s when health maintenance organizations were formed and proprietary influences in health care increased. Since then, a rich and comprehensive literature has emerged in defining professionalism, including desirable individual attributes and behaviors and how they may be taught, promoted, and assessed. More recently, scholarship has shifted from individual to organizational professionalism. This literature addresses the role that health care organizations can play to establish environments that are conducive to the consistent expression of professionalism by individuals and health care teams. We reviewed interdisciplinary empirical studies from health care effectiveness and outcomes, organizational sciences, positive psychology, and social psychology, finding evidence that organizational and individual professionalism is associated with a wide range of benefits to patients and the organization. We identify actionable organizational strategies and approaches that, if adopted, can foster and promote combined organizational and individual professionalism. In doing so, trust in the medical profession and its institutions can be enhanced, which in turn will reconfirm a commitment to the social compact. PMID:24797645

  14. [Health locus of control of patients in disease management programmes].

    PubMed

    Schnee, M; Grikscheit, F

    2013-06-01

    Health locus of control beliefs plays a major role in improving self-management skills of the chronically ill - a main goal in disease management programmes (DMP). This study aims at characterising participants in disease management regarding their health locus of control. Data are based on 4 cross-sectional postal surveys between spring and autumn of 2006 and 2007 within the Health Care Monitor of the Bertelsmann Foundation. Among the 6 285 respondents, 1 266 are chronically ill and not enrolled in a DMP and 327 are participating in a DMP. A high internal locus of control (HLC) occurs significantly less often in DMP patients than in normal chronically ill patients (and healthy people) controlling for age, gender and social class. With increasing age, a high internal locus of control is also significantly less likely. When comparing healthy people, the chronically ill and the DMP participants a social gradient of a high internal locus of control belief can be observed. The weaker internal and higher doctor-related external locus of control of DMP participants should be carefully observed by the physician when trying to strengthen the patients' self-management skills. Evaluators of DMP should take into account the different baselines of DMP patients and relevant control groups and incorporate these differences into the evaluation. PMID:22864845

  15. Metabolic issues in patients affected by schizophrenia: clinical characteristics and medical management

    PubMed Central

    Ventriglio, Antonio; Gentile, Alessandro; Stella, Eleonora; Bellomo, Antonello

    2015-01-01

    Patients affected by psychotic disorders are more likely to develop high rates of co-morbidities, such as obesity, type 2 diabetes, dyslipidemias, hypertension, metabolic syndrome, myocardial infarction, stroke etc., in the long-term. These morbidities have a significant impact on the life-expectancy of these patients. Patients with chronic psychoses show a 2–3-fold increased risk of death mostly from cardiovascular and metabolic diseases. Although there may be an independent link, between schizophrenia and metabolic conditions the cardio-metabolic risk is mostly related to an unhealthy lifestyle and the usage of antipsychotic agents (especially Second Generation Antipsychotics or atypical) even when these remain effective treatments in the management of major psychoses. Recently, many international organizations have developed screening and monitoring guidelines for the control of modifiable risk factors in order to reduce the rate of co-morbidity and mortality among patients affected by schizophrenia. This paper is a review of current knowledge about the metabolic issues of patients affected by schizophrenia and describes clinical characteristics and medical management strategies for such conditions. PMID:26388714

  16. Stress potential and esotericity of health problems: the significance of the physician's affective behavior.

    PubMed

    Ben-Sira, Z

    1982-04-01

    The study examines the assumptions and the interpretation of data from recent studies that were intended to identify and explain patients' inclination to assess the efficacy of medical treatment on the basis of physicians' affective behavior toward them. It was hypothesized that this manner of assessment is specific to the doctor-patient relationship due to the uniqueness of the patient's problem, which is characterized by a relatively high stress potential and esotericity requiring professional help. Empirical investigation of four types of problems that varied in the level of their stress potential and the need for professional help ascertains that a) the stress potential of a problem and the need for a professional solution affect separately the propensity of assessing the content of the agent's assistance on the basis of the mode of its presentation; b) judgment of the mode indeed determines the assessment of the content of the professional solution; and c) this manner of assessment may apply also to other roles of the medical setting. PMID:7078297

  17. Health care financing policy for hospitalized nephrology patients.

    PubMed

    Muñoz, E; Barrau, L; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L

    1988-12-01

    The Medicare diagnosis-related group (DRG) prospective payment system is now entering its 6th year, with no reported major adverse effects on the health status of the American people. Currently 13 states are using DRG prospective "all-payer systems" for hospital reimbursement; other state may adopt DRG all payer systems. In DRG all-payer systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York state has been all-payer since January 1, 1988. This study simulated DRG all-payer methods on a large sample (n = 558) of adult nephrology patients for a 2-year period using both federal and New York DRG reimbursements now in effect. Both Medicare and Medicaid patients had (on average) longer hospital lengths of stay and higher total hospital costs compared with patients from Blue Cross and other commercial payers. Medicare and Medicaid patients also had greater severity of illness than patients from Blue Cross or other payers. However, all payers (ie, Medicaid, Blue Cross, Medicare, and commercial insurers) generated significant financial risk under our DRG all-payer scheme. These data suggest that federal, state, and private payers may be underreimbursing for the care of hospitalized nephrology patients using the DRG prospective hospital payment scheme. As DRG payment rates are further reduced compared with the real hospital costs of treating patients, both the access to and the quality of care for many nephrology patients may be jeopardized. PMID:3143261

  18. Internet chemotherapy information: impact on patients and health professionals

    PubMed Central

    Davies, E; Yeoh, K-W

    2012-01-01

    Background: Reliable information can improve patients' knowledge of chemotherapy. As internet chemotherapy information (ICI) is increasingly viewed as a valuable patient education tool, we investigated the impact of ICI on patient care and analysed health professionals' (HPs') attitudes towards ICI. Methods: The following questionnaires were distributed: (1) self-administered questionnaire randomly given to 261 patients receiving chemotherapy (80% returned); and (2) separate questionnaire given to 58 HPs at the same UK Oncology Centre (83% returned). Results: Just over half of the patient respondents accessed the internet regularly. They were younger, with higher incomes and qualifications. Key search topics included chemotherapy modes of action, symptom management and treatment success, and most considered ICI useful. More than half wanted to discuss ICI with HPs but most did not get the opportunity. Although the majority of HP respondents supported the need for patients to retrieve ICI, most questioned the accuracy of ICI and did not routinely recommend its use. Conclusion: This study has shown that ICI is generally perceived by patients to be a valuable information resource. Given the potential impact of ICI, the following should be addressed in future studies: (1) inequalities in accessing ICI; (2) maintaining the quality of ICI (with clear guidance on recommended websites); (3) bridging the gap between the perception of ICI by patients and HPs; (4) integration of ICI with traditional consultation models. PMID:22262319

  19. Behavior, affect, and cognition among psychogenic pain patients in group expressive psychotherapy.

    PubMed

    Corbishley, M A; Hendrickson, R; Beutler, L E; Engle, D

    1990-08-01

    In an exploratory study, the authors examined the cognitions, affect, and behaviors reported by eight female depressed chronic pain patients during experiential therapy sessions that focused on anger and depression. Subjects appeared to fit previously developed psychologic profiles of patients with chronic pain disorder: they presented as conscientious, compliant, passive, and rule-bound, viewing life and emotional expression as dangerous, avoiding conflict and risk, denying their own emotional needs. Their reports were compared with the self-reported affect behavior and cognitions of eight depressed female patients without chronic pain, under similar therapeutic conditions. Considerable differences in style and content were found. Implications of these findings for clinical practice are discussed. PMID:2384704

  20. The challenges in making electronic health records accessible to patients

    PubMed Central

    Beard, Leslie; Schein, Rebecca; Morra, Dante; Wilson, Kumanan

    2011-01-01

    It is becoming increasingly apparent that there is a tension between growing consumer demands for access to information and a healthcare system that may not be prepared to meet these demands. Designing an effective solution for this problem will require a thorough understanding of the barriers that now stand in the way of giving patients electronic access to their health data. This paper reviews the following challenges related to the sharing of electronic health records: cost and security concerns, problems in assigning responsibilities and rights among the various players, liability issues and tensions between flexible access to data and flexible access to physicians. PMID:22120207

  1. [Health care of geriatric patients with urinary incontinence].

    PubMed

    Mueller, Edgar A; Kirch, Wilhelm

    2015-04-01

    Urinary incontinence occurs frequently in geriatric patients. In the doctor's practice, the symptoms are often not mentioned by the patients; this may lead to loss of autonomy and social isolation. A screening for urinary incontinence should therefore be part of each geriatric assessment. In the presence of urinary incontinence, several treatment options are available, which need to be tailored according to the individual capabilities (mobility, motivation and cognitive performance) of the patient. Non-pharmacological treatment options, such as behavior modification, toilet training and pelvic floor training, should be exploited before any pharmacotherapy commences. If the pharmacological treatment involves the use of anticholinergic agents, the cognitive performance should be monitored. An interdisciplinary collaboration is a prerequisite for the optimized treatment and adequate health care of geriatric patients with urinary incontinence. PMID:25826038

  2. Congruence or Discrepancy? Comparing Patients' Health Valuations and Physicians' Treatment Goals for Rehabilitation for Patients with Chronic Conditions

    ERIC Educational Resources Information Center

    Nagl, Michaela; Farin, Erik

    2012-01-01

    The aim of this study was to test the congruence of patients' health valuations and physicians' treatment goals for the rehabilitation of chronically ill patients. In addition, patient characteristics associated with greater or less congruence were to be determined. In a questionnaire study, patients' health valuations and physicians' goals were…

  3. Factors affecting the performance of community health workers in India: a multi-stakeholder perspective

    PubMed Central

    Sharma, Reetu; Webster, Premila; Bhattacharyya, Sanghita

    2014-01-01

    Background Community health workers (CHWs) form a vital link between the community and the health department in several countries. In India, since 2005 this role is largely being played by Accredited Social Health Activists (ASHAs), who are village-level female workers. Though ASHAs primarily work for the health department, in a model being tested in Rajasthan they support two government departments. Focusing on the ASHA in this new role as a link worker between two departments, this paper examines factors associated with her work performance from a multi-stakeholder perspective. Design The study was done in 16 villages from two administrative blocks of Udaipur district in Rajasthan. The findings are based on 63 in-depth interviews with ASHAs, their co-workers and representatives from the two departments. The interviews were conducted using interview guides. An inductive approach with open coding was used for manual data analysis. Results This study shows that an ASHA's motivation and performance are affected by a variety of factors that emerge from the complex context in which she works. These include various personal (e.g. education), professional (e.g. training, job security), and organisational (e.g. infrastructure) factors along with others that emerge from external work environment. The participants suggested various ways to address these challenges. Conclusion In order to improve the performance of ASHAs, apart from taking corrective actions at the professional and organisational front on a priority basis, it is equally essential to promote cordial work relationships amongst ASHAs and other community-level workers from the two departments. This will also have a positive impact on community health. PMID:25319596

  4. Patient Ethnicity Affects Triage Assessments and Patient Prioritization in U.S. Department of Veterans Affairs Emergency Departments.

    PubMed

    Vigil, Jacob M; Coulombe, Patrick; Alcock, Joe; Kruger, Eric; Stith, Sarah S; Strenth, Chance; Parshall, Mark; Cichowski, Sara B

    2016-04-01

    Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment.The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses.A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, <1% American Indian/Alaska Native, and 1% mixed ethnicity. After controlling for demographic characteristics of nurses and patients, African-American, Hispanic, and mixed-ethnicity patients reported higher average PI scores but lower HRs and RRs than NHW patients. NHW patients received higher priority ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans).This study provides evidence for systemic differences in how patients' vital signs are applied for determining ESI scores for different ethnic groups. Additional

  5. Are school-based mental health interventions for war-affected children effective and harmless?

    PubMed Central

    2014-01-01

    In recent years, different approaches to large-scale mental health service provision for children in war-affected, mainly low- and middle-income, countries have been developed. Some school-based programs aiming at both strengthening resilience and reducing symptoms of trauma-related distress have been evaluated. In an article published in BMC Medicine, Tol and colleagues integrate their findings of the efficacy of universal school-based intervention across four countries and do not recommend classroom-based intervention as a treatment of trauma-related symptoms, since no consistent positive effects were found. On the contrary, for some children this type of universal intervention may impair recovery. Since universal school-based programs similar to the one evaluated here are widely implemented, Tol et al.’s results are highly relevant to inform the field of mental health service provision in war-affected countries. Please see related article http://www.biomedcentral.com/1741-7015/12/56. PMID:24885265

  6. High-fibre sunflower cake affects small intestinal digestion and health in broiler chickens.

    PubMed

    Kalmendal, R; Elwinger, K; Holm, L; Tauson, R

    2011-02-01

    1. An experiment was conducted to evaluate high-fibre sunflower cake (HF-SFC); a feed ingredient distinguished by large amounts of crude fibre and insoluble non-starch polysaccharides (i-NSP). 2. Broiler chickens (n = 160) were fed on pelleted maize-based diets free from coccidiostats and antibiotic growth promoters between 15 and 31 d of age. Diets included 0, 10, 20 or 30% HF-SFC. Performance and small intestinal health were assessed. 3. In general, HF-SFC inclusion mediated significant linear increases in ileal digestibility of fat and protein and significant linear decreases in ileal digestibility of dry matter, ash and energy. 4. Weight gain increased linearly with HF-SFC inclusion. Feed conversion was negatively affected by 30% HF-SFC but not by 20% HF-SFC. 5. In the jejunal lumen, inclusion of HF-SFC was associated with significant decreases in colony counts of Clostridium spp. 6. HF-SFC inclusion resulted in significant linear reductions of villus height, thickness of muscularis mucosa, and the circular and longitudinal layers of muscularis in the jejunum. Crypt depth and submucosal thickness were not affected. 7. The data indicate that broiler chickens may thrive on feeds with insoluble fibre contents far exceeding those used in practice, and that HF-SFC exerts some positive effects on digestion and small intestinal health. PMID:21337203

  7. Religion, spirituality, and physical health in cancer patients: A meta-analysis.

    PubMed

    Jim, Heather S L; Pustejovsky, James E; Park, Crystal L; Danhauer, Suzanne C; Sherman, Allen C; Fitchett, George; Merluzzi, Thomas V; Munoz, Alexis R; George, Login; Snyder, Mallory A; Salsman, John M

    2015-11-01

    Although religion/spirituality (R/S) is important in its own right for many cancer patients, a large body of research has examined whether R/S is also associated with better physical health outcomes. This literature has been characterized by heterogeneity in sample composition, measures of R/S, and measures of physical health. In an effort to synthesize previous findings, a meta-analysis of the relation between R/S and patient-reported physical health in cancer patients was performed. A search of PubMed, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library yielded 2073 abstracts, which were independently evaluated by pairs of raters. The meta-analysis was conducted for 497 effect sizes from 101 unique samples encompassing more than 32,000 adult cancer patients. R/S measures were categorized into affective, behavioral, cognitive, and 'other' dimensions. Physical health measures were categorized into physical well-being, functional well-being, and physical symptoms. Average estimated correlations (Fisher z scores) were calculated with generalized estimating equations with robust variance estimation. Overall R/S was associated with overall physical health (z = 0.153, P < .001); this relation was not moderated by sociodemographic or clinical variables. Affective R/S was associated with physical well-being (z = 0.167, P < .001), functional well-being (z = 0.343, P < .001), and physical symptoms (z = 0.282, P < .001). Cognitive R/S was associated with physical well-being (z = 0.079, P < .05) and functional well-being (z = 0.090, P < .01). 'Other' R/S was associated with functional well-being (z = 0.100, P < .05). In conclusion, the results of the current meta-analysis suggest that greater R/S is associated with better patient-reported physical health. These results underscore the importance of attending to patients' religious and spiritual needs as part of comprehensive

  8. Relationship of Negative Affect and Outcome of an Opioid Therapy Trial Among Low Back Pain Patients

    PubMed Central

    Jamison, Robert N.; Edwards, Robert R.; Liu, Xiaoxia; Ross, Edgar L.; Michna, Edward; Warnick, Meredith; Wasan, Ajay D.

    2013-01-01

    Objectives Patients with chronic noncancer pain frequently report symptoms of depression and anxiety (negative affect), which are associated with higher ratings of pain intensity and a greater likelihood of being prescribed chronic opioid therapy. The purpose of this secondary analysis was to test the hypothesis that initial levels of negative affect can predict treatment-related outcomes in a double-blind, placebo-controlled study of extended-release (ER) hydromorphone among opioid-tolerant patients with chronic low back pain. Methods Four hundred fifty-nine (N = 459) patients participated in the titration/conversion phase of a multicenter study, of which 268 were randomized to receive once-daily hydromorphone or placebo. All patients completed the Hospital Anxiety and Depression Scale (HADS) at baseline and were divided evenly into Low (N = 157), Moderate (N = 155), and High (N = 147) negative affect groups based on their scores. Group differences in numerical pain intensity measures at home and in the clinic, Roland–Morris Disability ratings, and measures of symptoms from the Subjective Opiate Withdrawal Scale (SOWS) throughout the trial were analyzed. Results Two hundred sixty-eight of the initial 459 subjects who entered the 2 to 4-week titration/conversion phase (pretreatment) were successfully randomized to either placebo or ER hydromorphone; a total of 110 patients then completed this double-blind phase of the study. Those in the Moderate and High negative affect groups tended to drop out more often during the titration/conversion phase because of the adverse effects or lack of efficacy of their prescribed opioid than those in the Low negative mood group (P < 0.05). Overall, those patients in the Moderate and High groups reported significantly higher pain intensity scores in at-home and in-clinic pain intensity ratings (P < 0.05), greater disability on the Roland–Morris Scale (P < 0.01), and more withdrawal symptoms on the SOWS (P < 0.05) than those in

  9. Inappropriate overuse of inhaled corticosteroids for COPD patients: impact on health costs and health status.

    PubMed

    de Miguel-Díez, Javier; Carrasco-Garrido, Pilar; Rejas-Gutierrez, Javier; Martín-Centeno, Antonio; Gobartt-Vázquez, Elena; Hernandez-Barrera, Valentín; Gil de, Miguel Angel; Jimenez-Garcia, Rodrigo

    2011-06-01

    The aim of this study was to evaluate the relationship between inappropriate overuse of inhaled corticosteroids and self-reported health status and the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) recruited in the primary-care setting. An observational, crossover, descriptive study was conducted. Patients with stable COPD and aged ≥40 years, evaluated in primary care, were included. Data collected were demographic variables, clinical characteristics, self-reported health status (SF-12), the severity of the illness, treatment, and health-care resource utilization in the past year. The patients were recruited during a period of 3 months (from January 1 to March 31, 2003). Use was considered inappropriate when corticosteroids were prescribed by physicians for patients not meeting criteria for its use as recommended in guidelines. A total of 10,711 patients [75.6% males; mean age = 67.1 (SD = 9.66) years] were evaluated. Disease severity was mild in 35.5% of the cases, moderate in 53.4%, and severe in 11.2%. Among them, 3,697 (34.5%) subjects were prescribed inhaled corticosteroids or drug combinations containing such therapies, with a rate of inappropriate use of 18.2%. Physical health status was significantly lower among patients showing inappropriate corticosteroids use: 37.35 (SD = 9.53) vs. 40.7 (SD = 9.80) (p < 0.05). The annual cost per patient of COPD management was significantly higher in the group with inappropriate inhaled corticosteroids use: 1,590 (SD = 1,834) vs. 1,157 (SD = 1,536) (p < 0.05). Factors statistically associated with inappropriate use of corticosteroids were educational attainment [OR: 2.77 (95% CI: 1.36-5.63) for nonuniversity training], a history of heart disease [OR: 1.42 (95% CI: 1.02-1.97)], depression [OR: 1.47 (95% CI: 1.05-2.05)], any allergy [OR 1.69 (95% CI: 1.13-2.54)], and physical health status [OR 0.97 (95% CI: 0.96-0.98)]. Lack of adherence to the

  10. Patient-centered medical home: how it affects psychosocial outcomes for diabetes.

    PubMed

    Jortberg, Bonnie T; Miller, Benjamin F; Gabbay, Robert A; Sparling, Kerri; Dickinson, W Perry

    2012-12-01

    Fragmentation of the current U.S. health care system and the increased prevalence of chronic diseases in the U.S. have led to the recognition that new models of care are needed. Chronic disease management, including diabetes, is often accompanied by a myriad of associated psychosocial issues that need to be addressed as part of a comprehensive treatment plan. Diabetes care should be aligned with comprehensive whole-person health care. The patient-centered medical home (PCMH) has emerged as a model for enhanced primary care that focuses on comprehensive integrated care. PCMH demonstration projects have shown improvements in quality of care, patient experience, care coordination, access to care, and quality measures for diabetes. Key PCMH transformative features associated with psychosocial issues related to diabetes reviewed in this article include integration of mental and behavioral health, care management/coordination, payment reform, advanced access, and putting the patient at the center of health care. This article also reviews the evidence supporting comprehensive and integrated care for addressing psychosocial issues associated with diabetes in the medical home. PMID:22961115

  11. Underlying personality differences between alcohol/substance-use disorder patients with and without an affective disorder.

    PubMed

    Janowsky, D S; Hong, L; Morter, S; Howe, L

    1999-01-01

    The Myers-Briggs Type Indicator (MBTI), a popular personality test, was used to profile the personalities of in-patient alcoholics/substance-use disorder patients who had, and those who did not have, a concurrent affective disorder diagnosis. The MBTI divides individuals into eight categories: Extroverts and Introverts, Sensors and Intuitives, Thinkers and Feelers, and Judgers and Perceivers. Alcohol/substance-use disorder patients with no affective disorder differed from a normative population only in being significantly more often Sensing and significantly less often Intuitive single-factor types. The Extroverted/Sensing/ Feeling/Judging four-factor type was also significantly over-represented in this group, compared to a normative population. In contrast, mood-disordered alcohol/substance-use disorder patients were significantly more often Introverted, Sensing, Feeling, and Perceiving and significantly less often Extroverted, Intuitive, Thinking, and Judging single-factor types. They were also significantly more often Introverted/Sensing/ Feeling/Perceiving and Introverted/Intuitive/Feeling/Perceiving four-factor types. 'Pure' alcohol/ substance-use disorder patients differed from alcohol/substance-use disorder patients with a mood disorder in that they were significantly more often Extroverted and Thinking and significantly less often Introverted and Feeling single-factor types; and significantly less often were an Introverted/Sensing/ Feeling/Perceiving four-factor type. The above results may have psychogenetic, diagnostic, and psychotherapeutic implications. PMID:10414613

  12. Patient Ethnicity Affects Triage Assessments and Patient Prioritization in U.S. Department of Veterans Affairs Emergency Departments

    PubMed Central

    Vigil, Jacob M.; Coulombe, Patrick; Alcock, Joe; Kruger, Eric; Stith, Sarah S.; Strenth, Chance; Parshall, Mark; Cichowski, Sara B.

    2016-01-01

    Abstract Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment. The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses. A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, <1% American Indian/Alaska Native, and 1% mixed ethnicity. After controlling for demographic characteristics of nurses and patients, African-American, Hispanic, and mixed-ethnicity patients reported higher average PI scores but lower HRs and RRs than NHW patients. NHW patients received higher priority ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans). This study provides evidence for systemic differences in how patients’ vital signs are applied for determining ESI scores for different ethnic groups

  13. Persistent reflux symptoms cause anxiety, depression, and mental health and sleep disorders in gastroesophageal reflux disease patients.

    PubMed

    Kimura, Yoshihide; Kamiya, Takeshi; Senoo, Kyouji; Tsuchida, Kenji; Hirano, Atsuyuki; Kojima, Hisayo; Yamashita, Hiroaki; Yamakawa, Yoshihiro; Nishigaki, Nobuhiro; Ozeki, Tomonori; Endo, Masatsugu; Nakanishi, Kazuhisa; Sando, Motoki; Inagaki, Yusuke; Shikano, Michiko; Mizoshita, Tsutomu; Kubota, Eiji; Tanida, Satoshi; Kataoka, Hiromi; Katsumi, Kohei; Joh, Takashi

    2016-07-01

    Some patients with gastroesophageal reflux disease experience persistent reflux symptoms despite proton pump inhibitor therapy. These symptoms reduce their health-related quality of life. Our aims were to evaluate the relationship between proton pump inhibitor efficacy and health-related quality of life and to evaluate predictive factors affecting treatment response in Japanese patients. Using the gastroesophageal reflux disease questionnaire, 145 gastroesophageal reflux disease patients undergoing proton pump inhibitor therapy were evaluated and classified as responders or partial-responders. Their health-related quality of life was then evaluated using the 8-item Short Form Health Survey, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale questionnaires. Sixty-nine patients (47.6%) were partial responders. These patients had significantly lower scores than responders in 5/8 subscales and in the mental health component summary of the 8-item Short Form Health Survey. Partial responders had significantly higher Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale scores, including anxiety and depression scores, than those of responders. Non-erosive reflux disease and double proton pump inhibitor doses were predictive factors of partial responders. Persistent reflux symptoms, despite proton pump inhibitor therapy, caused mental health disorders, sleep disorders, and psychological distress in Japanese gastroesophageal reflux disease patients. PMID:27499583

  14. Health Courts” and Accountability for Patient Safety

    PubMed Central

    Mello, Michelle M; Studdert, David M; Kachalia, Allen B; Brennan, Troyen A

    2006-01-01

    Proposals that medical malpractice claims be removed from the tort system and processed in an alternative system, known as administrative compensation or ‘health courts,’ attract considerable policy interest during malpractice ‘crises,’ including the current one. This article describes current proposals for the design of a health court system and the system's advantages for improving patient safety. Among these advantages are the cultivation of a culture of transparency regarding medical errors and the creation of mechanisms to gather and analyze data on medical injuries. The article discusses the experiences of foreign countries with administrative compensation systems for medical injury, including their use of claims data for research on patient safety; choices regarding the compensation system's relationship to physician disciplinary processes; and the proposed system's possible limitations. PMID:16953807

  15. Somatic focus/awareness: Relationship to negative affect and pain in chronic pain patients

    PubMed Central

    O’Brien, Erin M.; Atchison, James W.; Gremillion, Henry A.; Waxenberg, Lori B.; Robinson, Michael E.

    2009-01-01

    Somatic focus refers to the tendency to notice and report physical symptoms, and has been investigated in relation to chronically painful conditions. This study investigated the relationship between somatic focus, as measured by the Pennebaker Inventory of Limbic Languidness (PILL), negative affect and pain. A secondary purpose of the present study was to examine sex differences in these relationships. Participants included 280 chronic pain patients (69.6% females, 88.9% Caucasian), who completed a battery of self-report measures on somatic focus, pain, negative affect, coping, and dysfunction. Results for the overall sample revealed that the PILL shares considerable variance with measures of negative affect, particularly with the physiological components of anxiety and depression. When the results were analyzed separately for male and female patients, it was found that several components of negative affect and cognitive factors play a stronger role in predicting somatic focus among men compared to women. Additional analyses then examined whether somatic focus was predictive of male and female patients’ pain reports. Results indicated that somatic focus explained a small, but unique amount of variance in female patients’ pain reports, which differed from the relationship observed among male patients. PMID:17524684

  16. Affective disorders in patients with HIV infection: impact of antiretroviral therapy.

    PubMed

    Arendt, Gabriele

    2006-01-01

    At the beginning of the AIDS pandemic, affective disorders (such as depressed mood) were seen in a considerable number of HIV-1-infected individuals. These disorders were a result of the poor physical condition of the patients, brain involvement by the virus (e.g. encephalopathy) or a reaction to disadvantageous living conditions (losing friends, jobs, etc.). In the era of highly active antiretroviral therapy (HAART), mental illness related to physical weakness is declining, as is the incidence of HIV-1-associated encephalopathy. However, depressed mood and fatigue caused by efavirenz (a standard component of HAART) is becoming increasingly important, particularly in individuals who are infected long-term with HIV-1. Whatever the cause of affective disorders, their presence has been shown to negatively influence adherence to HAART and HIV-1 disease progression. Specialist knowledge of HIV-1 infection, and HAART and its psychiatric complications (particularly in subgroups of patients such as drug abusers and older people), is needed to care adequately for patients. Furthermore, prospective studies are needed to more fully differentiate between the various aetiologies of affective disorders seen in individuals living with HIV/AIDS and to determine their incidence and prevalence. Such information is important to ensure that affective disorders are recognised and adequately treated, which will in turn improve the efficacy of HAART. PMID:16734500

  17. Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System

    PubMed Central

    Zulman, Donna M; Pal Chee, Christine; Wagner, Todd H; Yoon, Jean; Cohen, Danielle M; Holmes, Tyson H; Ritchie, Christine; Asch, Steven M

    2015-01-01

    Objectives To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. Design In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals’ outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. Setting USA VA Health Care System. Participants 5.2 million VA patients. Measures Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. Results The 5% highest cost patients (n=261 699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (−0.6 percentage points per affected body system, p<0.01). Conclusions Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease

  18. Surgonomics. Health care financing policy for hospitalized otolaryngology patients.

    PubMed

    Muñoz, E; Zahtz, G; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L

    1988-11-01

    The Medicare diagnosis related group (DRG) prospective payment model is changing hospital payment. Currently many states are using DRG prospective "All Payor Systems" for hospital reimbursement. In All Payor Systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York State has been All Payor since Jan 1, 1988. This study simulated DRG All Payor methods on a large sample (N = 1074) of adult otolaryngology patients for a two-year period using both federal and New York DRG reimbursement now in effect. Both Medicare and Medicaid patients had (on average) a longer hospital stay and total hospital cost compared with patients from Blue Cross and other commercial payors. Medicare and Medicaid patients also had a greater severity of illness compared with patients from Blue Cross or other payors. All payors (ie, Medicaid, Blue Cross, and commercial insurers), except Medicare, generated financial risk under the DRG All Payor scheme. These data suggest that state and private payors may be underreimbursing for the care of the hospitalized otolaryngology patient using the DRG prospective hospital payment scheme. Health care financing policy described in this study may limit both the access and/or the quality of care for many otolaryngology patients in the future. PMID:3139014

  19. Health care financing policy for hospitalized pulmonary medicine patients.

    PubMed

    Muñoz, E; Barrau, L; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L

    1989-01-01

    Several federal bodies provide ongoing analyses of the Medicare DRG prospective hospital payment system. Many states are using DRG prospective "all payor systems" for hospital reimbursement (based on the federal model). In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; New York State has been All Payor since 1/1/88. This study simulated DRG All Payor methods on a large sample (n = 1,662) of pulmonary medicine patients for a two-year period using both federal and New York DRG reimbursement now in effect at our hospital. Medicare patients had (on average) a longer hospital length of stay and total hospital cost compared to patients from Medicaid, Blue Cross, and other commercial payors. Medicare patients also had a greater severity of illness compared to patients from Blue Cross Medicaid or other payors. All payors, however, (Medicaid, Blue Cross, Medicare and commercial insurers) generated significant financial risk under the DRG All Payor scheme. These data suggest that federal, state, and private payors may be underreimbursing for the care of the hospitalized pulmonary medicine patients using the DRG prospective hospital payment scheme. Health care financing policy, as demonstrated in this study, may limit both the access and quality of care for many pulmonary medicine patients in the future. PMID:2491799

  20. A Quantitative Exploration of the Relationship between Patient Health and Electronic Personal Health Records

    ERIC Educational Resources Information Center

    Hines, Denise Williams

    2009-01-01

    The use of electronic personal health records is becoming increasingly more popular as healthcare providers, healthcare and government leaders, and patients are seeking ways to improve healthcare quality and to decrease costs (Abrahamsen, 2007). This quantitative, descriptive correlational study examined the relationship between the degree of…

  1. Affective temperaments and psychopathological dimensions of personality in bipolar and cyclothymic patients.

    PubMed

    Harnic, Désirée; Pompili, Maurizio; Mazza, Marianna; Innamorati, Marco; Di Nicola, Marco; Catalano, Valeria; Bruschi, Angelo; Del Bono, Diletta; Forte, Alberto; Lester, David; Girardi, Paolo; Bria, Pietro; Janiri, Luigi

    2013-01-01

    The aims of the study were: (1) to study possible associations between temperament, personality dimensions, and psychopathological variables in a clinical sample of euthymic patients with bipolar disorder (BD) and cyclothymia; and (2) to assess how Cloninger's temperament and personality dimensions were associated with affective temperaments. Participants, consisting of 60 patients with BD (type I or II) and cyclothymia in the euthymic phase, completed Akiskal's Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), and Cloninger's Temperament and Character Inventory-revised version (TCI-R). The diagnostic groups differed in past hospitalization, for age at onset of the disorder, and on two affective temperaments: the TEMPS-A Hyperthymia, and the TEMPS-A Irritability. There were six significant associations between affective temperaments and Cloninger's personality dimensions, ranging from 0.26 to 0.54. The measures of Akiskal and of Cloninger tap common behavioral features in patients with bipolar disorder and cyclothymia, yet the differences indicate that the two measures are not redundant. BD and cyclothymic patients differed significantly in temperament and personality, differences that may have important implications for treatment. PMID:23398272

  2. Prognostic Value of Affective Symptoms in First-Admission Psychotic Patients

    PubMed Central

    Arrasate, Marta; González-Ortega, Itxaso; García-Alocén, Adriana; Alberich, Susana; Zorrilla, Iñaki; González-Pinto, Ana

    2016-01-01

    Background: Very little research has been conducted in patients with first-episode psychosis using a dimensional approach. Affective dimensional representations might be useful to predict the clinical course and treatment needs in such patients. Methods: Weincluded 112 patients with first-episode psychosis in a longitudinal-prospective study with a five-year follow-up (N = 82). Logistic analyses were performed to determine the predictive factors associated with depressive, manic, activation, and dysphoric dimensions. Results: High scores on the depressive dimension were associated with the best prognosis. On the other hand, high scores on the activation dimension and the manic dimension were associated with a poorer prognosis in terms of relapses. Only the dysphoric dimension was not associated with syndromic or functional prognosis. Conclusion: Ourresults suggest that the pattern of baseline affective symptoms helps to predict the course of psychotic illness. Therefore, the systematic assessment of affective symptoms would enable us to draw important conclusions regarding patients’ prognosis. Interventions for patients with high scores on manic or activation dimensions could be beneficial in decreasing relapses in first-episode psychosis. PMID:27376266

  3. Factors That Affect the Rehabilitation Duration in Patients With Congenital Muscular Torticollis

    PubMed Central

    Jung, Ah Young; Lee, Sung Hoon; Nam, Doo Hyeon; Cheon, Ji Hwan; Kim, Hyo Jung

    2015-01-01

    Objective To determine which factors