Health Service Delivery in Developing Countries

ERIC Educational Resources Information Center

Benyoussef, Amor

1977-01-01

Reviews recent work dealing with methodological and technical issues in health and development; presents examples of the application of social sciences, including health demography and economics, in questions of health services delivery; and analyzes delivery of health services to rural and nomadic populations in Africa, Asia, and Latin America.…

Building Responsive Health Systems to Help Communities Affected by Migration: An International Delphi Consensus

PubMed Central

Pottie, Kevin; Hui, Charles; Rahman, Prinon; Ingleby, David; Akl, Elie A.; Russell, Grant; Ling, Li; Wickramage, Kolitha; Mosca, Davide; Brindis, Claire D.

2017-01-01

Persons affected by migration require health systems that are responsive and adaptable to the needs of both disadvantaged migrants and non-migrant populations. The objective of this study is to support health systems for populations affected by migration. Materials and Methods: An international Delphi consensus process was used to identify policy approaches to improve health systems for populations affected by migration. Participants were leading migrant health experts from Americas, Europe, Middle East, Asia, and Australasia. We calculated average ranking scores and qualitatively analyzed open-ended questions. Results: Participants identified the following key areas as priorities for policy development: health inequities, system discrimination, migrant related health data, disadvantaged migrant sub-groups, and considerations for disadvantaged non-migrant populations. Highly ranked items to improve health systems were: Health Equity Impact Assessment, evidence based guidelines, and the International Organization for Migration annual reports. Discussion: Policy makers need tools, data and resources to address health systems challenges. Policies need to avoid preventable deaths of migrants and barriers to basic health services. PMID:28165380

Hypertension in Black and Other Populations: Environmental Factors and Approaches to Management

PubMed Central

Hosten, Adrian O.

1980-01-01

Hypertension is a major health problem for industrialized as well as developing countries, especially those with sizeable black populations. The author analyzes various aspects of hypertension in black and other populations with emphasis on contributing factors and therapeutic approaches. PMID:7365811

[Therapeutical itineraries in poverty situations: diversity and plurality].

PubMed

Gerhardt, Tatiana Engel

2006-11-01

The low-income population's practices and strategies for coping with daily problems, especially in relation to the search for health care, are analyzed by means of therapeutic itineraries. To unveil this population's coping strategies in relation to their health-disease process means identifying the individual and collective strategies and the meaning of these social dynamics related directly or indirectly to health. The search for treatment is described and analyzed here in relation to socio-cultural practices in terms of the paths chosen by individuals in the attempt to solve their health problems. The study thus indicates an interdisciplinary and multi-methodological and conceptual approach relating concepts of practices, strategies, and health and life situations. The point of departure is that ways of coping with health problems require an understanding of the strategies developed in a process of (re)appropriation and (re)construction of knowledge. It is equally important to identify social support networks and individual capacity to mobilize such resources. The recognition of these practices allows (re)directing actions in collective health.

[Morbidity observed in a health area: Impact on professionals and funding].

PubMed

de Miguel, Pablo; Caballero, Isabel; Rivas, Francisco Javier; Manera, Jaime; de Vicente, María Auxiliadora; Gómez, Ángel

2015-05-01

To analyze morbidity, in the context of a health area, and broken down by health centre, of patients who made contact with healthcare services, in order to propose an adjustment to finance the payment per capita. A descriptive study of morbidity observed in citizens assigned a health area during year 2010. SITE: Health Area 9. Autonomous Community of Madrid. Formed by the municipalities of Fuenlabrada, Humanes, and Moraleja de Enmedio. All levels of health care included. All citizens with health card assigned to a health center in the area who has maintained contact with the public health service's own area. Coded contact of patients are grouped using the Population Grouping Clinical Risk 3M TM Software (CRG). Each patient is included in a homogeneous and exclusive group with a numerical morbidity and clinical sense. Through the health card is known primary care centre, physician, age and sex. The distribution of morbidity is obtained by primary care centre, primary care physician, age and sex analyzing differences and combinations. It was found that the average values of the population morbidity are different in each primary care centre. In order to maintain the principle of equity in health care, it is suggested that an adjustment is made to the per capita payment based on the morbidity rate of the population. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Hospitalization among migrants in Italy: Access to health care as an opportunity for integration and inclusion.

PubMed

Barsanti, Sara

2018-03-30

This paper analyzes migrant access to health care by comparing hospitalizations of native and immigrant population with respect the Tuscany Region (Italy). In the analyses, a critical gap both for legal and undocumented migrant population is highlighted. Indeed, we found some key differences between the migrant and native populations related to the use of specific hospital services in Tuscany and, indirectly, of community and primary care services. Moreover, especially for undocumented migrants, hospitals seem to be the only point of access to the health-care system for migrant populations. The results suggest that the Italian health-care system is unable to ensure an equitable access to health services. In this context, maternity care could be a key point of access to the welfare system that allows participation in the health system not only for mothers but also for all migrant family members. Copyright © 2018 John Wiley & Sons, Ltd.

Health and indigenous people: intercultural health as a new paradigm toward the reduction of cultural and social marginalization?

PubMed

Torri, Maria Costanza

2010-01-01

The precarious socio-economic and health conditions of indigenous populations legitimize claims of marginalization and attest to the inherent inequality that indigenous groups suffer. In the last few years, advocates have urged the use of traditional indigenous health practices as more culturally fitting for most indigenous populations. An intercultural health program can reduce the conditions of social and cultural marginalization in an indigenous population. However, accepting and integrating indigenous medicine into a westernized health system presents a major challenge to intercultural healthcare in Latin America. The objective of this paper is to analyze the case of Makewe hospital, one of the first and few examples of intercultural health initiatives in Chile. The paper will examine the implementation of this initiative and the main challenges in creating an effective intercultural health program.

Who and what is a "population"? Historical debates, current controversies, and implications for understanding "population health" and rectifying health inequities.

PubMed

Krieger, Nancy

2012-12-01

The idea of "population" is core to the population sciences but is rarely defined except in statistical terms. Yet who and what defines and makes a population has everything to do with whether population means are meaningful or meaningless, with profound implications for work on population health and health inequities. In this article, I review the current conventional definitions of, and historical debates over, the meaning(s) of "population," trace back the contemporary emphasis on populations as statistical rather than substantive entities to Adolphe Quetelet's powerful astronomical metaphor, conceived in the 1830s, of l'homme moyen (the average man), and argue for an alternative definition of populations as relational beings. As informed by the ecosocial theory of disease distribution, I then analyze several case examples to explore the utility of critical population-informed thinking for research, knowledge, and policy involving population health and health inequities. Four propositions emerge: (1) the meaningfulness of means depends on how meaningfully the populations are defined in relation to the inherent intrinsic and extrinsic dynamic generative relationships by which they are constituted; (2) structured chance drives population distributions of health and entails conceptualizing health and disease, including biomarkers, as embodied phenotype and health inequities as historically contingent; (3) persons included in population health research are study participants, and the casual equation of this term with "study population" should be avoided; and (4) the conventional cleavage of "internal validity" and "generalizability" is misleading, since a meaningful choice of study participants must be in relation to the range of exposures experienced (or not) in the real-world societies, that is, meaningful populations, of which they are a part. To improve conceptual clarity, causal inference, and action to promote health equity, population sciences need to expand and deepen their theorizing about who and what makes populations and their means. © 2012 Milbank Memorial Fund.

Socioeconomic determinants of health inequalities among the older population in India: a decomposition analysis.

PubMed

Goli, Srinivas; Singh, Lucky; Jain, Kshipra; Pou, Ladumai Maikho Apollo

2014-12-01

This study quantified and decomposed health inequalities among the older population in India and analyzes how health status varies for populations between 60 to 69 years and 70 years and above. Data from the 60th round of the National Sample Survey (NSS) was used for the analyses. Socioeconomic inequalities in health status were measured by using Concentration Index (CI) and further decomposed to find critical determinants and their relative contributions to total health inequality. Overall, CI estimates were negative for the older population as a whole (CI = -0.1156), as well as for two disaggregated groups, 60 to 69 years (CI = -0.0943) and 70 years and above (CI = -0.08198). This suggests that poor health status is more concentrated among the socioeconomically disadvantaged older population. Decomposition analyses revealed that poor economic status (54 %) is the dominant contributor to total health inequalities in the older population, followed by illiteracy (24 %) and rural place of residence (20 %). Other indicators, such as religion, gender and marital status were positive, while Caste was negatively associated with health inequality in the older populations. Finally, a comparative assessment of decomposition results suggest that critical contributors for health inequality vary for the older population of 60 to 69 years and 70 years and above. These findings provide important insights on health inequalities among the older population in India. Implications are advanced.

[The modern international public health and globalization challenges].

PubMed

2012-01-01

The article deals with the issues of impact of globalization on population health and public health. The positive and negative aspects of this process are analyzed. The role of international organizations (UN, WHO, UNESCO, ILO, UNISEF) is demonstrated in the area of management of globalization impact on public health of different countries, Russia included.

Holistic model-based monitoring of the human health status in an urban environment system: pilot study in Verona city, Italy.

PubMed

Tarocco, S; Amoruso, I; Caravello, G

2011-06-01

In recent decades the global health paradigm gained an increasing systemic characterization. The ecosystem health theory states that a healthy ecosystem, whether natural or artificial, significantly contributes to the good health status of the human population. The present study describes an interdisciplinary monitoring model that retrospectively analyzes the intersection between the urban environment and citizens. The model analyzes both the biophysical and the anthropic subsystems through the application of landscape ecology and environmental quality indexes along with human health indicators. Particularly, ecological quality of landscape pattern, atmospheric pollution, outdoor noise levels and local health indicators were assessed. Verona municipality was chosen as study area to test the preliminary efficiency of the model. Territory was split into two superimposed layers of land units, which were further geo-referentiated with Geographical Information System (GIS) technology. Interdependence of any of the analyzed traits was further investigated with Fisher exact test. Landscape composition was assessed and an Average Ecological Quality (AEQ) score assigned to each land unit. A direct proportionality emerged for concentrations of considered air pollutants and traffic levels: a spatial model for the atmospheric pollution was drawn. A map depicting the distribution of traffic-related noise levels was also drawn. From chosen indicators, a quality class score was assigned to every minor and major land unit. Age-standardised rates about hospitalizations for the municipal population and specific rates for the over-65s/1000 inhabitants were calculated. Quality class assignement for each health indicator was graphically rendered. After direct standardisation of rates for the population sample, data were compared with two reference populations, the Regional population and the Local Socio-sanitary Unit (ULSS20) population. Standardised hospitalization rates for the whole municipal population always resulted lower than the ULSS20 rates, except for auditory pathologies. It was notable that rates of hospitalizations for cancerous diseases for Verona municipal population were four times and two times lower than the ULSS20 and the Regional population ones, respectively. Contingency table were made for the health main indicator (specific rates for the over-65s/1000 inhabitants) and the environmental quality key factors of landscape ecological quality, outdoor noise level and air pollution. H0 of independence was rejected for respiratory pathologies and air pollution and for the triad cardiocirculatory pathologies, air pollution and landscape ecological quality at (a = 0.05). Fisher exact test confirmed the non-independence of cardiocirculatory diseases and biophysical environment and the analogous association for respiratory pathologies when comparison was made with global environmental quality index. The first testing of the model suggests some possible elements of implementation and integration which could further enhance it. Among them, the subjective investigation of the health status assumes a primary role. On the whole the monitoring model seems to effectively represent the real complexity of the urban environment systems and should be regarded as an important contribution to the new way of health research.

[Mortality rates of circulatory system diseases and malignant neoplasms in Zagreb population younger than sixty-five--call for alarm].

PubMed

Vizintin, Marina Polić; Mrcela, Nada Tomasović; Kovacić, Luka

2012-12-01

The aim of this work was to analyze the public health indicators for circulatory heart diseases and malignant neoplasms in the population younger than 65 in the City of Zagreb, Croatia, and compare them with the European Union (EU) countries. The purpose was to evaluate the situation and propose the public health preventive measures. The study population were Zagreb citizens aged 0-64 according to the 2001 census. Total Zagreb population was 779145, making 17.6% of total Croatian population. Data from the Croatian Bureau of Statistics and Dr Andrija Stampar Institute of Public Health were used. The standardized 0-64 mortality rates of the selected diseases 2006-2010 were used in the analysis. In 2010, the standardized mortality rates of all analyzed diseases were significantly higher in Zagreb population aged 0-64 than the EU averages except for cervical cancer. In 2010, the mortality rates in Zagreb population aged 0-64 were as follows: circulatory system diseases 61.22, ischemic heart disease 28.99, cerebrovascular diseases 12.51, malignant neoplasms 94.69, tracheal and lung cancer 24.92, breast cancer 21.08 and cervical cancer 2.05. Standardized mortality rates in Zagreb population aged 0-64 for circulatory system were lower than for Croatia (61.22 vs. 63.25), but higher for malignant neoplasms (94.69 vs. 91.2), except for cervical cancer (2.05 vs. 3.14). High standardized mortality rates for the selected diseases in the City of Zagreb, Croatia, were observed. The rates were higher in Zagreb population compared to EU averages except for cervical cancer. This situation urges revision of the public health strategy and implementation of more intensive preventive and screening measures to reduce the risk factors.

Experiences and Lessons from Urban Health Insurance Reform in China.

PubMed

Xin, Haichang

2016-08-01

Health care systems often face competing goals and priorities, which make reforms challenging. This study analyzed factors influencing the success of a health care system based on urban health insurance reform evolution in China, and offers recommendations for improvement. Findings based on health insurance reform strategies and mechanisms that did or did not work can effectively inform improvement of health insurance system design and practice, and overall health care system performance, including equity, efficiency, effectiveness, cost, finance, access, and coverage, both in China and other countries. This study is the first to use historical comparison to examine the success and failure of China's health care system over time before and after the economic reform in the 1980s. This study is also among the first to analyze the determinants of Chinese health system effectiveness by relating its performance to both technical reasons within the health system and underlying nontechnical characteristics outside the health system, including socioeconomics, politics, culture, values, and beliefs. In conclusion, a health insurance system is successful when it fits its social environment, economic framework, and cultural context, which translates to congruent health care policies, strategies, organization, and delivery. No health system can survive without its deeply rooted socioeconomic environment and cultural context. That is why one society should be cautious not to radically switch from a successful model to an entirely different one over time. There is no perfect health system model suitable for every population-only appropriate ones for specific nations and specific populations at the right place and right time. (Population Health Management 2016;19:291-297).

[The impact of the social economic conditions on the reproduction processes].

PubMed

Leonova, N G

2007-01-01

The social economic conditions of population reproduction in the Trans-Dniester Region with the emphasis on its specifics are analyzed. The natural dynamics of population is estimated including gender and age peculiarities, marriage and divorces statistics, migration processes and population health in the region. It is shown that the population reproduction dynamics follows the natural laws and processes. The role of the post-Soviet period social economic conditions harmful to health are considered. The interdependencies between the social economic development and population reproduction are revealed. The recommendations related to the means of the further enhancement of social economic conditions as related to population reproduction in the Trans-Dniester Region are proposed.

mHealth data collector: an application to collect and report indicators for assessment of cardiometabolic risk.

PubMed

Shishido, Henrique Yoshikazu; Alves da Cruz de Andrade, Ricardo; Eler, Gabrielle Jacklin

2014-01-01

Traditional population surveys use paper forms that are filled manually by an interviewer. This process can take a long time; in comparison, computerizing the process reduces time, promotes safety and accuracy of data, improves patient care, and offers better control over the compiled information. From this perspective, it can be argued that mobile health supports mechanisms for the diagnosis, control, and prevention of metabolic diseases. In recent years, mobile devices have been applied in several health areas, such as remote monitoring, data logging, clinical decision-making, and with applications that can help maintain or initiate practices beneficial to individual health and wellbeing. However, there is a lack of applications for conducting population surveys. Thus, this work presents an application called mHealth Data Collector (mHDC) as a model for applications used in population surveys that contain such data as Body Mass Index (BMI), health-related issues, and health habit indicators. The design of this system occurred through interviews with health professionals who utilized a prototyping method to extract requirements. To develop this mobile app, the Android platform was adopted and the SQLite database was used to store patients' health data. The JExcelAPI and AchartEngine were also employed to generate spreadsheets and charts. The mHDC was tested using a case study in a Brazilian city. The results indicated that the health team took half the time to interview patients. In addition, the system has reduced the use of paper; centered and organized data; and allowed quick data recovery and standardization to improve the readability of data input. The mHDC proved efficient at collecting, analyzing, and safely exporting the results, thus reducing time collecting and analyzing the population survey.

Navigating the digital divide: A systematic review of eHealth literacy in underserved populations in the United States.

PubMed

Chesser, Amy; Burke, Anne; Reyes, Jared; Rohrberg, Tessa

2016-01-01

eHealth provides an important mechanism to connect medically underserved populations with health information, but little is known about gaps in eHealth literacy research in underserved adult populations within the U.S. Between June and July 2013, three systematic literature reviews of five databases were conducted and a subsequent hand search was completed. Identified literature was screened and studies meeting exclusion and inclusion criteria were synthesized and analyzed for common themes. Of the 221 articles critically appraised, 15 met these criteria. Thirty-five of these studies were excluded due to international origin. Of the articles meeting the inclusion criteria, underserved populations assessed included immigrant women, the elderly, low-income, the un- and underemployed, and African-American and Hispanic populations. eHealth literacy assessments utilized included one or two item screeners, the eHEALS scale, health information competence and cognitive task analysis. Factors examined in relation to eHealth literacy included age, experience, overall health literacy, education, income and culture. The majority did not assess the impact of locality and those that did were predominately urban. These data suggest that there is a gap in the literature regarding eHealth literacy knowledge for underserved populations, and specifically those in rural locations, within the U.S.

Population Consultation: A Powerful Means to Ensure that Health Strategies are Oriented Towards Universal Health Coverage.

PubMed

Rohrer, Katja; Rajan, Dheepa; Schmets, Gerard

2017-01-01

We seek to highlight why population consultations need to be promoted more strongly as a powerful means to move health reforms towards Universal Health Coverage (UHC). However, despite this increasing recognition that the "population" is the key factor of successful health planning and high-quality service delivery, there has been very little systematic reflection and only limited (international) attention brought to the idea of specifically consulting the population to improve the quality and soundness of health policies and strategies and to strengthen the national health planning process and implementation. So far, research has done little to assess the significance of population consultations for the health sector and its importance for strategic planning and implementation processes; in addition, there has been insufficient evaluation of population consultations in the health sector or health-related areas. We drew on ongoing programmatic work of World Health Organization (WHO) offices worldwide, as most population consultations are not well-documented. In addition, we analyzed any existing documentation available on population consultations in health. We then elaborate on the potential benefits of bringing the population's voice into national health planning. We briefly mention the key methods used for population consultations, and we put forward recent country examples showing that population consultation is an effective way of assessing the population's needs and expectations, and should be more widely used in strategizing health. Giving the voice to the population is a means to strengthen accountability, to reinforce the commitment of policy makers, decision-makers and influencers (media, political parties, academics, etc.) to the health policy objectives of UHC, and, in the specific case of donor-dependent countries, to sensitize donors' engagement and alignment with national health strategies. The consequence of the current low international interest for population consultations probably has the most negative effect on resource-poor countries, as this analytical oversight comes with a high price. However, a population consultation has the potential to give more benefit and added value to contexts where resources are scarce and where planning processes pose a high extra burden, and should thus be promoted among international donor agencies.

Liberating the people from their "loathsome practices:" public health and "silent racism" in post-revolutionary Bolivia.

PubMed

Pacino, Nicole L

2017-01-01

After the Movimiento Nacionalista Revolucionario (MNR) took power in the 1952 National Revolution, the party expanded rural public health programs to address what early twentieth-century elites called the "Indian problem:" the idea that indigenous culture was an impediment to Bolivia's modernization. After 1952, the MNR used public health as a project of cultural assimilation, and state-sponsored health programs sought to culturally whiten the population by transforming personal habits. This essay analyzes the language with which health workers discussed the indigenous population to show that despite the regime's intention to move away from defining the rural population on racial terms, medical and political elites continued to define indigenous customs as an obstacle to progress and a remnant of an antiquated past.

[Premature death and disability profile in the population affiliated to the Mexican Institute of Social Security (IMSS)].

PubMed

Rodríguez-Abrego, Gabriela; Escobedo de la Peña, Jorge; Zurita, Beatriz; Ramírez, Teresita de Jesús

2007-01-01

To carry out estimations of the burden of disease for 129 causes in order to identify health priorities in the different geographic regions of the country and to present comparative data between 1995 and 2000. Indicators such as disability-adjusted life years (DALYs) and disability adjusted life expectancy (DALE) were analyzed for the population covered by IMSS in 1995 and 2000; for both years, the methodology proposed by the Burden of Disease Worldwide Study was applied. Data corresponding to 1995 were analyzed in 1997, while data corresponding to 2000 were analyzed in 2001. The comparative study was carried out in 2006 by IMSS, Mexico. The higher proportion of DALYs was due to chronic diseases, although the 2000 rate is 1.5 times higher than that of 1995. Priorities that were identified were diabetes mellitus, ischemic cardiopathy, and cerebrovascular disease, with a loss that is mainly accounted for by premature death, as well as by diseases related to disability with an important burden of disease, such as AIDS or depression. Epidemiological backlogs can still be observed. The population covered by IMSS is still in a phase of epidemiologic transition, favoring polarization in health conditions. Health policies need to be directed toward bringing about an improved response and reversing the trend in diseases that represent an institutional risk for the financing of health care.

EQ-5D Portuguese population norms.

PubMed

Ferreira, Lara Noronha; Ferreira, Pedro L; Pereira, Luis N; Oppe, Mark

2014-03-01

The EQ-5D is a widely used preference-based measure. Normative data can be used as references to analyze the effects of healthcare, determine the burden of disease and enable regional or country comparisons. Population norms for the EQ-5D exist for other countries but have not been previously published for Portugal. The purpose of this study was to derive EQ-5D Portuguese population norms. The EQ-5D was applied by phone interview to a random sample of the Portuguese general population (n = 1,500) stratified by age, gender and region. The Portuguese value set was used to derive the EQ-5D index. Mean values were computed by gender and age groups, marital status, educational attainment, region and other variables to obtain the EQ-5D Portuguese norms. Health status declines with advancing age, and women reported worse health status than men. These results are similar to other EQ-5D population health studies. This study provides Portuguese population health-related quality of life data measured by the EQ-5D that can be used as population norms. These norms can be used to inform Portuguese policy makers, health care professionals and researchers in issues related to health care policy and planning and quantification of treatment effects on health status.

Who and What Is a “Population”? Historical Debates, Current Controversies, and Implications for Understanding “Population Health” and Rectifying Health Inequities

PubMed Central

Krieger, Nancy

2012-01-01

Context The idea of “population” is core to the population sciences but is rarely defined except in statistical terms. Yet who and what defines and makes a population has everything to do with whether population means are meaningful or meaningless, with profound implications for work on population health and health inequities. Methods In this article, I review the current conventional definitions of, and historical debates over, the meaning(s) of “population,” trace back the contemporary emphasis on populations as statistical rather than substantive entities to Adolphe Quetelet's powerful astronomical metaphor, conceived in the 1830s, of l’homme moyen (the average man), and argue for an alternative definition of populations as relational beings. As informed by the ecosocial theory of disease distribution, I then analyze several case examples to explore the utility of critical population-informed thinking for research, knowledge, and policy involving population health and health inequities. Findings Four propositions emerge: (1) the meaningfulness of means depends on how meaningfully the populations are defined in relation to the inherent intrinsic and extrinsic dynamic generative relationships by which they are constituted; (2) structured chance drives population distributions of health and entails conceptualizing health and disease, including biomarkers, as embodied phenotype and health inequities as historically contingent; (3) persons included in population health research are study participants, and the casual equation of this term with “study population” should be avoided; and (4) the conventional cleavage of “internal validity” and “generalizability” is misleading, since a meaningful choice of study participants must be in relation to the range of exposures experienced (or not) in the real-world societies, that is, meaningful populations, of which they are a part. Conclusions To improve conceptual clarity, causal inference, and action to promote health equity, population sciences need to expand and deepen their theorizing about who and what makes populations and their means. PMID:23216426

[Mexico health care system's objectives: importance to its population and determining factors].

PubMed

Tapia-Cruz, José Antonio

2006-01-01

To document the importance to Mexico's population of the five intrinsic objectives of Mexico's present health care system (SS) and describe some of the determinants of its evaluation; the purpose is to contribute elements for defining priorities and to support the fulfillment of said objectives. This is a cross-sectional study to the importance for Mexican population of the five objectives of SS, considered intrinsic or final in the National Evaluation and Performance Survey. The dependent variable was the ranking given by the population surveyed to each one of the objectives, based on the question: Which SS objective do you believe is most important? The independent variables (nominal and categorical) were: state of residence, type of locality, gender, age, education, present employment, quality of present state of health, last occurrence when medical assistance was needed but not received, grade of satisfaction with the operation of the country's medical care system and satisfaction with one's own health. A univaried analysis was conducted and summarized using percentages. The chi square test was used to validate or reject the hypothesis according to whether the rank assigned by the population to the SS objectives is the same, regardless of which variables were used in the comparison. A multinomial (politomic) logistical regression model was also developed to correlate the effect of the independent variables employed in the study with the importance assigned by the population to the SS objectives. The reference category of the model was the objective of improving the health of the population. The analysis was conducted using the statistical package STATA version 7.0. From the population studied, 31.8% reported that the most important objective is to improve treatment within the health care system. In rural areas, 31.46% of the population thinks the most important objective is to improve health, a result related with the self-perception of one's present state of health and lack of medical care. The probability of preferring the objective of improving treatment over improving health, between the populations with average education and higher levels of education is, respectively, 10% and 16% greater than the population with no education. Among the population that works independently, 31.2% consider improving health the most important objective, a greater percentage than that reported by the population of business owners and the one consisting of public and private employees. In general terms, the population analyzed by this study considered the improvement of treatment within the health care system to be most important, which differs from that suggested by the PRONASA 2001-2006. It was indicated that the importance assigned to the objectives can vary according to the group analyzed, its characteristics and the influence of diverse external factors on the individual, as a result of which the null hypothsesis is rejected. Variations among the populations' evaluations occurred, in particular, between the objective of improving treatment within the health care system and that of the improvement of the population's health. The obtained results guide the steps for communication and the strengthening of the health care system in order to adjust itself to the expectations of the population and support the fulfillment of the established objectives.

The Non-linear Health Consequences of Living in Larger Cities.

PubMed

Rocha, Luis E C; Thorson, Anna E; Lambiotte, Renaud

2015-10-01

Urbanization promotes economy, mobility, access, and availability of resources, but on the other hand, generates higher levels of pollution, violence, crime, and mental distress. The health consequences of the agglomeration of people living close together are not fully understood. Particularly, it remains unclear how variations in the population size across cities impact the health of the population. We analyze the deviations from linearity of the scaling of several health-related quantities, such as the incidence and mortality of diseases, external causes of death, wellbeing, and health care availability, in respect to the population size of cities in Brazil, Sweden, and the USA. We find that deaths by non-communicable diseases tend to be relatively less common in larger cities, whereas the per capita incidence of infectious diseases is relatively larger for increasing population size. Healthier lifestyle and availability of medical support are disproportionally higher in larger cities. The results are connected with the optimization of human and physical resources and with the non-linear effects of social networks in larger populations. An urban advantage in terms of health is not evident, and using rates as indicators to compare cities with different population sizes may be insufficient.

Factors Perceived as Influencing Local Health Department Involvement in Mental Health.

PubMed

Purtle, Jonathan; Peters, Rachel; Kolker, Jennifer; Klassen, Ann C

2017-01-01

Local health departments (LHDs) are potentially well positioned to implement population-based approaches to mental health promotion, but research indicates that most LHDs are not substantively engaged in activities to address mental health. Little is known about factors that influence if and how LHDs address population mental health. The objectives of this qualitative study were to (1) understand how LHD officials perceive population mental health; (2) identify factors that influence these perceptions and LHD activities to address population mental health; and (3) develop an empirically derived conceptual framework of LHD engagement in population mental health. Twenty-one semi-structured interviews were conducted with a purposive sample of LHD officials and analyzed using thematic content analysis in 2014-2015. Transcripts were double coded, inter-rater reliability statistics were calculated, and categories with κ ≥0.60 were retained. Respondents perceived mental health as a public health issue and expressed that it has emerged as a priority through community health needs assessment processes, such as those conducted for health department accreditation. However, most LHDs were not substantively engaged in population mental health activities because of limited resources, knowledge, data, and hesitancy to infringe upon the territory of local behavioral health agencies. LHDs and local behavioral health agencies had difficulty communicating and collaborating because of divergent perspectives and financing arrangements. LHD officials are eager to embrace population mental health, but resources, training and education, and systems-level changes are needed. Contemporary reforms to the structure and financing of the U.S. health system offer opportunities to address these challenges. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Some problems of human adaptation and ecology under the aspect of general pathology

NASA Technical Reports Server (NTRS)

Kaznacheyev, V. P.

1980-01-01

The main problems of human adaptation at the level of the body and the population in connection with the features of current morbidity of the population and certain demographic processes are analyzed. The concepts of health and adaptation of the individual and human populations are determined. The importance of the anthropo-ecological approach to the investigation of the adaptation process of human populations is demonstrated. Certain features of the etiopathogenesis of diseases are considered in connection with the population-ecological regularities of human adaptation. The importance of research on general pathology aspects of adaptation and the ecology of man for planning, and organization of public health protection is discussed.

[Role of the UNASUR national institutes of health in generating evidence on the social determinants of health].

PubMed

Rosenberg, Félix; Tobar, Sebastián; Buss, Paulo

2015-08-01

The present article analyzes the role of the Union of South American Nations (UNASUR) national institutes of health since their creation at the beginning of the 20th century up until the present time. It postulates that the national institutes of health are in a position to play a strategic role in generating knowledge and evidence to facilitate decision-making through monitoring and research on the social determinants of health and health inequities. To explore this hypothesis, the national institutes of health are analyzed in the context of the current global scenario, which is generating increased social inequalities, thus leading in turn to serious inequities in health conditions. The article proposes a new model of health promotion, disease prevention, and health care, where necessary, as well as policies and intersectoral actions that address these social determinants. In this new stage, the UNASUR national institutes of health should play a significant strategic role in identifying and analyzing correlations between patterns of production and consumption, social divisions that exist in the territory, conditions of development, and the health of their populations. These national institutes of health are members of the UNASUR Network of National Institutes of Health (RINS-UNASUR). The literature on their creation, drawn from the Network's websites and the proceedings of its meetings and seminars, is reviewed. Given that the current globalized development model is generating enormous social inequalities, by definition, the proposed hypothesis is that the national institutes of health should assume a much broader role in addressing the consequent inequities in the health of the population, complementing their traditional activities with this new strategic role. Without a major reduction in the existing social inequalities and economic inequities, it will be impossible to make significant improvements in health in a democratic manner.

Mental health differences between German gay and bisexual men and population-based controls.

PubMed

Sattler, Frank A; Franke, Gabriele H; Christiansen, Hanna

2017-07-21

International studies have revealed that gay and bisexual men present more mental health problems than the general male population. Furthermore, there is evidence that minority stress predicts mental health problems in gay and bisexual men. The aim of the present study is to provide initial data on mental health differences in Germany and to analyze the effect of minority stress. Mental health data on n = 1903 German gay and bisexual men and n = 958 men from a population-based sample were assessed using a shortened version of the SCL-90-S. The mental health of the two samples was compared. Furthermore, a linear regression was conducted for the gay and bisexual sample: mental health was used as the criterion and minority stressors as predictors. As compared to our population sample, gay and bisexual men demonstrated more mental health problems with a moderate effect size. In the regression, minority stress predicted mental health problems in the gay and bisexual sample. We observed pronounced mental health differences between gay and bisexual men versus the population sample. These differences could be at least partly due to the minority stress gay and bisexual men face. Research should focus on how to reduce and cope with minority stress.

Arsenic: geochemical distribution and health risk in Italy

NASA Astrophysics Data System (ADS)

Zuzolo, Daniela; Cicchella, Domenico; Albanese, Stefano; Catani, Vittorio; Dinelli, Enrico; Lima, Annamaria; Valera, Paolo; De Vivo, Benedetto

2017-04-01

Characterization of risks to human health is determinant for risk management and population surveillance. This study represent the first work at national scale for Italy about arsenic occurrence, distribution and health impact. We analyzed the As geochemical distribution in different environmental matrices on the whole Italian territory, and assessed both carcinogenic and non-carcinogenic risks for different exposure routes and age groups. The results demonstrate that, in Italy, arsenic is present in significant concentrations both in water (up to 27.2 µg/L) and soils (up to 70 mg/kg). Its presence is mainly controlled by geological processes and locally reflects the industrial history of the Country. The population of the Central Italy, where high content of arsenic in the analyzed samples is due to the presence of alkaline volcanics, are the most exposed to the health risk. Based on the results of our work, it is clear that the consumption of tap water for potable use is the most impactful route for As daily exposure and play an important role in governing potential cancer and non-cancer risks for the considered population. It is interesting to observe that the Incremental Life Cancer Risk through water ingestion show that almost 80% of data falls above the internationally accepted benchmark value of 1 x 10-5. Moreover it was demonstrated that childhood is the most susceptible age stage to As exposure. Geochemical mapping provided a useful tool to spatially analyze and represent data and to highlight the most critic areas and the most exposed population to arsenic at national scale. In conclusion, this study improve knowledge about As occurrence for an entire Country, recognizing an health emerging problem. It might be a good starting point to support the urgently needed policy actions, in order to prevent and reduce the health risk. Moreover, the performed method in this case study research is potentially generalizable and applicable in other countries.

School Psychologists' Report of School-Based Mental Health Service Programs across Pennsylvania School Systems

ERIC Educational Resources Information Center

Cross, Ajani Yanea

2013-01-01

This study explored the mental health needs and services of children and adolescents within Pennsylvania school communities; this included a focus upon evidence-based counseling approaches. Relationships were analyzed between population density, SES status, grade level and the type of mental health issues serviced. Survey data from 314 respondents…

[The impact of the economic crisis on the health and healthcare of the immigrant population. SESPAS report 2014].

PubMed

Vázquez, María Luisa; Vargas, Ingrid; Aller, Marta-Beatriz

2014-06-01

Despite the economic crisis, the immigrant population of Spain continues to be high, with 5.7 million persons (11.4%). This population, whose health needs are similar to those of the general population, is more vulnerable due to their exposure to worse social determinants (living and working conditions together with a higher risk of exclusion from social services). In this article, we analyze how the economic crisis affects or can affect the health of the immigrant population in Spain by examining distinct population-specific or institutional factors that influence the effects of the crisis and the available data. The available evidence is limited, but several effects can be identified: firstly, some social determinants, such as higher unemployment rates and worse working conditions, have deteriorated, which can be expected to lead to a worsening of health status. These consequences have already been described for mental health or have been estimated for infectious diseases. Secondly, political decisions have had a direct impact, excluding-with some exceptions-undocumented immigrants from the right to health care. Finally, the lower priority given to adapting health services to the specific characteristics of the immigrant population (most of whom are documented) together with the introduction of new barriers, has hampered or will hamper access to health care. As a result, the economic crisis can be expected to have a greater impact on the immigrant population. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Socioeconomic Inequalities in the Use of Healthcare Services: Comparison between the Roma and General Populations in Spain

PubMed Central

Mosquera, Paola A.; San Sebastian, Miguel

2018-01-01

This paper explores whether the principles of horizontal and vertical equity in healthcare are met by the Spanish national health system in the case of the Roma and general populations. The 2011/2012 Spanish National Health Survey (n = 21,650) and the 2014 National Health Survey of the Spanish Roma Population (n = 1167) were analyzed. Use of healthcare services was measured in terms of visits to a general practitioner (GP), visits to an emergency department, and hospitalizations. Healthcare need was measured using (a) self-rated health and (b) the reported number of chronic diseases. The Roma reported worse self-rated health and a higher prevalence of chronic diseases. A redistributive effect (increased healthcare service use among Roma and those in lower socio-economic classes) was found for hospitalizations and emergency visits. This effect was also observed in GP visits for women, but not for men. Vertical inequity was observed in the general population but not in the Roma population for GP visits. The results suggest the existence of horizontal inequity in the use of GP services (Roma women), emergency department visits (Roma and general population), and hospitalizations (Roma population) and of vertical inequity in the use of GP services among the general population. PMID:29329246

Health system productivity change in Zambia: A focus on the child health services.

PubMed

Achoki, Tom; Kinfu, Yohannes; Masiye, Felix; Frederix, Geert W J; Hovels, Anke; Leufkens, Hubert G

2017-02-01

Efficiency and productivity improvement have become central in global health debates. In this study, we explored productivity change, particularly the contribution of technological progress and efficiency gains associated with improvements in child survival in Zambia (population 15 million). Productivity was measured by applying the Malmquist productivity index on district-level panel data. The effect of socioeconomic factors was further analyzed by applying an ordinary least squares regression technique. During 2004-2009, overall productivity in Zambia increased by 5.0 per cent, a change largely attributed to technological progress rather than efficiency gains. Within-country productivity comparisons revealed wide heterogeneity in favor of more urbanized and densely populated districts. Improved cooking methods, improved sanitation, and better educated populations tended to improve productive gains, whereas larger household size had an adverse effect. Addressing such district-level factors and ensuring efficient delivery and optimal application of existing health technologies offer a practical pathway for further improving population health.

Trends in leisure time and work-related physical activity in the Spanish working population, 1987-2006.

PubMed

Alonso-Blanco, Cristina; Palacios-Ceña, Domingo; Hernández-Barrera, Valentín; Carrasco-Garrido, Pilar; Jiménez-García, Rodrigo; Fernández-de-Las-Peñas, César

2012-01-01

To analyze time trends in the prevalence of leisure time (LTPA) and work-related (WRPA) physical activity between 1987 and 2006 in the Spanish working population. We analyzed data taken from the Spanish National Health Surveys for 1987 (n = 29,647), 1993 (n = 20,707), 1995-1997 (n = 12,800), 2001 (n = 21,058), 2003 (n = 21,650), and 2006 (n = 29,478). The main variables were LTPA and WRPA in working adults aged 18-64 years old. We analyzed sociodemographic characteristics, self-perceived health status, lifestyle habits and associated comorbidities using multivariate logistic regression models. The prevalences of LTPA and WRPA were lower in women than in men (p < 0.05). The practice of LTPA (OR: 1.54, 95%CI: 1.32-1.80 for women; OR = 1.15, 95%CI: 1.02-1.31 for men) and WRPA (OR = 1.73, 95%CI: 1.38-2.19 for women; OR = 1.55, 95%CI: 1.44-1.91 for men) significantly increased from 1987 to 2006. In both genders, the variables associated with a higher likelihood of practicing LTPA were greater age, higher educational level and being an ex- or non-smoker, while negative predictors included being married, worse self-perceived health, and obesity. Factors that increased the probability of reporting WRPA were being married, worse self-rated health status, and sleeping > 8h per day. The only factor that reduced the probability of reporting WRPA was being an ex- or non-smoker. We found an increase in LTPA and WRPA in the last 20 years in the Spanish working population. Several factors were associated with a higher or lower likelihood of practicing LTPA or WRPA in this population. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

[Indigenous peoples, HIV and public policy in Latin America: an exploration of the current situations of epidemiological prevalence, prevention, care and timely treatment].

PubMed

Ponce, Patricia; Muñoz, Rubén; Stival, Matías

2017-01-01

This article aims to describe and analyze the situations of epidemiological prevalence, prevention, care and treatment of HIV in indigenous populations of Latin America. In order to do so, 304 published materials - including declarations, public policy and health program protocols, case studies and literature reviews with local, national and regional scopes - were identified, classified and analyzed. The differential social vulnerability to HIV infection and the inequity in health care access among indigenous populations can be attributed to the juxtaposition of factors such as structural violence, gender, racism, and discrimination due health condition (living with HIV) as well as the subordinated position of indigenous peoples in societies stratified not only socially and economically but also ethnically and culturally. The few studies done in the region on epidemiological prevalence, morbidity and mortality that are disaggregated by ethnicity reveal alarming data highlighting the need for further information on the epidemic in this population so as to address its repercussions in terms of prevention, care and timely follow-up.

[Impact of Morbidity on Health Care Costs of a Department of Health through Clinical Risk Groups. Valencian Community, Spain].

PubMed

Caballer Tarazona, Vicent; Guadalajara Olmeda, Natividad; Vivas Consuelo, David; Clemente Collado, Antonio

2016-06-08

Risk adjustment systems based on diagnosis stratify the population according to the observed morbidity. The aim of this study was to analyze the total health expenditure in a health area, relating to age, gender and morbidity observed in the population. Observational cross-sectional study of population and area of health care costs in the Health District of Denia-Marina Salud (Alicante) in 2013. Population (N=156,811) were stratified by Clinical Risk Groups into 9 states of health, state 1 being healthy, and state 9 the highest disease burden. Each inhabitant was charged with the hospital costs, primary care and outpatient pharmacy to obtain the total costs. Health status and severity by age and gender, as well as the costs of each group were analysed. The statistical tests, student t and χ2 were applied to verify the existence of significant differences between and intra groups. The average cost per inhabitant was 983 euros which increased from 240 euros to 42,881 at the state 9 and severity level 6. Patients of health states 5 and 6 caused the largest expenditure by concentration of the population, but health states 8 and 9 had the highest average expenditure, with 80% of hospitalised cost. A different composition of health expenditure per individual morbidity was corroborated, with an exponential growth in hospital spending.

Hospitalization for primary care susceptible conditions, health spending and Family Health Strategy: an analysis of trends.

PubMed

Morimoto, Tissiani; Costa, Juvenal Soares Dias da

2017-03-01

The goal of this study was to analyze the trend over time of hospitalizations due to conditions susceptible to primary healthcare (HCSPC), and how it relates to healthcare spending and Family Health Strategy (FHS) coverage in the city of São Leopoldo, Rio Grande do Sul State, Brazil, between 2003 and 2012. This is an ecological, time-trend study. We used secondary data available in the Unified Healthcare System Hospital Data System, the Primary Care Department and Public Health Budget Data System. The analysis compared HCSPC using three-year moving averages and Poisson regressions or negative binomials. We found no statistical significance in decreasing HCSPC indicators and primary care spending in the period analyzed. Healthcare spending, per-capita spending and FHS coverage increased significantly, but we found no correlation with HCSPC. The results show that, despite increases in the funds invested and population covered by FHS, they are still insufficient to deliver the level of care the population requires.

Remote Safety Monitoring for Elderly Persons Based on Omni-Vision Analysis

PubMed Central

Xiang, Yun; Tang, Yi-ping; Ma, Bao-qing; Yan, Hang-chen; Jiang, Jun; Tian, Xu-yuan

2015-01-01

Remote monitoring service for elderly persons is important as the aged populations in most developed countries continue growing. To monitor the safety and health of the elderly population, we propose a novel omni-directional vision sensor based system, which can detect and track object motion, recognize human posture, and analyze human behavior automatically. In this work, we have made the following contributions: (1) we develop a remote safety monitoring system which can provide real-time and automatic health care for the elderly persons and (2) we design a novel motion history or energy images based algorithm for motion object tracking. Our system can accurately and efficiently collect, analyze, and transfer elderly activity information and provide health care in real-time. Experimental results show that our technique can improve the data analysis efficiency by 58.5% for object tracking. Moreover, for the human posture recognition application, the success rate can reach 98.6% on average. PMID:25978761

Genetic diversity of disease-associated loci in Turkish population.

PubMed

Karaca, Sefayet; Cesuroglu, Tomris; Karaca, Mehmet; Erge, Sema; Polimanti, Renato

2015-04-01

Many consortia and international projects have investigated the human genetic variation of a large number of ethno-geographic groups. However, populations with peculiar genetic features, such as the Turkish population, are still absent in publically available datasets. To explore the genetic predisposition to health-related traits of the Turkish population, we analyzed 34 genes associated with different health-related traits (for example, lipid metabolism, cardio-vascular diseases, hormone metabolism, cellular detoxification, aging and energy metabolism). We observed relevant differences between the Turkish population and populations with non-European ancestries (that is, Africa and East Asia) in some of the investigated genes (that is, AGT, APOE, CYP1B1, GNB3, IL10, IL6, LIPC and PON1). As most complex traits are highly polygenic, we developed polygenic scores associated with different health-related traits to explore the genetic diversity of the Turkish population with respect to other human groups. This approach showed significant differences between the Turkish population and populations with non-European ancestries, as well as between Turkish and Northern European individuals. This last finding is in agreement with the genetic structure of European and Middle East populations, and may also agree with epidemiological evidences about the health disparities of Turkish communities in Northern European countries.

The Health Care Costs of Violence against Women

ERIC Educational Resources Information Center

Kruse, Marie; Sorensen, Jan; Bronnum-Hansen, Henrik; Helweg-Larsen, Karin

2011-01-01

The aim of this study is to analyze the health care costs of violence against women. For the study, we used a register-based approach where we identified victims of violence and assessed their actual health care costs at individual level in a bottom-up analysis. Furthermore, we identified a reference population. We computed the attributable costs,…

Population pharmacogenetics of Ibero-Latinoamerican populations (MESTIFAR 2014).

PubMed

Sosa-Macias, Martha; Moya, Graciela E; LLerena, Adrián; Ramírez, Ronald; Terán, Enrique; Peñas-LLedó, Eva M; Tarazona-Santos, Eduardo; Galaviz-Hernández, Carlos; Céspedes-Garro, Carolina; Acosta, Hildaura

2015-01-01

MESTIFAR 2014 28-30 November 2014, Panama City, Panama The CEIBA consortium was created within the Ibero-American network of Pharmacogenetics (RIBEF) to study population pharmacogenetics. The current status of these initiatives and results of the MESTIFAR project were analyzed in Panama, 28-30 November 2014. The MESTIFAR project focused on studying CYPs genetic polymorphisms in populations of different ethnic origin. So far, more than 6000 healthy volunteers have been evaluated, making this one of the largest population pharmacogenomic studies worldwide. Three symposia were organized, 'Pharmacogenetics of indigenous and mestizos populations and its clinical implications', 'Methodological innovation in pharmacogenetics and its application in health', and 'General discussion and concluding remarks', about mechanisms and proposals for training, diffusion of pharmacogenetics for Spanish- and Portuguese-speaking health professionals, and 'bench to bedside' pilot projects.

Qualifications and Competencies for Population Health Management Positions: A Content Analysis of Job Postings.

PubMed

Meyer, Melanie

2017-12-01

The need for population health management expertise has increased as the health care industry shifts toward value-based care. However, many organizations report hiring gaps as they seek to fill positions. The purpose of this study was to analyze the types of population health management positions for which health care organizations are hiring, including qualifications and competencies required for these positions. A content analysis was conducted on 271 job postings collected during a 2-month period. A typology of qualifications and competencies was developed based on the content analysis. Profiles were generated for the top 5 job title classifications: directors, coordinators, care managers, analysts, and specialists. This study highlights the investment health care organizations are making in population health management and the prominent role these positions are playing in the health care environment today. Many organizations are building out population health management teams resulting in multiple positions at different levels being added. As the market demands competent candidates who are equipped with specialized population health expertise as well as practical experience in program development, technology applications, care management, and analytics, professional education programs will need to adapt curricula to address the required areas. Competencies for specific job title classifications may need further evaluation and refinement over time. Study results can be used by organizations for strategic planning, by educators to target needed qualifications and competencies, and by researchers and policy advisors to assess progress toward value-based care.

The Relative Contribution of Health Status and Quality of Life Domains in Subjective Health in Old Age

ERIC Educational Resources Information Center

Prieto-Flores, Maria-Eugenia; Moreno-Jimenez, Antonio; Fernandez-Mayoralas, Gloria; Rojo-Perez, Fermina; Forjaz, Maria Joao

2012-01-01

To analyze the influence of different health status dimensions and quality of life (QoL) domains on older adults' subjective health, and to assess the role that residential satisfaction plays in these relationships. A QoL survey was conducted on a representative sample of the community-dwelling older adult population in Madrid province (Spain).…

Challenges facing the finance reform of the health system in Chile.

PubMed

Herrera, Tania

2014-05-28

Financing is one of the key functions of health systems, which includes the processes of revenue collection, fund pooling and acquisitions in order to ensure access to healthcare for the entire population. The article analyzes the financing model of the Chilean health system in terms of the first two processes, confirming low public spending on healthcare and high out-of-pocket expenditure, in addition to an appropriation of public resources by private insurers and providers. Insofar as pooling, there is lack of solidarity and risk sharing leading to segmentation of the population that is not consistent with the concept of social security, undermines equity and reduces system-wide efficiency. There is a pressing need to jumpstart reforms that address these issues. Treatments must be considered together with public health concerns and primary care in order to ensure the right to health of the entire population.

Effects of habitat characteristics on the growth of carrier population leading to increased spread of typhoid fever: a model.

PubMed

Shukla, J B; Goyal, Ashish; Singh, Shikha; Chandra, Peeyush

2014-06-01

In this paper, a non-linear model is proposed and analyzed to study the effects of habitat characteristics favoring logistically growing carrier population leading to increased spread of typhoid fever. It is assumed that the cumulative density of habitat characteristics and the density of carrier population are governed by logistic models; the growth rate of the former increases as the density of human population increases. The model is analyzed by stability theory of differential equations and computer simulation. The analysis shows that as the density of the infective carrier population increases due to habitat characteristics, the spread of typhoid fever increases in comparison with the case without such factors. Copyright © 2013 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

Surfing the internet for health information: an italian survey on use and population choices.

PubMed

Siliquini, Roberta; Ceruti, Michele; Lovato, Emanuela; Bert, Fabrizio; Bruno, Stefania; De Vito, Elisabetta; Liguori, Giorgio; Manzoli, Lamberto; Messina, Gabriele; Minniti, Davide; La Torre, Giuseppe

2011-04-07

Recent international sources have described how the rapid expansion of the Internet has precipitated an increase in its use by the general population to search for medical information. Most studies on e-health use investigated either through the prevalence of such use and the social and income patterns of users in selected populations, or the psychological consequences and satisfaction experienced by patients with particular diseases. Few studies have been carried out in Europe that have tried to identify the behavioral consequences of Internet use for health-related purposes in the general population.The aims of this study are to provide information about the prevalence of Internet use for health-related purposes in Italy according to demographic and socio-cultural features, to investigate the impact of the information found on health-related behaviors and choices and to analyze any differences based on health condition, self-rated health and relationships with health professionals and facilities. A multicenter survey was designed within six representative Italian cities. Data were collected through a validated questionnaire administered in hospital laboratories by physicians. Respondents were questioned about their generic condition, their use of the Internet and their health behaviors and choices related to Internet use. Data were analyzed using descriptive statistics and logistic regression to assess any differences by socio-demographic and health-related variables. The sample included 3018 individuals between the ages of 18 and 65 years. Approximately 65% of respondents reported using the Internet, and 57% of them reported using it to search for health-related information. The main reasons for search on the Internet were faster access and a greater amount of information. People using the Internet more for health-related purposes were younger, female and affected by chronic diseases. A large number of Internet users search for health information and subsequently modify their health behaviors and relationships with their medical providers. This may suggest a strong public health impact with consequences in all European countries, and it would be prudent to plan educational and prevention programs. However, it could be important to investigate the quality of health-related websites to protect and inform users.

Surfing the internet for health information: an italian survey on use and population choices

PubMed Central

2011-01-01

Background Recent international sources have described how the rapid expansion of the Internet has precipitated an increase in its use by the general population to search for medical information. Most studies on e-health use investigated either through the prevalence of such use and the social and income patterns of users in selected populations, or the psychological consequences and satisfaction experienced by patients with particular diseases. Few studies have been carried out in Europe that have tried to identify the behavioral consequences of Internet use for health-related purposes in the general population. The aims of this study are to provide information about the prevalence of Internet use for health-related purposes in Italy according to demographic and socio-cultural features, to investigate the impact of the information found on health-related behaviors and choices and to analyze any differences based on health condition, self-rated health and relationships with health professionals and facilities. Methods A multicenter survey was designed within six representative Italian cities. Data were collected through a validated questionnaire administered in hospital laboratories by physicians. Respondents were questioned about their generic condition, their use of the Internet and their health behaviors and choices related to Internet use. Data were analyzed using descriptive statistics and logistic regression to assess any differences by socio-demographic and health-related variables. Results The sample included 3018 individuals between the ages of 18 and 65 years. Approximately 65% of respondents reported using the Internet, and 57% of them reported using it to search for health-related information. The main reasons for search on the Internet were faster access and a greater amount of information. People using the Internet more for health-related purposes were younger, female and affected by chronic diseases. Conclusions A large number of Internet users search for health information and subsequently modify their health behaviors and relationships with their medical providers. This may suggest a strong public health impact with consequences in all European countries, and it would be prudent to plan educational and prevention programs. However, it could be important to investigate the quality of health-related websites to protect and inform users. PMID:21470435

Improving pathways to primary health care among LGBTQ populations and health care providers: key findings from Nova Scotia, Canada.

PubMed

Gahagan, Jacqueline; Subirana-Malaret, Montse

2018-06-13

This study explores the perceived barriers to primary health care as identified among a sample of Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) identified individuals and health care providers in Nova Scotia, Canada. These findings, based on a province-wide anonymous online survey, suggest that additional efforts are needed to improve pathways to primary health among LGBTQ populations and in deepening our understanding of how to advance the unique primary health needs of these populations. Data were collected from the LGBTQ community through an online, closed-ended anonymous survey. Inclusion criteria for participation were self-identifying as LGBTQ, offering primary health care to LGBTQ patients, being able to understand English, being 16 years of age or older, and having lived in Nova Scotia for at least one year. A total of 283 LGBTQ respondents completed the online survey which included sociodemographic questions, perceptions of respondents' health status, and their primary health care experiences. In addition, a total of 109 health care providers completed the survey based on their experiences providing care in Nova Scotia, and in particular, their experiences and perceptions regarding LGBTQ access to primary health care and physician-patient interactions. Our results indicate that, in several key areas, the primary health care needs of LGBTQ populations in Nova Scotia are not being met and this may in turn contribute to their poor health outcomes across the life course. A framework of intersectionality and health equity was used to interpret and analyze the survey data. The key findings indicate the need to continue improving pathways to primary health care among LGBTQ populations, specifically in relation to additional training and related supports for health care providers who work with these populations.

Attempts by one local health department to provide only essential public health services: a 10-year retrospective case study.

PubMed

Richardson, J Matthew; Pierce, J Rush; Lackan, Nuha

2012-01-01

Because of local political circumstances, in 1996, the local public health department in Amarillo, Texas, divested itself of almost all personal health services and chose to retain only essential population-based public health services. We analyzed function, funding, and staffing for various health department activities in FY 1997 and again in FY 2007. The figures were adjusted for inflation and population growth. We interviewed key personnel about the motivation and effects of the changes that occurred with this 10-year period. The local health department both transferred and reassumed some personal health services during this period. This was primarily in the area of immunization services and care for special population such as refugees. Public health preparedness also became a significant new area of activity. Most personal health services provided by the health department before 1996 remained the function of other health care entities in the community. When adjusted for inflation and population growth, most of the growth in the health department's personnel and budget was the result of state and federally mandated program changes. Growth in this local health department, which was committed to provide only essential health services, was driven primarily by state and federally mandated programs. Real growth for essential public health services did not occur over a 10-year period.

The association between dental, general, and mental health status among underserved and vulnerable populations served at health centers in the US.

PubMed

Nguyen, Vy H; Lin, Sue C; Cappelli, David P; Nair, Suma

2018-12-01

Vulnerable populations in underserved communities are disproportionately at high risk for multiple medical, dental, and behavioral health conditions. This study aims to: a) examine the occurrence of acute dental needs and b) investigate the association of acute dental needs and self-rated general and mental health status among the adult dentate health center population. This cross-sectional study analyzed data on adult patients (n = 5,035) from the 2014 Health Center Patient Survey, a nationally representative survey of health center patients. Multivariate logistic regression was used to assess the association of acute dental needs and a) self-rated general health status and b) mental health status. Approximately, two thirds of adult dentate heath center patients reported having an acute dental need. After adjusting for confounding factors, not having or having had health insurance that pays for dental care, general health status of fair or poor, and ever having a mental illness were associated with higher odds of having an acute dental need. The results highlight the role of health centers in addressing oral health disparities among vulnerable populations and the importance of a team-based multidisciplinary approach to ensuring the integration and coordination of oral health services within a comprehensive primary care delivery system. © 2017 American Association of Public Health Dentistry.

Healthy Volunteer 2020: Comparing Peace Corps Volunteers' health metrics with Healthy People 2020 national objectives.

PubMed

Henderson, Susan J; Newman, Jeannette; Ferguson, Rennie W; Jung, Paul

2016-12-01

Healthy People 2020 (HP2020) provides a set of quantifiable objectives for improving the health and well-being of Americans. This study examines Peace Corps Volunteers' health metrics in comparison with the Leading Health Indicators (LHIs) in order to set baseline measures for Volunteers' health care and align our measurements with Healthy People 2020 standards. Health data from multiple internal Peace Corps datasets were compared with relevant LHIs and analyzed using descriptive statistics. Seventeen (65%) of the 26 LHIs were relevant to Peace Corps Volunteers. Of these, Volunteers' health measures met or were more favorable than the goals of 13 (76%) of the LHIs. There were no data available for 4 (24%) of the LHIs. The entire Volunteer population has full access to primary care, oral health, and reproductive health services. No suicides or homicides were reported among Volunteers during the analyzed time period. Utilizing the LHIs, we have identified high-priority public health issues relevant for the Peace Corps Volunteer population. We discuss the need for quality data to measure and monitor Volunteers' health progress and outcomes over time, and also to standardize our measurements with Healthy People 2020 benchmarks. This framework may foster greater collaboration to engage in health promotion and disease prevention activities driven by evidence-based information, which may, in turn, encourage healthy behavior among Volunteers.

Mental Health Disparities Among Low-Income US Hispanic Residents of a US-Mexico Border Colonia.

PubMed

Marquez-Velarde, Guadalupe; Grineski, Sara; Staudt, Kathleen

2015-12-01

Unregulated residential settlements along the US side of the US-Mexico border, often called "colonias", are mainly populated by low-income Mexican-origin Hispanics. Colonia residents face numerous social, environmental, economic and public health challenges. Despite this, the mental health of individuals living in colonias has remained largely understudied. Drawing from a survey (N = 98) conducted through a community-based participatory research project in one colonia suffering from numerous environmental and social challenges, this study analyzes residents' mental health outcomes and access to mental health care with a focus on intra-ethnic disparities based on environmental concerns, nativity, language acculturation, comorbidity, gender, health insurance, and stressful life events. Data were analyzed using descriptive statistics, correlation, and regression. More than one third of the residents have been diagnosed with a mental health condition and over half reported stress and excess worry. In terms of mental health care, 77 % of individuals diagnosed with a mental health problem have sought additional help mainly through a primary care provider despite the high levels of uninsured individuals. Comorbidity, being female, recent negative life events, and high levels of environmental concerns were significant predictors of negative mental health outcomes. This study contributes to the understanding of the complex health dynamics of the US Hispanic population. It also highlights the need for additional research and resources devoted to the mental health of low-income minorities in isolated communities.

Type 1 diabetes, quality of life, occupational status and education level - A comparative population-based study.

PubMed

Nielsen, Helena B; Ovesen, Louise L; Mortensen, Laust H; Lau, Cathrine J; Joensen, Lene E

2016-11-01

Type 1 diabetes requires extensive self-management to avoid complications and may have negative effects on the everyday life of people with the disease. The aim of this study was to compare adults with type 1 diabetes to the general population in terms of health-related quality of life, occupational status (level of employment, working hours and sick leave) and education level. 2415 adults (aged 18-98years) with type 1 diabetes were compared to 48,511 adults (aged 18-103years) from the general population. Data were obtained from two cross-sectional surveys conducted in 2010 and 2011 of adults living or treated in the Capital Region in Denmark. Differences between adults with type 1 diabetes and the general population were standardised for age and sex and analyzed using linear probability models and negative binomial regression. Differences were further analyzed in subgroups. Compared to the general population, adults with type 1 diabetes experienced lower health-related quality of life, were more frequently unemployed, had more sick leave per year and were slightly better educated. Differences in health-related quality of life and employment increased with age and were larger among women, as compared to men. No significant differences were found with regard to working hours. Our findings suggest that type 1 diabetes is associated with lower health-related quality of life, higher unemployment and additional sick leave. The negative association with type 1 diabetes is more pronounced in women and older adults. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Operational Definitions of Sexual Orientation and Estimates of Adolescent Health Risk Behaviors

PubMed Central

Matthews, Derrick D.; Blosnich, John R.; Farmer, Grant W.; Adams, Brian J.

2014-01-01

Purpose Increasing attention to the health of lesbian, gay, and bisexual (LGB) populations comes with requisite circumspection about measuring sexual orientation in surveys. However, operationalizing these variables also requires considerable thought. This research sought to document the consequences of different operational definitions of sexual orientation by examining variation in health risk behaviors. Methods Using Massachusetts Youth Risk Behavior Survey data, we examined how operational definitions of sexual behavior and sexual identity influenced differences among three health behaviors known to disparately affect LGB populations: smoking, suicide risk, and methamphetamine use. Sexual behavior and sexual identity were also examined together to explore if they captured unique sources of variability in behavior. Results Estimates of health disparities changed as a result of using either sexual behavior or sexual identity. Youth who reported their sexual identity as “not sure” also had increased odds of health risk behavior. Disaggregating bisexual identity and behavior from same-sex identity and behavior frequently resulted in the attenuation or elimination of health disparities that would have otherwise been attributable to exclusively same-sex sexual minorities. Finally, sexual behavior and sexual identity explained unique and significant sources of variability in all three health behaviors. Conclusion Researchers using different operational definitions of sexual orientation could draw different conclusions, even when analyzing the same data, depending upon how they chose to represent sexual orientation in analyses. We discuss implications that these manipulations have on data interpretation and provide specific recommendations for best-practices when analyzing sexual orientation data collected from adolescent populations. PMID:25110718

Overall prescription medication use among adults: findings from the Survey of the Health of Wisconsin.

PubMed

Che, Jianhong; Malecki, Kristen C; Walsh, Matthew C; Bersch, Andrew J; Chan, Vincent; McWilliams, Christine A; Nieto, F Javier

2014-12-01

To analyze overall prescription medication use patterns among study participants in a representative statewide sample of Wisconsin adults. We analyzed data on 1572 participants from the 2008-2010 cycles of the Survey of the Health of Wisconsin (SHOW). SHOW is a statewide population-based survey that collects health information, including prescription medications, from 21 to 74 year olds. Prescription medication use was examined according to demographic and socioeconomic characteristics. Almost 55% of participants reported using at least 1 medication in the past month and 14% reported using at least 5 medications. The top 5 medications reported were lisinopril, hydrochlorothiazide, simvastatin, levothyroxine, and metoprolol. Overall prescription medication use increased significantly with age. Medication use was greater among females, former smokers, adults with body mass index (BMI) ≥ 30, or with low family income, and non-hispanic blacks. Adults having health insurance, drug coverage, or a regular source of care were more likely to report medication use. The prevalence of prescription medication use in a general population sample in Wisconsin was high. Age, gender, race, BMI, family income, smoking history, health insurance, prescription drug coverage, and having a regular source of health care were associated with prescription medication use.

[Health-related quality-of-life in the smoking general population of Spain: An approach from the National Health Survey].

PubMed

de Lossada, A; Rejas, J

2016-10-01

Smoking has been associated with an important health risk. The aim was to analyze the health-related quality of life (HRQoL) status of the adult Spanish general population included in the National Health Survey according to its smoking status. Data were included from National Health Survey for the year 2011-2012 with information of HRQoL status in general population over 15 years of age. Adult male and female, 18 years of age or above, were categorized into 3 exclusive groups according to their current smoking status: smokers (daily smokers of any form of tobacco, at least the previous 12 months), ex-smokers of one or more years since quitting smoking and people who have never smoked (non smokers). HRQoL was assessed with the Spanish version of the EQ-5D-5L questionnaire included into the National Health Survey. A total of 19,604 records were analyzed: 4,723 (24.09%) smokers, 3,797 (19.37%) ex-smokers, and 11,084 (56.54%) non smokers, male and female with 18 years of age or above. Smokers showed significantly adjusted mean scores (95% CI) in utility of 0.903 (0.899-0.908) and 75.36 (74.06-76.69) in the visual analogue scale of current state of health, ex-smokers 0.924 (0.919-0.929) and 76.85 (76.67-78.07), and non smokers 0.902 (0.899-0.905) and 76.25 (75.02-77.51), P<.01 between groups in both variables. In the Spanish general population, subjects who are ex-smokers showed better utility values and state health scores, supporting the hypothesis that quitting smoking could be associated with a discreet improvement of HRQoL. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Exposure to psychosocial risk factors in the context of work: a systematic review.

PubMed

Fernandes, Cláudia; Pereira, Anabela

2016-01-01

To analyze the scientific literature about the effects of exposure to psychosocial risk factors in work contexts. A systematic review was performed using the terms "psychosocial factors" AND "COPSOQ" in the databases PubMed, Medline, and Scopus. The period analyzed was from January 1, 2004 to June 30, 2012. We have included articles that used the Copenhagen Psychosocial Questionnaire (COPSOQ) as a measuring instrument of the psychosocial factors and the presentation of quantitative or qualitative results. German articles, psychometric studies or studies that did not analyze individual or work factors were excluded. We included 22 articles in the analysis. Individual factors, such as gender, age, and socioeconomic status, were analyzed along with work-related factors such as labor demands, work organization and content, social relationships and leadership, work-individual interface, workplace values, justice and respect, personality, health and well-being, and offensive behaviors. We analyzed the sample type and the applied experimental designs. Some population groups, such as young people and migrants, are more vulnerable. The deteriorated working psychosocial environment is associated with physical health indicators and weak mental health. This environment is also a risk factor for the development of moderate to severe clinical conditions, predicting absenteeism or intention of leaving the job. The literature shows the contribution of exposure to psychosocial risk factors in work environments and their impact on mental health and well-being of workers. It allows the design of practical interventions in the work context to be based on scientific evidences. Investigations in specific populations, such as industry, and studies with more robust designs are lacking.

A health equity impact assessment umbrella program (AAPRISS) to tackle social inequalities in health: program description.

PubMed

Lang, Thierry; Bidault, Elsa; Villeval, Mélanie; Alias, François; Gandouet, Benjamin; Servat, Martine; Theis, Ivan; Breton, Eric; Haschar-Noé, Nadine; Grosclaude, Pascale

2016-09-01

The failure to simultaneously address two objectives (increasing the average health of the population and reducing health inequalities) may have led to what has been observed in France so far: an overall decrease in mortality and increase in inequality. The Apprendre et Agir pour Réduire les Inégalités Sociales de Santé (AAPRISS) methodology is to analyze and modify interventions that are already underway in terms of their potential impact on health inequalities. It relies on partnership between researchers and actors in the health field, as well as policy makers. In this paper, we describe the program and discuss its feasibility and acceptability. This program is not a single intervention, but a process aiming at assessing and reshaping existing health programs, therefore acting as a kind of meta-intervention. The program develops scientific and methodological support stemming from co-construction methods aimed at increasing equity within the programs. Stakeholders from prevention policy-making and the health care system, as well as researchers, collaborate in defining interventions, monitoring their progress, and choosing indicators, methods and evaluation procedures. The target population is mainly the population of the greater Toulouse area. The steps of the process are described: (1) establishment of AAPRISS governance and partnerships; (2) inclusion of projects; and (3) the projects' process. Many partners have rallied around this program, which has been shown to be feasible and acceptable by partners and health actors. A major challenge is understanding each partner's expectations in terms of temporality of interventions, expected outcomes, assessment methods and indicators. Analyzing the projects has been quite feasible, and some modifications have been implemented in them in order to take inequalities in health into account. © The Author(s) 2015.

The health of European populations: introduction to the special supplement on the 2014 European Social Survey (ESS) rotating module on the social determinants of health.

PubMed

Beckfield, Jason; Balaj, Mirza; McNamara, Courtney L; Huijts, Tim; Bambra, Clare; Eikemo, Terje A

2017-02-01

This introduction summarizes the main findings of the Supplement 'Social inequalities in health and their determinants' to the European Journal of Public Health. The 16 articles that constitute this supplement use the new ESS (2014) health module data to analyze the distribution of health across European populations. Three main themes run across these articles: documentation of cross-national variation in the magnitude and patterning of health inequalities; assessment of health determinants variation across populations and in their contribution to health inequalities; and the examination of the effects of health outcomes across social groups. Social inequalities in health are investigated from an intersectional stance providing ample evidence of inequalities based on socioeconomic status (occupation, education, income), gender, age, geographical location, migrant status and their interactions. Comparison of results across these articles, which employ a wide range of health outcomes, social determinants and social stratification measures, is facilitated by a shared theoretical and analytical approach developed by the authors in this supplement. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Health impact: longitudinal analysis of employment at middle and old age in Mexico

PubMed Central

GONZÁLEZ-GONZÁLEZ, César; WONG, Rebeca

2015-01-01

We use longitudinal data from the Mexican Health and Aging Study to analyze the relationship between health and labor force participation of population aged 50 years and older in Mexico. The results confirm that health, measured through chronic diseases and difficulty to perform activities of daily living, has a powerful influence on labor force participation. We also find important differences by gender; hypertension and diabetes have effects in both, men and women; heart disease and stroke only in men. We provide concrete evidence on economic participation and highlight the importance of public policies to create adequate jobs for the population at middle and old age. PMID:25722646

An exploration of citizen science for population health research in retail food environments.

PubMed

Pomeroy, Stephanie J; Minaker, Leia M; Mah, Catherine L

2018-01-22

Public engagement is an essential component of public health research, practice, knowledge exchange processes, and decision making. Citizen science was first documented in the early 1900s as an approach to public engagement and there is growing interest in how it can be used in health research. This commentary describes how citizen science approaches were incorporated into a public engagement activity as part of a population health intervention research project on the retail food environment, a workshop we hosted called The Food In This Place in St. John's, Newfoundland and Labrador. We used citizen science methods and approaches to train and support participants to critically analyze a sample of everyday local retail food environments.

Self-Rated Health at the Intersection of Sexual Identity and Union Status

PubMed Central

Reczek, Corinne; Liu, Hui; Spiker, Russell

2016-01-01

There is a well-established relationship between union status and health within the general population, and growing evidence of an association between sexual identity and well-being. Yet, what is unknown is whether union status stratifies health outcomes across sexual identity categories. In order to elucidate this question, we analyzed nationally representative population-based data from the National Health Interview Surveys 2013–2014 (N = 53,135) to examine variation in self-rated health by sexual partnership status (i.e., by sexual identity across union status). We further test the role of socioeconomic status and gender in these associations. Results from logistic regression models show that union status stratifies self-rated health across gay, lesbian, and heterosexual populations, albeit in different ways for men and women. Socioeconomic status does not play a major role in accounting for these differences. Findings highlight the need for specific interventions with lesbian women, who appear to experience the most strident disadvantage across union status categories. PMID:28202146

Self-rated health at the intersection of sexual identity and union status.

PubMed

Reczek, Corinne; Liu, Hui; Spiker, Russell

2017-03-01

There is a well-established relationship between union status and health within the general population, and growing evidence of an association between sexual identity and well-being. Yet, what is unknown is whether union status stratifies health outcomes across sexual identity categories. In order to elucidate this question, we analyzed nationally representative population-based data from the National Health Interview Surveys 2013-2014 (N = 53,135) to examine variation in self-rated health by sexual partnership status (i.e., by sexual identity across union status). We further test the role of socioeconomic status and gender in these associations. Results from logistic regression models show that union status stratifies self-rated health across gay, lesbian, and heterosexual populations, albeit in different ways for men and women. Socioeconomic status does not play a major role in accounting for these differences. Findings highlight the need for specific interventions with lesbian women, who appear to experience the most strident disadvantage across union status categories. Copyright © 2016 Elsevier Inc. All rights reserved.

Mapping Disparities in Access to Safe, Timely, and Essential Surgical Care in Zambia.

PubMed

Esquivel, Micaela M; Uribe-Leitz, Tarsicio; Makasa, Emmanuel; Lishimpi, Kennedy; Mwaba, Peter; Bowman, Kendra; Weiser, Thomas G

2016-11-01

Surgical care is widely unavailable in developing countries; advocates recommend that countries evaluate and report on access to surgical care to improve availability and aid health planners in decision making. To analyze the infrastructure, capacity, and availability of surgical care in Zambia to inform health policy priorities. In this observational study, all hospitals providing surgical care were identified in cooperation with the Zambian Ministry of Health. On-site data collection was conducted from February 1 through August 30, 2011, with an adapted World Health Organization Global Initiative for Emergency and Essential Surgical Care survey. Data collection at each facility included interviews with hospital personnel and assessment of material resources. Data were geocoded and analyzed in a data visualization platform from March 1 to December 1, 2015. We analyzed time and distance to surgical services, as well as the proportion of the population living within 2 hours from a facility providing surgical care. Surgical capacity, supplies, human resources, and infrastructure at each surgical facility, as well as the population living within 2 hours from a hospital providing surgical care. Data were collected from all 103 surgical facilities identified as providing surgical care. When including all surgical facilities (regardless of human resources and supplies), 14.9% of the population (2 166 460 of 14 500 000 people) lived more than 2 hours from surgical care. However, only 17 hospitals (16.5%) met the World Health Organization minimum standards of surgical safety; when limiting the analysis to these hospitals, 65.9% of the population (9 552 780 people) lived in an area that was more than 2 hours from a surgical facility. Geographic analysis of emergency and essential surgical care, defined as access to trauma care, obstetric care, and care of common abdominal emergencies, found that 80.7% of the population (11 704 700 people) lived in an area that was more than 2 hours from these surgical facilities. A large proportion of the population in Zambia does not have access to safe and timely surgical care; this percentage would change substantially if all surgical hospitals were adequately resourced. Geospatial visualization tools assist in the evaluation of surgical infrastructure in Zambia and can identify key areas for improvement.

[Hospital admissions and morbidity in people with intellectual developmental disorders].

PubMed

Bernal-Celestino, Rubén José; León-Hurtado, David; Martínez-Leal, Rafael

2017-01-01

People with intellectual developmental disorders (IDD) have worse health statuses in comparison with general population. The objective of this paper is to compare access and hospital morbimortality in people with IDD and general population. We conducted a retrospective cross-sectional analytical study and analyzed data on admissions and discharges between IDD patients and the rest of them, in Ciudad Real, España. Out of 51 325 hospital admissions, 441 (0.9%) belonged to the group of persons with IDD. The IDD group had fewer programmed hospitalization than the general population and fewer surgical interventions. They presented more admissions for mental disorders and respiratory system diseases. The data presented confirm TDI population have different patterns of disease. Furthermore, this study reveal potential difficulties in access to health care in this population.

The confidence in health care and social services in northern Sweden--a comparison between reindeer-herding Sami and the non-Sami majority population.

PubMed

Daerga, Laila; Sjölander, Per; Jacobsson, Lars; Edin-Liljegren, Anette

2012-08-01

To investigate the confidence in primary health care, psychiatry and social services among the reindeer-herding Sami and the non-Sami population of northern Sweden. A semi-randomized, cross-sectional study design comprising 325 reindeer-herding Sami (171 men, 154 women) and a control population of 1,437 non-Sami (684 men, 753 women). A questionnaire on the confidence in primary health care, psychiatry, social services, and work colleagues was distributed to members of reindeer-herding families through the Sami communities and to the control population through the post. The relative risk for poor confidence was analyzed by calculating odds ratios with 95% confidence intervals adjusted for age and level of education. The confidence in primary health care and psychiatry was significantly lower among the reindeer-herding Sami compared with the control group. No differences were found between men and women in the reindeer-herding Sami population. In both the reindeer-herding Sami and the control population, younger people (≤ 48 years) reported significantly lower confidence in primary health care than older individuals (>48 years). A conceivable reason for the poor confidence in health care organizations reported by the reindeer-herding Sami is that they experience health care staff as poorly informed about reindeer husbandry and Sami culture, resulting in unsuitable or unrealistic treatment suggestions. The findings suggest that the poor confidence constitutes a significant obstacle of the reindeer-herding Sami to fully benefit from public health care services.

Privacy by Design at Population Data BC: a case study describing the technical, administrative, and physical controls for privacy-sensitive secondary use of personal information for research in the public interest.

PubMed

Pencarrick Hertzman, Caitlin; Meagher, Nancy; McGrail, Kimberlyn M

2013-01-01

Population Data BC (PopData) is an innovative leader in facilitating access to linked data for population health research. Researchers from academic institutions across Canada work with PopData to submit data access requests for projects involving linked administrative data, with or without their own researcher-collected data. PopData and its predecessor-the British Columbia Linked Health Database-have facilitated over 350 research projects analyzing a broad spectrum of population health issues. PopData embeds privacy in every aspect of its operations. This case study focuses on how implementing the Privacy by Design model protects privacy while supporting access to individual-level data for research in the public interest. It explores challenges presented by legislation, stewardship, and public perception and demonstrates how PopData achieves both operational efficiencies and due diligence.

Privacy by Design at Population Data BC: a case study describing the technical, administrative, and physical controls for privacy-sensitive secondary use of personal information for research in the public interest

PubMed Central

Pencarrick Hertzman, Caitlin; Meagher, Nancy; McGrail, Kimberlyn M

2013-01-01

Population Data BC (PopData) is an innovative leader in facilitating access to linked data for population health research. Researchers from academic institutions across Canada work with PopData to submit data access requests for projects involving linked administrative data, with or without their own researcher-collected data. PopData and its predecessor—the British Columbia Linked Health Database—have facilitated over 350 research projects analyzing a broad spectrum of population health issues. PopData embeds privacy in every aspect of its operations. This case study focuses on how implementing the Privacy by Design model protects privacy while supporting access to individual-level data for research in the public interest. It explores challenges presented by legislation, stewardship, and public perception and demonstrates how PopData achieves both operational efficiencies and due diligence. PMID:22935136

Factors associated with cholera in Kenya, 2008-2013.

PubMed

Cowman, Gretchen; Otipo, Shikanga; Njeru, Ian; Achia, Thomas; Thirumurthy, Harsha; Bartram, Jamie; Kioko, Jackson

2017-01-01

Kenya experienced widespread cholera outbreaks in 1997-1999 and 2007-2010. The re-emergence of cholera in Kenya in 2015 indicates that cholera remains a public health threat. Understanding past outbreaks is important for preventing future outbreaks. This study investigated the relationship between cholera occurrence in Kenya and various environmental and demographic factors related to water, sanitation, socio-economic status, education, urbanization and availability of health facilities during the time period 2008-2013. The primary outcome analyzed was the number of cholera cases at the district level, obtained from the Kenya Ministry of Health's national cholera surveillance records. Values of independent variables were obtained from the 2009 Kenya Population and Housing Census and other national surveys. The data were analyzed using a zero-inflated negative binomial regression model. Multivariate analysis indicated that the risk of cholera was associated with open defecation, use of unimproved water sources, poverty headcount ratio and the number of health facilities per 100,000 population (p < 0.05). No statistically significant association was found between cholera occurrence and education, percentage of population living in urban areas or population density. The Sustainable Development Goals and Kenya's blueprint for development, Kenya Vision 2030 , call for access to sanitation facilities and clean water for all by 2030. Kenya has made important economic strides in recent years but continues to be affected by diseases like cholera that are associated with low socio-economic status. Further expansion of access to sanitation facilities and clean water is necessary for preventing cholera in Kenya.

[Impact of cardiovascular risk factors on the consumption of resources in Primary Care according to Clinical Risk Groups].

PubMed

Millá Perseguer, Magdalena; Guadalajara Olmeda, Natividad; Vivas Consuelo, David

2018-06-13

To analyze the prevalence of Cardiovascular Risk Factors (CVRF) in the context of a Basic Health Area and the impact they generate on morbidity and consumption of healthcare resources in the stratified population according to the Clinical System Risk Groups (CRG) in Primary Care, with the purpose of identifying the population with multimorbidity to apply preventive measures, as well as the one that generates the highest care burden and social needs. Observational, cross-sectional and population-based study for a basic health area during 2013. Department of Health 2 (Castellón), Comunidad Valenciana (CV). Includes outpatient care in Primary Care and specialized. All citizens registered in the Population Information System, N=32,667. From the computerized system Abucasis we obtained the demographic, clinical and consumption variables of health resources. We consider the prevalence of CVRF based on the presence or absence of the ICD.9.MC diagnostic codes. The relationship of the CVRF with the 9 CRG health states was analyzed and a predictive analysis was performed with the logistic regression model to evaluate the explanatory capacity of each variable. In addition, an explanatory model of ambulatory pharmaceutical expenditure was obtained through multivariate regression. The population of health status CRG4 and above had multimorbidity. The CRG7 and 6 health states have a higher prevalence of CVRF; it was predictive that the higher the morbidity, the greater the consumption of resources through OR above the mean, p<0.05 and the 95% confidence intervals. It was observed that 59.8% of ambulatory pharmaceutical expenditure was explained by the CRG system and all the CVRF (p<0.05 and R 2 corrected=0.598). Regarding the effect of the CVRF on the CRG health states, there was a significant association (p<0.05) for the alteration of blood glucose, dyslipidemia and HBP in all the CRG states. The study of CVRF in a stratified population using the CRG system identifies and predicts where the greatest impact on morbidity and consumption of healthcare resources is generated. It allows us to know the groups of patients where to develop prevention and chronicity strategies. At the level of clinical practice, a new concept of multimorbidity is provided, defined from the state of health CRG 4 and above. Publicado por Elsevier España, S.L.U.

Current knowledge of US metal and nonmetal miner health: Current and potential data sources for analysis of miner health status

PubMed Central

Yeoman, K. M.; Halldin, C. N.; Wood, J.; Storey, E.; Johns, D.; Laney, A. S.

2016-01-01

ABSTRACT Little is known about the current health status of US metal and nonmetal (MNM) miners, in part because no health surveillance systems exist for this population. The National Institute for Occupational Safety and Health (NIOSH) is developing a program to characterize burden of disease among MNM miners. This report discusses current knowledge and potential data sources of MNM miner health. Recent national surveys were analyzed, and literature specific to MNM miner health status was reviewed. No robust estimates of disease prevalence were identified, and national surveys did not provide information specific to MNM miners. Because substantial gaps exist in the understanding of MNM miners' current health status, NIOSH plans to develop a health surveillance program for this population to guide intervention efforts to reduce occupational and personal risks for chronic illness. PMID:25658684

Reliability and validity of 12-item Short-Form health survey (SF-12) for the health status of Chinese community elderly population in Xujiahui district of Shanghai.

PubMed

Shou, Juan; Ren, Limin; Wang, Haitang; Yan, Fei; Cao, Xiaoyun; Wang, Hui; Wang, Zhiliang; Zhu, Shanzhu; Liu, Yao

2016-04-01

The 12-item Short-Form Health Survey (SF-12) is the abridged practical version of SF-36. This cross-sectional study was aimed to assess the reliability and validity of SF-12 for the health status of Chinese community elderly population. The Chinese community elderly people in Xujiahui district of Shanghai were investigated. The internal consistency reliability was assessed using Cronbach's alpha and split-half reliability coefficients. Construct validity was analyzed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Spearman's correlation coefficient (ρ) was used for the evaluation of criterion, convergent, and discriminant validity with Spearman's ρ ≥ 0.4 as satisfactory. Comparisons of the SF-12 summary scores among populations that differed in demographics were performed for discriminant validity. Total 1343 individuals aged ≥60 and <85 years old (response rate: 91.3 %) were analyzed. The Cronbach's α value (0.910) and the split-half reliability coefficient (0.812) reflected satisfactory internal consistency reliability of SF-12. EFA extracted a two-factor model (physical and mental health). About 60.7 % of the total variance was explained by the two factors. CFA showed that the two-factor solution provided a good fit to the data. Good convergent validity and discriminant validity of SF-12 were proved by the correction analyses (Spearman's ρ > 0.4) and the comparisons of the SF-12 summary scores among populations (P < 0.05). SF-12 summary scores were significantly correlated with the SF-36 summary scores (Spearman's ρ > 0.4, P < 0.05). In conclusion, SF-12 had satisfactory reliability and validity in measuring health status of Chinese community elderly population in Xujiahui district of Shanghai.

Medical cost and frequent mental distress among the non-elderly US adult population.

PubMed

Bruning, John; Arif, Ahmed A; Rohrer, James E

2014-03-01

Frequent mental distress (FMD) is an important measure of perceived poor mental health. With the rising cost of health care, it is not uncommon for working adults to delay seeking care. The objective of this study was to determine the relationship between avoidance of medical care due to cost and FMD among the non-elderly US population. We analyzed data from 282 044 non-elderly US population from a 2008 Behavioral Risk Factor Surveillance System survey. Multivariable logistic regression models were used to assess the association between avoidance of medical care due to cost and FMD adjusted for covariates. The overall prevalence of FMD in the non-elderly population was 11.1%; whereas it was 24.2% for those reporting avoiding medical care due to cost. Approximately 18% of the population had no health insurance coverage and the prevalence of FMD was significantly greater in this group. The odds of FMD were >2-fold elevated for respondents who were unable to see a doctor because of cost (adjusted odds ratio: 2.40, 99% confidence interval: 2.19, 2.63). These findings highlight the need for affordable medical care for reducing mental distress and improving population health.

Health Disparities and Delayed Health care among Older Adults in California: A Perspective from Race, Ethnicity, and Immigration.

PubMed

Du, Yan; Xu, Qingwen

2016-09-01

To examine racial/ethnic/immigration disparities in health and to investigate the relationships among race/ethnic/immigration status, delayed health care, and health of the elderly. Responses from 13,508 people aged 65 and above were analyzed based on the California Health Interview Survey (CHIS) 2011-2012. Key variables include race/ethnicity/immigration status, health outcome, and delayed health care. Age, gender, education, work status, and annual family income are used as covariates. The findings indicate that Whites (regardless of country of birth) and U.S.-born Asians enjoy better health than Latinos, African-Americans, and Foreign-born Asians. Foreign-born Asians and foreign-born Latinos have the poorest self-reported health and mental health, respectively. Delayed use of health care is negatively associated with both self-reported health and mental health status. Health disparities exist among older adult populations; the combined effects of minority and immigrant status can be approximated from the results in this study. Health care accessibility and the quality of care should be promoted in minority/immigrant populations. Public health nurses have a strong potential to aide in reducing health disparities among an aging American population that continues to exhibit increasing racial/ethnic diversity. © 2016 Wiley Periodicals, Inc.

Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

PubMed

Rocha, T A H; da Silva, N C; Amaral, P V; Barbosa, A C Q; Rocha, J V M; Alvares, V; de Almeida, D G; Thumé, E; Thomaz, E B A F; de Sousa Queiroz, R C; de Souza, M R; Lein, A; Toomey, N; Staton, C A; Vissoci, J R N; Facchini, L A

2017-12-01

Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). Cross-sectional ecological study. Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Participatory assessment of the health of Latino immigrant men in a community with a growing Latino population.

PubMed

Documėt, Patricia I; Kamouyerou, Andrea; Pesantes, Amalia; Macia, Laura; Maldonado, Hernan; Fox, Andrea; Bachurski, Leslie; Morgenstern, Dawn; Gonzalez, Miguel; Boyzo, Roberto; Guadamuz, Thomas

2015-02-01

Latino immigrant men are an understudied population in the US, especially in areas with small yet growing Latino populations. For this community-based participatory health assessment we conducted four focus groups and 66 structured surveys with Latino immigrant men, and 10 openended interviews with service providers. We analyzed transcripts using content analysis and survey data using Pearson Chi-square tests. Overall, 53% of participating men had not completed high school. Our findings suggest that their social circumstances precluded men from behaving in a way they believe would protect their health. Loneliness, fear and lack of connections prompted stress among men, who had difficulty locating healthcare services. Newly immigrated men were significantly more likely to experience depression symptoms. Latino immigrant men face social isolation resulting in negative health consequences, which are amplified by the new growth community context. Men can benefit from interventions aimed at building their social connections.

Health Related Quality of Life in a Dutch Rehabilitation Population: Reference Values and the Effect of Physical Activity.

PubMed

Krops, Leonie A; Jaarsma, Eva A; Dijkstra, Pieter U; Geertzen, Jan H B; Dekker, Rienk

2017-01-01

To establish reference values for Health Related Quality of Life (HRQoL) in a Dutch rehabilitation population, and to study effects of patient characteristics, diagnosis and physical activity on HRQoL in this population. Former rehabilitation patients (3169) were asked to fill in a questionnaire including the Dutch version of the RAND-36. Differences between our rehabilitation patients and Dutch reference values were analyzed (t-tests). Effects of patient characteristics, diagnosis and movement intensity on scores on the subscales of the RAND-36 were analyzed using block wise multiple regression analyses. In total 1223 patients (39%) returned the questionnaire. HRQoL was significantly poorer in the rehabilitation patients compared to Dutch reference values on all subscales (p<0.001) except for health change (p = 0.197). Longer time between questionnaire and last treatment was associated with a smaller health change (p = 0.035). Higher age negatively affected physical functioning (p<0.001), social functioning (p = 0.004) and health change (p = 0.001). Diagnosis affected outcomes on all subscales except role limitations physical, and mental health (p ranged <0.001 to 0.643). Higher movement intensity was associated with better outcomes on all subscales except for mental health (p ranged <0.001 to 0.190). HRQoL is poorer in rehabilitation patients compared to Dutch reference values. Physical components of HRQoL are affected by diagnosis. In rehabilitation patients an association between movement intensity and HRQoL was found. For clinical purposes, results of this study can be used as reference values for HRQoL in a rehabilitation setting.

Identifying Health Promotion Needs Among Dominican-American Adolescents.

PubMed

Champion, Jane Dimmitt; Roye, Carol F

Immigration from the Dominican Republic to the United States has grown rapidly. Yet, although adolescent pregnancy and obesity are common concerns among Hispanics, little is known specifically about Dominican adolescent health. This study was undertaken to assess Dominican-American adolescents' health concerns and their perceptions about their health promotion needs. Dominican-American adolescents (N=25) were recruited in a pediatric clinic in New York City which primarily serves a Dominican population. Eligibility criteria included age 13-21years, self-identifying as Dominican ethnicity, and able to speak and read English. They completed a questionnaire, with demographic questions and questions about their risk behaviors including sexual and substance use. After completing the questionnaire, they participated in a semi-structured interview addressing their health education experiences and suggestions for such programs. Quantitative data were analyzed using frequencies to provide a demographic and behavioral profile. Qualitative data were analyzed using thematic analysis. Twenty-five adolescents, ages 13-21years, (female N=19, male N=6) participated in the study. Most were in school (92%) and were sexually experienced (68%). Programmatic preferences included in-person programs rather than online. They spontaneously addressed the importance of cultural issues, and the need to address several issues in addition to sexuality, including obesity and substance use. Programming for this population should address a broad conceptualization of health, and incorporate Dominican cultural issues. Nurses working with adolescents of Dominican origin, should provide health education that incorporates the specific needs of this population, including culturally congruent face-to-face interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

Health situation analysis of Thai population 2010: implications for health education and health service reform.

PubMed

Sutra, Sumitr; Chirawatkul, Aroon; Leelapanmetha, Pichet; Sirisuwan, Somnuk; Thavompitak, Yupa; Thepsuthammarat, Kaewjai

2012-07-01

Between 1990 and 2010, many national and international factors converged to both beneficially and antagonistically affect people's health and the Thai healthcare system. Moreover Thailand is moving to aged society and a low birth rates. To analyze Thailand's health issues for baseline information for changing medical education, services and researches. Information on illness of in-patients, out-patients and casualties came from hospitals nationwide and from hospitals withdrawals from the three health insurance schemes in fiscal 2010. The data included 96% of the population. Research literature was also extensively reviewed. The data were analyzed by age groups and burdensome diseases. Out-patients were treated 326,230,155 times and in-patients 6,880,815 times at Community Hospitals (44%), Provincial Hospitals (22%), Central or University Hospitals (26%) and Private Hospitals (8%). Infants and elderly were the patients most commonly treated in hospital. Among pediatric patients, perinatal disease, intestinal infection, respiratory tract infection, injury and poisoning and teenage pregnancy predominated; while among adults, it was accident, non-communicable and chronic disease. Thailand is faced with the dual burden of infection and non-communicable diseases. Risky behavior and changing social structure are underlined this epidemiological transition. Medical schools and health service systems need to be recalibrated to response proactively to these challenges.

Local health practices and the knowledge of medicinal plants in a Brazilian semi-arid region: environmental benefits to human health.

PubMed

Zank, Sofia; Peroni, Nivaldo; de Araújo, Elcida Lima; Hanazaki, Natalia

2015-02-23

The concept of eco-cultural health considers the dynamic interaction between humans and ecosystems, emphasizing the implications of the health of the ecosystem for the health and well-being of human populations. Ethnobotanical studies focusing on folk medicine and medicinal plants can contribute to the field of eco-cultural health if they incorporate the perspective and local knowledge of communities. We investigated the local health practices in three rural communities living within the vicinity of a protected area of sustainable use in a semi-arid region of Brazil. We analyzed the opinions of local health experts on the elements that influence human health and on how the environment contributes to this influence. We also analyzed and compared the local knowledge of medicinal plants, as knowledge of this type is an important factor when considering the interaction between environmental and human health. We performed structured interviews and free-listings with 66 local health experts. We used content analysis to systematize the elements of the influences on human health. We compared the richness of the plants cited among communities and analyzed the differences among the three communities regarding the ways in which the plants were obtained and the environments in which plants were collected. The local experts identified several influences of the environment on human health. These influences can be associated with ecosystem services, such as climatic conditions, water and air quality, recreation and medicinal and food resources. We identified 192 medicinal plant species, most of which were gathered from wild ecosystems. The most important environments for the three communities were the plateau mountain and backyards. The informants had a broad and integrated view of health, perceiving the importance of conserving the environment within the National Forest of Araripe for the health and well-being of the local populations.

Select Personality Characteristic Differences between Caregivers for Persons with Acquired Immune Deficiency Syndrome and Caregivers for Other Types of Illness.

ERIC Educational Resources Information Center

Angel, Daniel Scott; Heritage, Jeannette

The purpose of this study was to analyze select personality characteristics of individuals working within the Acquired Immune Deficiency Syndrome (AIDS) population in comparison to non-AIDS caregivers by using two personality assessment instruments. Subjects were from two health care provider populations. Two hundred research packets were…

Population structure analysis and association mapping of seed antioxidant content in USDA cowpea (Vigna unguiculata L. Walp.) core collection using SNPs

USDA-ARS?s Scientific Manuscript database

Cowpea (Vigna unguiculata (L) Walp.) is an important legume and the antioxidants in cowpea seeds have been recognized as health-promoting compounds for human. The objectives of this study were to analyze the population structure of cowpea collections using single nucleotide polymorphism (SNP) and to...

The educative impact of health care treatment on malarial prevention behavior for the poor in Guinea, West Africa

PubMed Central

McFadden, Daniel L.; Sunkara, Vasu

2004-01-01

We analyze the malarial health behavior of rural populations by using data from the 1999 Demographic and Health Survey for Guinea, West Africa. We find that prior formal health care treatment is associated with heightened malaria prevention behaviors for the poorest uneducated populations in this rural cohort. Individuals from this subgroup that report no history of malarial infection and exclude themselves from health care treatment further appear to be misdiagnosing the disease at a substantial level. We conjecture that the use of formal health care options provides informational exposure to the clinical aspects of malarial pathogenesis. For individuals steeped in the most severe poverty, this exposure appears to have a particularly robust educative effect. The health behavioral dynamics we observe here have putative extensions for regional health policy as well with other infectious diseases, such as HIV/AIDS. PMID:15277676

The role of urban municipal governments in reducing health inequities: A meta-narrative mapping analysis

PubMed Central

2010-01-01

Background The 1986 Ottawa Charter for Health Promotion coincided with a preponderance of research, worldwide, on the social determinants of health and health inequities. Despite the establishment of a 'health inequities knowledge base', the precise roles for municipal governments in reducing health inequities at the local level remain poorly defined. The objective of this study was to monitor thematic trends in this knowledge base over time, and to track scholarly prescriptions for municipal government intervention on local health inequities. Methods Using meta-narrative mapping, four bodies of scholarly literature - 'health promotion', 'Healthy Cities', 'population health' and 'urban health' - that have made substantial contributions to the health inequities knowledge base were analyzed over the 1986-2006 timeframe. Article abstracts were retrieved from the four literature bodies using three electronic databases (PubMed, Sociological Abstracts, Web of Science), and coded for bibliographic characteristics, article themes and determinants of health profiles, and prescriptions for municipal government interventions on health inequities. Results 1004 journal abstracts pertaining to health inequities were analyzed. The overall quantity of abstracts increased considerably over the 20 year timeframe, and emerged primarily from the 'health promotion' and 'population health' literatures. 'Healthy lifestyles' and 'healthcare' were the most commonly emphasized themes in the abstracts. Only 17% of the abstracts articulated prescriptions for municipal government interventions on local health inequities. Such interventions included public health campaigns, partnering with other governments and non-governmental organizations for health interventions, and delivering effectively on existing responsibilities to improve health outcomes and reduce inequities. Abstracts originating from Europe, and from the 'Healthy Cities' and 'urban health' literatures, were most vocal regarding potential avenues for municipal government involvement on health inequities. Conclusions This study has demonstrated a pervasiveness of 'behavioural' and 'biomedical' perspectives, and a lack of consideration afforded to the roles and responsibilities of municipal governments, among the health inequities scholarly community. Thus, despite considerable research activity over the past two decades, the 'health inequities knowledge base' inadequately reflects the complex aetiology of, and solutions to, population health inequities. PMID:20500850

Analyzing best practices in employee health management: how age, sex, and program components relate to employee engagement and health outcomes.

PubMed

Terry, Paul E; Grossmeier, Jessica; Mangen, David J; Gingerich, Stefan B

2013-04-01

Examine the influence of employee health management (EHM) best practices on registration, participation, and health behavior change in telephone-based coaching programs. Individual health assessment data, EHM program data, and health coaching participation data were analyzed for associations with coaching program enrollment, active participation, and risk reduction. Multivariate analyses occurred at the individual (n = 205,672) and company levels (n = 55). Considerable differences were found in how age and sex impacted typical EHM evaluation metrics. Cash incentives for the health assessment were associated with more risk reduction for men than for women. Providing either a noncash or a benefits-integrated incentive for completing the health assessment, or a noncash incentive for lifestyle management, strengthened the relationship between age and risk reduction. In EHM programs, one size does not fit all. These results can help employers tailor engagement strategies for their specific population.

Utilization of health technologies-Do not look where there is a light; shine your light where there is a need to look! Relating national health goals with resource allocation decision-making; illustration through examining the Israeli healthcare system.

PubMed

Shavit, Oren

2009-10-01

Innovative health technologies are often the focus of attention. However, in the allocation of public resources for improving health, the focus should be on the health needs of the population. It is the need that should be analyzed first, and decision makers should then evaluate the full range of interventions available, whether new or old, to meet this need. This is in contrast to analyzing the technology first and then characterizing the need it meets, which is the current practice in reimbursement decision-making in several countries. The identified health need should define national health goals, and these goals should be proactively assimilated into the reimbursement decision-making process. Differential reimbursement rates could reflect the relative contribution of the technology to the unmet health need.

Utilization of nuclear medicine scintigraphy in Taiwan, 1997-2009.

PubMed

Hung, Mao-Chin; Hsieh, Wanhua Annie; Chang, Peter Wushou; Hwang, Jeng-Jong

2011-12-01

To analyze the utilization of nuclear medicine scintigraphy in the Taiwanese population within the national health-care system between 1997 and 2009. Based on the Taiwan's National Health Insurance Research Database of 1997-2009, a retrospective population-based analysis was conducted. Descriptive statistics and regression analysis were employed to analyze the frequencies and longitudinal trends in the utilization of diagnostic nuclear medicine procedures during the period. In addition, correlation analysis was applied to determine the correlated factors in the utility of nuclear medicine scintigraphy. The annual total nuclear medicine scintigraphy was estimated to be 256,389 on average in 1997-2009 and 11.7 per 1,000 population over the period. The frequency had increased by 67% over the years, from 8.2 per 1,000 population in 1997 to 13.7 per 1,000 population in 2009. The most frequently performed procedures were whole-body bone scans (33.4% of total) and myocardial perfusion scans (29.4% of total), with 4,615 and 5,620 increments per year, respectively. Most patients were in the age group of 41-65 years old when taking examinations. In addition, male subjects were slightly more than female patients (51.5 vs. 48.5%). Furthermore, the frequencies of whole-body bone scans and PET scans were proportional to the incidences of cancers (correlation coefficients were 0.96 and 0.94, respectively). The utilization of nuclear medicine scintigraphy with the National Health Insurance system in Taiwan has been changed considerably in the past 13 years. Both whole-body bone scan and myocardial perfusion scan were performed most often with significantly increases. The trend of nuclear medicine scintigraphy may have potential impact on making health-care policy in Taiwan.

Exposure to psychosocial risk factors in the context of work: a systematic review

PubMed Central

Fernandes, Cláudia; Pereira, Anabela

2016-01-01

ABSTRACT OBJECTIVE To analyze the scientific literature about the effects of exposure to psychosocial risk factors in work contexts. METHODS A systematic review was performed using the terms “psychosocial factors” AND “COPSOQ” in the databases PubMed, Medline, and Scopus. The period analyzed was from January 1, 2004 to June 30, 2012. We have included articles that used the Copenhagen Psychosocial Questionnaire (COPSOQ) as a measuring instrument of the psychosocial factors and the presentation of quantitative or qualitative results. German articles, psychometric studies or studies that did not analyze individual or work factors were excluded. RESULTS We included 22 articles in the analysis. Individual factors, such as gender, age, and socioeconomic status, were analyzed along with work-related factors such as labor demands, work organization and content, social relationships and leadership, work-individual interface, workplace values, justice and respect, personality, health and well-being, and offensive behaviors. We analyzed the sample type and the applied experimental designs. Some population groups, such as young people and migrants, are more vulnerable. The deteriorated working psychosocial environment is associated with physical health indicators and weak mental health. This environment is also a risk factor for the development of moderate to severe clinical conditions, predicting absenteeism or intention of leaving the job. CONCLUSIONS The literature shows the contribution of exposure to psychosocial risk factors in work environments and their impact on mental health and well-being of workers. It allows the design of practical interventions in the work context to be based on scientific evidences. Investigations in specific populations, such as industry, and studies with more robust designs are lacking. PMID:27253900

Health-Related Quality of Life among Artisanal Fisherwomen/Shellfish Gatherers: Lower than the General Population.

PubMed

Müller, Juliana Dos Santos; Falcão, Ila Rocha; Couto, Maria Carolina Barreto Moreira; Viana, Wendel da Silva; Alves, Ivone Batista; Viola, Denise Nunes; Woods, Courtney Georgette; Rêgo, Rita Franco

2016-05-05

Quality of life is an indicator of how well one perceives that he/she is functioning physically and mentally. The aim of this paper is to determine the health-related quality of life (HRQOL) of artisanal fisherwomen/shellfish gatherers from the Saubara municipality in Bahia, Brazil in comparison to the general population. A structured questionnaire was administered to a sample of 209 artisanal fisherwomen selected at random. The HRQOL questionnaire, known as the 36-Item Short-Form Health Survey version 1 (SF-36v01), was also used, having been translated and verified cross-culturally for the Brazilian population. Sociodemographic, lifestyle and comorbidity information was also collected. Chronic diseases and indicators of musculoskeletal disorders (MSDs) were self-reported. The study population consisted primarily of individuals between 30 and 45 years of age (78%), of self-classified races black or brown (96.2%), with no more than an elementary school education (77%) and married (64.6%). In all the SF-36v01 dimensions, the values in the sample were lower than in the general population of Brazil, which was used as the reference population. In the "Physical Health" domain (Physical Functioning; Physical Role Limitations; Bodily Pain; General Health Perception) a tendency toward a lower health-related quality of life was observed among those who were older, had a lower education level, and had a prevalence of MSDs, hypertension or arthritis. The interference of health conditions linked to the fisherwomen's work activities may contribute to lower HRQOL in all analyzed aspects, in comparison to the general population. In light of these findings, public health policies must consider these informal workers who contribute greatly to Brazil's economy and food system.

Analysis of Suicide Behaviors in the Navy Active Duty and Reserve Component Population

DTIC Science & Technology

2015-03-01

deployment are exposed to combat or have the same combat experiences that could affect other facets of their physical and mental health . 4. Transitions...specific demographics, access to firearms, experiencing a loss (relational, financial, or career), physical and mental health , substance abuse...CODE 13. ABSTRACT (maximum 200 words) We analyze the role of service-specific and mental health risk factors in active duty and reserve

[Suffering and mental health during social crises].

PubMed

Stagnaro, Juan Carlos

In this paper the author analyzes the epidemiological data of the effects of the social crisis on the mental health against the background of the political and social events in Argentine in the last years. These effects are found both in the general population and in the health care professionals. The article reviews the clinical and psychopathological approaches to understand the disorders of the patients during a social crisis.

Supply, distribution, and capacity of optometrists in Indiana.

PubMed

Marshall, E C

2000-05-01

The Indiana Optometric Association and the Indiana Health Care Professional Development Commission identified a need to collect and analyze data on the health professions workforce for formulating goals and strategies to accommodate demands for health care services in Indiana. This study looks at the supply, distribution, and services of optometrists practicing in Indiana. Data compiled by the Indiana State Department of Health, Indiana Health Care Development Commission, and the Project HOPE Center for Health Affairs were analyzed with the results of a survey of practitioner members of the Indiana Optometric Association. Supply, distribution, services, provider-to-population ratios, per capita demand, and optometric productivity were used to evaluate the current and future capacity of Indiana optometrists to the year 2010. An estimated 893 optometrists practiced in 86 of 92 counties and comprised 77% of the state's licensed eye and vision care workforce in 1995. Optometric workforce capacity appeared to be related to county population, but unrelated to the urban/rural classification or the per-capita income of Indiana counties. Contact lenses, disease, geriatrics, and pediatrics were the most prevalent areas of practice specialty. Optometrist capacity in Indiana is sufficient at both the state and county levels, and optometric services are appropriately distributed such that patient access to optometric care is geographically unburdened. Estimates regarding supply are elastic, depending on the assumptions applied.

How social policy contributes to the distribution of population health: the case of gender health equity.

PubMed

Beckfield, Jason; Morris, Katherine Ann; Bambra, Clare

2018-02-01

In this study we aimed to analyze gender health equity as a case of how social policy contributes to population health. We analyzed three sets of social-investment policies implemented in Europe and previously hypothesized to reduce gender inequity in labor market outcomes: childcare; active labor market programs; and long-term care. We use 12 indicators of social-investment policies from the OECD Social Expenditure Database, the OECD Family Database, and the Social Policy Indicators' Parental Leave Benefit Dataset. We draw outcome data from the 2015 Global Burden of Disease for years lived with disability and all-cause mortality among men and women ages 25-54 for 18 European nations over the 1995-2010 period. We estimate 12 linear regression models each for mortality and morbidity (i.e. years lived with disability), one per social-investment indicator. All models use country fixed-effects and cluster-robust standard errors. For years lived with disability, women benefit more from social investment for most indicators. The only exception is the percentage of young children in publicly funded childcare or schooling, which equally benefits men. For all-cause mortality, men benefit more or equally from social investment for most indicators, while women benefit more from government spending on direct job creation through civil employment. Social policy contributes to the distribution of population health. Social-investment advocates argue such policies in particular enhance economic gender equity. Our results show that these polices have ambiguous effects on gender health equity and even differential improvements among men for some outcomes.

Examining Demographic Factors Related to Cigarette Smoking among Undergraduate Students at a Turkish University

ERIC Educational Resources Information Center

Oktay, Erkan; Çelik, Ali Kemal; Akbaba, Ahmet Ilker

2013-01-01

Cigarette smoking is the leading global preventable health risk, and it is associated with well-known health risks such as morbidity, mortality, cancer, cardiovascular disease, and nicotine addiction. When analyzed by age group, cigarette smoking in Turkey is the most prevalent among younger adult populations. The college years appear to be a time…

A Systematic Literature Review of Studies Analyzing Inequalities in Health Expectancy among the Older Population

PubMed Central

Pongiglione, Benedetta; De Stavola, Bianca L.; Ploubidis, George B.

2015-01-01

Aim To collect, organize and appraise evidence of socioeconomic and demographic inequalities in health and mortality among the older population using a summary measure of population health: Health Expectancy. Methods A systematic literature review was conducted. Literature published in English before November 2014 was searched via two possible sources: three electronic databases (Web of Science, Medline and Embase), and references in selected articles. The search was developed combining terms referring to outcome, exposure and participants, consisting in health expectancy, socioeconomic and demographic groups, and older population, respectively. Results Of 256 references identified, 90 met the inclusion criteria. Six references were added after searching reference lists of included articles. Thirty-three studies were focused only on gender-based inequalities; the remaining sixty-three considered gender along with other exposures. Findings were organized according to two leading perspectives: the type of inequalities considered and the health indicators chosen to measure health expectancy. Evidence of gender-based differentials and a socioeconomic gradient were found in all studies. A remarkable heterogeneity in the choice of health indicators used to compute health expectancy emerged as well as a non-uniform way of defining same health conditions. Conclusions Health expectancy is a useful and convenient measure to monitor and assess the quality of ageing and compare different groups and populations. This review showed a general agreement of results obtained in different studies with regard to the existence of inequalities associated with several factors, such as gender, education, behaviors, and race. However, the lack of a standardized definition of health expectancy limits its comparability across studies. The need of conceiving health expectancy as a comparable and repeatable measure was highlighted as fundamental to make it an informative instrument for policy makers. PMID:26115099

Factors associated with cholera in Kenya, 2008-2013

PubMed Central

Cowman, Gretchen; Otipo, Shikanga; Njeru, Ian; Achia, Thomas; Thirumurthy, Harsha; Bartram, Jamie; Kioko, Jackson

2017-01-01

Introduction Kenya experienced widespread cholera outbreaks in 1997-1999 and 2007-2010. The re-emergence of cholera in Kenya in 2015 indicates that cholera remains a public health threat. Understanding past outbreaks is important for preventing future outbreaks. This study investigated the relationship between cholera occurrence in Kenya and various environmental and demographic factors related to water, sanitation, socio-economic status, education, urbanization and availability of health facilities during the time period 2008-2013. Methods The primary outcome analyzed was the number of cholera cases at the district level, obtained from the Kenya Ministry of Health's national cholera surveillance records. Values of independent variables were obtained from the 2009 Kenya Population and Housing Census and other national surveys. The data were analyzed using a zero-inflated negative binomial regression model. Results Multivariate analysis indicated that the risk of cholera was associated with open defecation, use of unimproved water sources, poverty headcount ratio and the number of health facilities per 100,000 population (p < 0.05). No statistically significant association was found between cholera occurrence and education, percentage of population living in urban areas or population density. Conclusion The Sustainable Development Goals and Kenya's blueprint for development, Kenya Vision 2030, call for access to sanitation facilities and clean water for all by 2030. Kenya has made important economic strides in recent years but continues to be affected by diseases like cholera that are associated with low socio-economic status. Further expansion of access to sanitation facilities and clean water is necessary for preventing cholera in Kenya. PMID:29515719

Comorbidities of rheumatoid arthritis: Results from the Korean National Health and Nutrition Examination Survey.

PubMed

Jeong, Hyemin; Baek, Sun Young; Kim, Seon Woo; Eun, Yeong Hee; Kim, In Young; Kim, Hyungjin; Lee, Jaejoon; Koh, Eun-Mi; Cha, Hoon-Suk

2017-01-01

This study aimed to evaluate the prevalence of comorbidities in patients with rheumatoid arthritis (RA) compared with the non-RA population. The 2010-2012 Korea National Health and Nutrition Examination Survey (KNHANES), which assesses the general health status of populations in South Korea using interviews and basic health assessment, was analyzed retrospectively. Weighted prevalence and odds ratio (OR) of comorbidities were analyzed in patients with RA compared with the non-RA population. The overall weighted (n = 37,453,158) prevalence of RA was 1.5%. Patients with RA were older and more female predominant than subjects without RA. The prevalence of living in an urban area, college graduation, alcohol consumption and smoking was lower in patients with RA than non-RA. Patients with RA had more comorbidities including hypertension, dyslipidemia, myocardial infarction (MI) or angina, stoke, osteoarthritis, lung cancer, colon cancer, pulmonary tuberculosis, asthma, diabetes, depression, thyroid disease and chronic kidney disease. After adjusting socioeconomic and lifestyle characteristics, RA was associated with an increased prevalence of MI or angina (OR 1.86, 95% CI 1.17-2.96, p = 0.009), pulmonary TB (OR 1.95, 95% CI 1.24-3.09, p = 0.004), asthma (OR 1.97, 95% CI 1.05-3.71, p = 0.036), thyroid disease (OR 1.71, 95% CI 1.05-2.77), depression (OR 2.38, 95% CI 1.47-3.85, p < 0.001) and hepatitis B (OR 2.34, 95% CI 1.15-4.80, p = 0.020) compared with the non-RA population. Prevalence of solid cancer was not significantly associated with RA after adjustment.

The impact of minimum wages on population health: evidence from 24 OECD countries.

PubMed

Lenhart, Otto

2017-11-01

This study examines the relationship between minimum wages and several measures of population health by analyzing data from 24 OECD countries for a time period of 31 years. Specifically, I test for health effects as a result of within-country variations in the generosity of minimum wages, which are measured by the Kaitz index. The paper finds that higher levels of minimum wages are associated with significant reductions of overall mortality rates as well as in the number of deaths due to outcomes that have been shown to be more prevalent among individuals with low socioeconomic status (e.g., diabetes, disease of the circulatory system, stroke). A 10% point increase of the Kaitz index is associated with significant declines in death rates and an increase in life expectancy of 0.44 years. Furthermore, I provide evidence for potential channels through which minimum wages impact population health by showing that more generous minimum wages impact outcomes such as poverty, the share of the population with unmet medical needs, the number of doctor consultations, tobacco consumption, calorie intake, and the likelihood of people being overweight.

[Study of access to health care and drugs in Cameroon: 1. Methods and validation].

PubMed

Commeyras, Christophe; Ndo, Jean Rolin; Merabet, Omar; Koné, Hamidou; Rakotondrabé, Faraniaina Patricia

2005-01-01

During the 1980s, an economic depression and the concomitant decrease in the national health budget modified the population's health behavior. Improvement of the economy since the late 1990s makes it possible to renew the national health policy. To prepare the highly indebted and poor countries' program (HIPC), the Minister of Health and its partners commissioned a survey to measure the population's real access to health care and the factors that determine this accessibility and to propose concrete corrective actions. To fulfill these objectives, the steering committee decided to analyze health care demand, through a national population survey, and supply capacity, through a national survey of pharmacies and other drug dispensers. A survey of persons using medications will also be conducted (Fig.1). Focusing on this component of health care is justified by these findings: 95% of persons feeling ill buy drugs, whereas only 31% consult a physician or other healthcare provider, and half of the average household's health expenditures are for drugs. Financial, geographic, social and quality indicators were defined to measure accessibility and its determining factors (Table 1). The smallest administrative unit, the health area (HA), was chosen as the sampling unit, to enable us to survey together healthcare demand, supply and consumption according to different concentrations of supply and demand . It behaves as a cluster of sampling units of different populations: drug retailers of all sectors, drug users, households, and ill persons within the households. The HA samples include Yaounde and Douala, with urban and rural sub-samples, for which sampling ratios increase with the diversity of supply and demand, according to several pre-defined factors. The study includes 400 HAs, covering more than one third of the population (Table 2). Within these HAs, 900 pharmacies and other formal drug retailers, 709 street vendors, 4,505 households, 2,532 ill persons in these households, 4,121 pharmacy customers and 850 customers of street vendors were surveyed, i.e., more than 13,600 questionnaires. Assessment of data quality shows that the sample is representative of the national population for its socioeconomic characteristics. Its geographic distribution, even after correction, nonetheless favors urban areas, where both supply and demand are high. Generalizing the 3 sub-samples to the national level thus requires caution, especially for the geographic distribution. Other limitations and possible biases are described and evaluated. However, the retrospective demographic and statistic evaluation shows that the samples are representative of their population and that the data quality can be considered good. This article describes the background of this study and justifies its methodological choices. Future publications will analyze the data collected.

"Perspectives on financing population-based health care towards Universal Health Coverage among employed individuals in Ghanzi district, Botswana: A qualitative study".

PubMed

Mbogo, Barnabas Africanus; McGill, Deborah

2016-08-19

Globally, about 150 million people experience catastrophic healthcare expenditure services annually. Among low and middle income countries, out-of-pocket expenditure pushes about 100 million people into poverty annually. In Botswana, 83 % of the general population and 58 % of employed individuals do not have medical aid coverage. Moreover, inequity allocation of financial resources between health services suggests marginalization of population-based health care services (i.e. diseases prevention and health promotion). The purpose of the study is to explore perspectives on employed individuals regarding financing population based health care interventions towards Universal Health Coverage (UHC) in order to make recommendations to the Ministry of Health on health financing options to cover population-based health services. A qualitative design grounded in interpretivist epistemology through social constructivism lens was critical for exploring perspectives of employed individuals. Through purposive and snowballing sampling techniques, a total of 15 respondents including 8 males and 7 females were recruited and interviewed using a semi-structured format. Their age ranged from 23 to 59 years with a median of 36 years. Data was analyzed using Thematic Content Analysis technique. Use of social constructivism lens enabled to classify emerging themes into population coverage, health services coverage and financial protection issues. Despite broad understanding of health coverage schemes among participants, knowledge appears insignificant in increasing enrolment. Participants indicated limited understanding of UHC concepts, however showed willingness to embrace UHC upon brief description. Main thematic issues raised include: exclusion of population-based health services from coverage scheme; disparity in financial protection and health services coverage among enrollees; inability to sustain contracted employees; and systematic exclusion of unemployed individuals and informal sector employees. Increasing enrolment in health coverage schemes requires targeted campaign for information dissemination through use of myriads mass media including: social networks, TV, Radio and others. Moreover, re-designing health insurance schemes is critical in order to include population-based interventions; expand uptake of unemployed and informal sector employees; flexibility in monthly premiums payment plan and use of technology to increase access to payment points. Further study need to evaluate the content of health financing policy in Botswana measured against the World Health Organization Universal Health Coverage conceptual requirements for Low and Middle Income Countries.

Strengthening health system to improve immunization for migrants in China.

PubMed

Fang, Hai; Yang, Li; Zhang, Huyang; Li, Chenyang; Wen, Liankui; Sun, Li; Hanson, Kara; Meng, Qingyue

2017-07-01

Immunization is the most cost-effective method to prevent and control vaccine-preventable diseases. Migrant population in China has been rising rapidly, and their immunization status is poor. China has tried various strategies to strengthen its health system, which has significantly improved immunization for migrants. This study applied a qualitative retrospective review method aiming to collect, analyze and synthesize health system strengthening experiences and practices about improving immunizations for migrants in China. A conceptual framework of Theory of Change was used to extract the searched literatures. 11 searched literatures and 4 national laws and policies related to immunizations for migrant children were carefully studied. China mainly employed 3 health system strengthening strategies to significantly improve immunization for migrant population: stop charging immunization fees or immunization insurance, manage immunization certificates well, and pay extra attentions on immunization for special children including migrant children. These health system strengthening strategies were very effective, and searched literatures show that up-to-date and age-appropriate immunization rates were significantly improved for migrant children. Economic development led to higher migrant population in China, but immunization for migrants, particularly migrant children, were poor. Fortunately various health system strengthening strategies were employed to improve immunization for migrants in China and they were rather successful. The experiences and lessons of immunization for migrant population in China might be helpful for other developing countries with a large number of migrant population.

[The agribusiness industry in northwestern Mexico and the health of female farmworkers: a proposal for study].

PubMed

Aranda, Patricia; Castro Vásquez, María Del Carmen

2016-03-01

This article seeks to outline the structure of the export-oriented agribusiness industry in northwestern Mexico, so as to analyze the conditions of vulnerability of female farmworkers in terms of their access to health services and the medical attention they receive. Using a qualitative approach, focus groups and interviews were carried out with farmworkers and subject experts pertaining to academia and civil society. Their narratives were then analyzed using Pierre Bourdieu's concept of field. The primary results demonstrate a lack of access to health services and social security, and describe the main actors and their positions with respect to the vulnerability of this population.

[The economic-financial crisis and health in Spain. Evidence and viewpoints. SESPAS report 2014].

PubMed

Cortès-Franch, Imma; González López-Valcárcel, Beatriz

2014-06-01

The objectives of the SESPAS 2014 Report are as follows: a) to analyze the impact of the economic crisis on health and health-related behaviors, on health inequalities, and on the determinants of health in Spain; b) to describe the changes in the Spanish health system following measures to address the crisis and assess its potential impact on health; c) to review the evidence on the health impact of economic crises in other countries, as well as policy responses; and d) to suggest policy interventions alternative to those carried out to date with a population health perspective and scientific evidence in order to help mitigate the impact of the economic downturn on health and health inequalities. The report is organized in five sections: 1) the economic, financial and health crisis: causes, consequences, and contexts; 2) the impact on structural determinants of health and health inequalities; 3) the impact on health and health-related behaviors, and indicators for monitoring; 4) the impact on health systems; and 5) the impact on specific populations: children, seniors, and immigrants. There is some evidence on the relationship between the crisis and the health of the Spanish population, health inequalities, some changes in lifestyle, and variations in access to health services. The crisis has impacted many structural determinants of health, particularly among the most vulnerable population groups. Generally, policy responses on how to manage the crisis have not taken the evidence into account. The crisis may contribute to making public policy vulnerable to corporate action, thus jeopardizing the implementation of healthy policies. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Stability and Change in Health Insurance Among Older Mexican Americans: Longitudinal Evidence From the Hispanic Established Populations for Epidemiologic Study of the Elderly

PubMed Central

Angel, Ronald J.; Angel, Jacqueline L.; Markides, Kyriakos S.

2002-01-01

Objectives. This study examined the association between health insurance coverage, medical care use, limitations in activities of daily living, and mortality among older Mexican-origin individuals. Methods. We analyzed longitudinal data from the Hispanic Established Populations for Epidemiologic Study of the Elderly (H-EPESE). Results. The uninsured tend to be younger, female, poor, and foreign born. They report fewer health care visits, are less likely to have a usual source of care, and more often receive care in Mexico. Conversely, those with private health insurance are economically better off and use more health care services. Over time, the data reveal substantial changes in type of insurance coverage. Conclusions. The data reveal serious vulnerabilities among older Mexican Americans that result from a lack of private Medigap supplemental coverage. (Am J Public Health. 2002;92:1264–1271) PMID:12144982

[Organization and functioning of health services of the IMSS-Solidaridad program].

PubMed

Velázquez-Díaz, G

1992-01-01

In this report the organization and performance of the IMSS-Solidaridad Program of Mexico is described. This program is managed by the Mexican Institute for Social Security, which services 10.5 million inhabitants of the rural underserved areas, with federal government resources in 18 states. This study compares the structure and functioning of the IMSS-Solidaridad Program with Local Health Systems, as they have been proposed by the Panamerican Health Organization for country members and by the Ministry of Health of Mexico, particularly in relation to the decision-making process at local level. Some assets and limitations of the IMSS-Solidaridad Program are analyzed and, finally, concrete procedures to improve coordination between the IMSS-Solidaridad Program and other health services for similar populations (populations without social security protection) in Mexico are suggested, with the purpose of using resources more adequately and succeed in the national goal to achieve equity in health.

Psychological and health impact of working with victims of sex trafficking.

PubMed

Kliner, Merav; Stroud, Laura

2012-01-01

The UK is a major destination country for trafficking for sexual exploitation, and so increasing numbers of victims of trafficking are managed within health and social services. This study aims to assess the psychological and physical impact on health and social care staff working with an identified sex-trafficked population in a Northern City within England and identify methods to assist staff to manage this complex population. This research is a qualitative study of 12 members of health and social care staff through semi-structured interviews. The subjects were identified using purposive sampling, and data were analyzed using thematic analysis. Staff found working with sex-trafficked populations more difficult than with other vulnerable groups. They frequently described burnout and other adverse effects on their psychological and physical health. In general, staff felt undersupported and undertrained by their organizations. This led to concerns about the quality and sustainability of the service. Working with victims of sex trafficking significantly impacts on the physical and psychological health of staff. Staff working with such vulnerable groups require training and high levels of support to ensure that they are not adversely affected by their work and to ensure that high quality services are maintained. Practices to promote occupational health must be instilled within workplace policy and the organizational culture to limit the impact on psychological and physical health in staff working with vulnerable populations.

Comparison of health habits of military personnel with civilian populations.

PubMed Central

Ballweg, J A; Li, L

1989-01-01

The relationship between health habits and health status has gained attention in the literature in recent decades. In this report, the health habits of a particular occupational group--the military--are compared with those of the civilian population, and the extent to which the health habits of the military personnel are associated with their health status is examined. Responses to two surveys conducted in 1985 were analyzed by age group, sex, race, and educational level. The comparisons involved six of the seven health habits included in the Alameda study. Military personnel, because they are younger and their lives are more regimented, excel in meeting weight standards for the services and engaging in desirable levels of physical activity. Smoking habits of military personnel were less favorable than those of the civilians. An examination of the health status of the military for the year preceding the survey suggested that some health habits have immediate manifestations, but the impact of others may not be evident until later in life. PMID:2508180

[Impact of immunization measures by the Family Health Program on infant mortality from preventable diseases in Olinda, Pernambuco State, Brazil].

PubMed

Guimarães, Tânia Maria Rocha; Alves, João Guilherme Bezerra; Tavares, Márcia Maia Ferreira

2009-04-01

This article analyzes the impact of the Family Health Program (FHP) on infant health in Olinda, Pernambuco State, Brazil, evaluating immunization and infant mortality from vaccine-preventable diseases. A time-series study was conducted with data from the principal health information systems, analyzing indicators before and after implementation of the FHP in 1995. The independent variable was year of birth, related to degree of population coverage by the FHP. Three periods were analyzed: 1990-1994 (prior), 1995-1996 (implementation phase: 0 to 30% coverage), and 1997-2002 (intervention: coverage of 38.6% to 54%). Trends in the indicators were analyzed by simple linear regression, testing significance with the t test. During the implementation period there was an increase in all the vaccination coverage rates (176% BCG, 223% polio, 52% DPT, 61% measures) and a decrease in infant mortality from preventable diseases (12.7 deaths/year), even without a decrease in absolute poverty in the municipality or an increase in either coverage by the public health care system or the sewage system. Improvement in the indicators demonstrates the effectiveness of FHP actions in the municipality.

Socioeconomic and Health Profile of Haitian Immigrants in a Brazilian Amazon State.

PubMed

Borges, Fabiano Tonaco; Muraro, Ana Paula; da Costa Leão, Luís Henrique; de Andrade Carvalho, Luciana; Siqueira, Carlos Eduardo Gomes

2018-01-25

We analyzed the sociodemographic profile, migration journey, health conditions, and health care access and utilization among recent Haitian immigrants to the Brazilian Amazon state of Mato Grosso. We conducted a cross-sectional study with a probabilistic sample of 452 Haitians. We administered a bilingual questionnaire from December 2014 to February 2015. Data were analyzed using chi square tests to evaluate differences among groups. The majority of participants were married men younger than 35 years old. They mostly came from the Haiti's Artibonite Department, living in Brazil for less than a year. Half of the participants were employed at the time of the interviews, and 81.8% relied exclusively on the Brazilian Unified Healthcare System for medical care. The overall health profile and health care access were good. Haitian migration to Brasil is a case of South-South migration driven by economic needs. Our population had good health status despite socioeconomic challenges.

[Distributions of Mental Disorders and Psychosocial Pressures in Children and Adolescence of a Psychiatric Health Care Population].

PubMed

Belhadj Kouider, Esmahan; Dupont, Marc; Lorenz, Alfred L; Petermann, Franz

2016-07-01

Distributions in children's or adolescents' mental disorders or in psychosocial pressures were demonstrated. The health care population in child- and adolescent psychiatric institutions of Bremen in 2005 - 2012 (N = 7190) was analyzed. Amongst other burden factors pressures in school context or abnormal social environments increased significantly. Adjustment stress disorders or externalizing disorders were dominant, but the prevalence in affective and anxiety disorders increased considerably. The co-operation with school authorities or agencies should be intensified. © Georg Thieme Verlag KG Stuttgart · New York.

Transforming School Mental Health Services: Population-Based Approaches to Promoting the Competency and Wellness of Children

ERIC Educational Resources Information Center

Doll, Elizabeth J., Ed.; Cummings, Jack A., Ed.

2007-01-01

This book provides a "roadmap" for designing and implementing school psychological services for all students in a school. School psychologists will find guidelines for conducting a mental health needs assessment of the entire student body; analyzing patterns and trends to identify risk factors and common needs; and using the needs assessment to…

Syria: health in a country undergoing tragic transition.

PubMed

Ben Taleb, Ziyad; Bahelah, Raed; Fouad, Fouad M; Coutts, Adam; Wilcox, Meredith; Maziak, Wasim

2015-01-01

To document the ongoing destruction as a result of the tragic events in Syria, to understand the changing health care needs and priorities of Syrians. A directed examination of the scientific literature and reports about Syria before and during the Syrian conflict, in addition to analyzing literature devoted to the relief and rebuilding efforts in crisis situations. The ongoing war has had high direct war casualty, but even higher suffering due to the destruction of health system, displacement, and the breakdown of livelihood and social fabric. Millions of Syrians either became refugees or internally displaced, and about half of the population is in urgent need for help. Access to local and international aid organizations for war-affected populations is an urgent and top priority. Syrians continue to endure one of the biggest human tragedies in modern times. The extent of the crisis has affected all aspects of Syrians' life. Understanding the multi-faceted transition of the Syrian population and how it reflects on their health profile can guide relief and rebuilding efforts' scope and priorities.

Inequalities in out-of-pocket payments for health care services among elderly Germans – results of a population-based cross-sectional study

PubMed Central

2014-01-01

Introduction In order to limit rising publicly-financed health expenditure, out-of-pocket payments for health care services (OOPP) have been raised in many industrialized countries. However, higher health-related OOPP may burden social subgroups unequally. In Germany, inequalities in OOPP have rarely been analyzed. The aim of this study was to examine OOPP of the German elderly population in the different sectors of the health care system. Socio-economic and morbidity-related determinants of inequalities in OOPP were analyzed. Methods This cross-sectional analysis used data of N = 3,124 subjects aged 57 to 84 years from a population-based prospective cohort study (ESTHER study) collected in the Saarland, Germany, from 2008 to 2010. Subjects passed a geriatric assessment, including a questionnaire for health care utilization and OOPP covering a period of three months in the following sectors: inpatient care, outpatient physician and non-physician services, medical supplies, pharmaceuticals, dental prostheses and nursing care. Determinants of OOPP were analyzed by a two-part model. The financial burden of OOPP for certain social subgroups (measured by the OOPP-income-ratio) was investigated by a generalized linear model for the binomial family. Results Mean OOPP during three months amounted to €119, with 34% for medical supplies, 22% for dental prostheses, 21% for pharmaceuticals, 17% for outpatient physician and non-physician services, 5% for inpatient care and 1% for nursing care. The two-part model showed a significant positive association between income (square root equivalence scale) and total OOPP. Increasing morbidity was associated with significantly higher total OOPP, and in particular with higher OOPP for pharmaceuticals. Total OOPP amounted to about 3% of disposable income. The generalized linear model for the binomial family showed a significantly lower financial burden for the wealthiest quintile as compared to the poorest one. Conclusions This is the first study providing evidence of inequalities in OOPP in the German elderly population. Socio-economic and morbidity-related inequalities in OOPP and the resulting financial burden could be identified. The results of this study may contribute to the discussion about the mechanisms causing the observed inequalities and can thus help decision makers to consider them when adapting future regulations on OOPP. PMID:24397544

Effects of heat recovery for district heating on waste incineration health impact: a simulation study in Northern Italy.

PubMed

Cordioli, Michele; Vincenzi, Simone; De Leo, Giulio A

2013-02-01

The construction of waste incinerators in populated areas always causes substantial public concern. Since the heat from waste combustion can be recovered to power district heating networks and allows for the switch-off of domestic boilers in urbanized areas, predictive models for health assessment should also take into account the potential benefits of abating an important source of diffuse emission. In this work, we simulated the dispersion of atmospheric pollutants from a waste incinerator under construction in Parma (Italy) into different environmental compartments and estimated the potential health effect of both criteria- (PM(10)) and micro-pollutants (PCDD/F, PAH, Cd, Hg). We analyzed two emission scenarios, one considering only the new incinerator, and the other accounting for the potential decrease in pollutant concentrations due to the activation of a district heating network. We estimated the effect of uncertainty in parameter estimation on health risk through Monte Carlo simulations. In addition, we analyzed the robustness of health risk to alternative assumptions on: a) the geographical origins of the potentially contaminated food, and b) the dietary habits of the exposed population. Our analysis showed that under the specific set of assumptions and emission scenarios explored in the present work: (i) the proposed waste incinerator plant appears to cause negligible harm to the resident population; (ii) despite the net increase in PM(10) mass balance, ground-level concentration of fine particulate matter may be curbed by the activation of an extensive district heating system powered through waste combustion heat recovery and the concurrent switch-off of domestic/industrial heating boilers. In addition, our study showed that the health risk caused by waste incineration emissions is sensitive to assumptions about the typical diet of the resident population, and the geographical origins of food production. Copyright © 2012 Elsevier B.V. All rights reserved.

EQ-5D-3L as a health measure of Brazilian adult population.

PubMed

Menezes, Renata de Miranda; Andrade, Mônica Viegas; Noronha, Kenya Valéria Micaela de Souza; Kind, Paul

2015-11-01

This study explores the use of EQ-5D-3L as a measure of population health status in a Brazilian region with significant socioeconomic, demographic, and epidemiological heterogeneity. Data came from a study of 3363 literate individuals aged between 18 and 64 years living in urban areas of the state of Minas Gerais. Descriptive analysis and logistic and OLS regression models were performed to analyze the relationship between EQ-5D-3L (descriptive system and EQ VAS) and other health (self-assessed health status and 8 self-reported diagnosed chronic diseases), socioeconomic (educational level and economic class), and demographic (gender and age) measures. Additionally, a grade of membership (GoM) analysis was performed to identify multidimensional health profiles. A total of 76 health statuses were identified in the Brazilian population. The most prevalent one is full health (44 % of the sample). Elderly people, women, and individuals with poor health and lower socioeconomic conditions generally report more health problems in the EQ-5D-3L dimensions. The GoM analysis demonstrated that health status of older individuals is associated with the socioeconomic condition. Arthritis exhibited the strongest association with the EQ-5D-3L instrument. The results indicate that EQ-5D-3L is a good measure of health status for the Brazilian population. The instrument has a good discriminatory capacity in terms of demographic, socioeconomic, and health measures. The high prevalence of individuals with full health may indicate the presence of ceiling effect. However, this prevalence is smaller than that in other countries.

Chronic Disease Prevalence and Healthy Lifestyle Behaviors Among US Health Care Professionals.

PubMed

Dayoub, Elias; Jena, Anupam B

2015-12-01

Although health care professionals may be assumed to make healthier lifestyle choices and have better health outcomes than others because of their greater health literacy, little is known about how actual health outcomes of health care professionals compare with those of the overall population. We analyzed how trends in obesity, diabetes, hypertension, and coronary artery disease prevalence as well as several health behaviors (smoking, alcohol use, and exercise) varied between health care professionals and the general US population from 2002 to 2013, using nationally representative data collected by the National Health Interview Survey. We estimated multivariate logistic regressions of each disease and behavior adjusted for age, race, sex, geographic region, and year. Although rates of obesity, diabetes, and hypertension were lower among health care professionals compared with the overall population, disease was still common among health care professionals and increased over time at a rate similar to that of the overall population. For example, obesity prevalence was lower among health care professionals but increased similarly from 2002 to 2013 (health care professionals, 20.5% in 2002 to 22.1% in 2013; other occupations, 28.4% to 31.7%; P=.64 for difference in trend). Diabetes prevalence was modestly lower among health care professionals but increased at a similar rate (health care professionals, 7.4% in 2005 to 8.6% in 2013; other occupations, 8.7% to 9.9%; P=.67 for difference in trend). Similar patterns were noted in hypertension. Coronary artery disease prevalence declined over time among health care professionals but increased for others. Health care professionals reported better health behaviors than others in smoking and physical activity but not in moderate to heavy alcohol use. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Quality of life domains important and relevant to family caregivers of advanced cancer patients in an Asian population: a qualitative study.

PubMed

Lee, Geok Ling; Ow, Mandy Yen Ling; Akhileswaran, Ramaswamy; Pang, Grace Su Yin; Fan, Gilbert Kam Tong; Goh, Brandon Huat Heng; Wong, Cai Fong; Cheung, Yin Bun; Wee, Hwee Lin

2015-04-01

This study aims to identify domains of quality of life (QoL) that are culturally relevant to Chinese caregivers of advanced cancer patients in Singapore and to evaluate content adequacy of currently available instruments for use in the target population. English- and Chinese-speaking caregivers of advanced cancer patients receiving care under a tertiary cancer center and/or a community hospice home care/day care provider were recruited for in-depth interviews. The interviews were analyzed using thematic analysis. The identified domains, themes and sub-themes were compared to concepts addressed by items from five existing cancer-specific caregiver QoL instruments. Eighteen female and eight male caregivers aged 28-74 years participated in the study. Twenty-nine QoL themes and 59 sub-themes were identified in six domains, namely physical health, mental health, social health, spiritual health, financial health and daily life. Collectively, but not individually, the content of the five existing instruments adequately cover the physical health domain, social health domain and some themes on mental health domain for the study population. Content gaps were identified in the domains of mental health, spiritual health, daily life and financial health. The present study found culturally and contextually specific themes and sub-themes about positive emotional health, spiritual health and financial health.

Health Educators' Perceptions of a Sexual Health Intervention for Homeless Adolescents

PubMed Central

Rew, Lynn; Rochlen, Aaron B.; Murphey, Christina

2008-01-01

Objective The purpose of this qualitative descriptive study was to explore the perceptions and experiences of health educators in providing a brief, street-based intervention to homeless adolescents. Method Qualitative data were collected via e-mail from a purposive sample of 13 male and female health educators who provided the intervention and analyzed using manifest and latent content analysis techniques. Results Five categories with two or more subcategories were identified in the data and included how the educators' views changed, how they felt homeless youth were similar to and different from other adolescents, positive aspects and challenges of providing the intervention, and suggestions for future interventionists working with this population. Conclusions The health educators' practice was strengthened over the course of providing the intervention through their positive experiences, changes in their perceptions, some of which were biased, and ability to confront the challenges that accompany working with this vulnerable population. Practice Implications Health educators who work with this population should learn about the culture of homeless youth and characteristics of homeless youth that may influence their participation in a sexual health intervention. Moreover, they need to be non-judgmental, practice the intervention, be aware of their biases, and remain flexible. PMID:18343623

A geographical perspective on access to sexual and reproductive health care for women in rural Africa.

PubMed

Yao, Jing; Murray, Alan T; Agadjanian, Victor

2013-11-01

Utilization of sexual and reproductive health (SRH) services can significantly impact health outcomes, such as pregnancy and birth, prenatal and neonatal mortality, maternal morbidity and mortality, and vertical transmission of infectious diseases like HIV/AIDS. It has long been recognized that access to SRH services is essential to positive health outcomes, especially in rural areas of developing countries, where long distances as well as poor transportation conditions, can be potential barriers to health care acquisition. Improving accessibility of health services for target populations is therefore critical for specialized healthcare programs. Thus, understanding and evaluation of current access to health care is crucial. Combining spatial information using geographical information system (GIS) with population survey data, this study details a gravity model-based method to measure and evaluate access to SRH services in rural Mozambique, and analyzes potential geographic access to such services, using family planning as an example. Access is found to be a significant factor in reported behavior, superior to traditional distance-based indicators. Spatial disparities in geographic access among different population groups also appear to exist, likely affecting overall program success. Copyright © 2013 Elsevier Ltd. All rights reserved.

A geographical perspective on access to sexual and reproductive health care for women in rural Africa

PubMed Central

Yao, Jing; Murray, Alan T.; Agadjanian, Victor

2015-01-01

Utilization of sexual and reproductive health (SRH) services can significantly impact health outcomes, such as pregnancy and birth, prenatal and neonatal mortality, maternal morbidity and mortality, and vertical transmission of infectious diseases like HIV/AIDS. It has long been recognized that access to SRH services is essential to positive health outcomes, especially in rural areas of developing countries, where long distances as well as poor transportation conditions, can be potential barriers to health care acquisition. Improving accessibility of health services for target populations is therefore critical for specialized healthcare programs. Thus, understanding and evaluation of current access to health care is crucial. Combining spatial information using geographical information system (GIS) with population survey data, this study details a gravity model-based method to measure and evaluate access to SRH services in rural Mozambique, and analyzes potential geographic access to such services, using family planning as an example. Access is found to be a significant factor in reported behavior, superior to traditional distance-based indicators. Spatial disparities in geographic access among different population groups also appear to exist, likely affecting overall program success. PMID:24034952

Public information officers' and journalists' perceived barriers to providing quality health information.

PubMed

Avery, Elizabeth Johnson; Lariscy, Ruthann Weaver; Sohn, Youngju

2009-06-01

Given the increase in the volume of health and medical news over the past few years, the expanding population of journalists committed to feeding the public's voracious appetite for such information, and the important role of government public health organizations in producing and disseminating public health information, it is surprising that little research exists that explores the relationships among public health entities and health journalists. This article describes and analyzes similarities and differences in perceptions between journalists and information officers in public health agencies on a number of issues to reveal how public information officers and health journalists can work to build a local public health agenda free from the burden of unnecessary or inconsistent barriers. This study reports findings from a study with a 3-stage pretest and 90 interviews with state and local public health information officers and the health journalists who cover public health beats across the United States. Despite some agreement, results indicate wide disparities between these populations' identification of what the barriers to high-quality health care and information are, and a generalized absence of a "shared vision."

[Use of an index of social welfare for health planning at a municipal level].

PubMed

Ochoa-Díaz López, H; Sánchez-Pérez, H J; Martínez-Guzmán, L A

1996-01-01

This paper analyzes the relationship between a living standards index for small areas based on census data and information on morbidity and health care utilization. The information was gathered through a health interview survey of a random sample of 1 238 households from rural areas of Tlaxcala, Mexico. The population from localities with lower living standards showed significantly higher prevalences of morbidity and worse self-reported health status measures, as compared to localities with higher living standards. On the contrary, higher living standards were related with a greater utilization of health services. The approach proved to be useful in discriminating localities and areas of high and low prevalence of morbidity and utilization of health care services, which in turn could be used to identify those areas where needs are greatest. The implications of the results for health planning and resource allocation (based on population health needs and underlying social conditions) at the local level are discussed.

Equity monitoring for social marketing: use of wealth quintiles and the concentration index for decision making in HIV prevention, family planning, and malaria programs.

PubMed

Chakraborty, Nirali M; Firestone, Rebecca; Bellows, Nicole

2013-01-01

The majority of social marketing programs are intended to reach the poor. It is therefore essential that social marketing organizations monitor the health equity of their programs and improve targeting when the poor are not being reached. Current measurement approaches are often insufficient for decision making because they fail to show a program's ability to reach the poor and demonstrate progress over time. Further, effective program equity metrics should be benchmarked against a national reference population and consider exposure, not just health outcomes, to measure direct results of implementation. This study compares two measures of health equity, concentration indices and wealth quintiles, using a defined reference population, and considers benefits of both measures together to inform programmatic decision making. Three datasets from recent cross-sectional behavioral surveys on malaria, HIV, and family planning from Nepal and Burkina Faso were used to calculate concentration indices and wealth quintiles. Each sample was standardized to national wealth distributions based on recent Demographic and Health Surveys. Wealth quintiles were generated and concentration indices calculated for health outcomes and program exposure in each sample. Chi-square and t-tests were used to assess statistical significance of results. Reporting wealth quintiles showed that recipients of Population Services International (PSI) interventions were wealthier than national populations. Both measures indicated that desirable health outcomes were usually concentrated among wealthier populations. Positive and significant concentration indices in all three surveys indicated that wealth and program exposure were correlated; however this relationship was not necessarily linear. In analyzing the equity of modern contraceptive use stratified by exposure to family planning messages in Nepal, the outcome was equitable (concentration index = 0.006, p = 0.68) among the exposed, while the wealthy were more likely to use modern contraceptives (concentration index = 0.071, p < 0.01) among the unexposed. Using wealth quintiles and concentration indices together for equity monitoring improves usability of findings for decision making. Applying both metrics, and analyzing equity of exposure along with health outcomes, provides results that have statistical and programmatic significance. Benchmarking equity data against national data improves generalizability. This approach benefits social marketers and global health implementers to improve strategic decision making and programs' ability to reach the poor.

Equity monitoring for social marketing: use of wealth quintiles and the concentration index for decision making in HIV prevention, family planning, and malaria programs

PubMed Central

2013-01-01

Background The majority of social marketing programs are intended to reach the poor. It is therefore essential that social marketing organizations monitor the health equity of their programs and improve targeting when the poor are not being reached. Current measurement approaches are often insufficient for decision making because they fail to show a program's ability to reach the poor and demonstrate progress over time. Further, effective program equity metrics should be benchmarked against a national reference population and consider exposure, not just health outcomes, to measure direct results of implementation. This study compares two measures of health equity, concentration indices and wealth quintiles, using a defined reference population, and considers benefits of both measures together to inform programmatic decision making. Methods Three datasets from recent cross-sectional behavioral surveys on malaria, HIV, and family planning from Nepal and Burkina Faso were used to calculate concentration indices and wealth quintiles. Each sample was standardized to national wealth distributions based on recent Demographic and Health Surveys. Wealth quintiles were generated and concentration indices calculated for health outcomes and program exposure in each sample. Chi-square and t-tests were used to assess statistical significance of results. Results Reporting wealth quintiles showed that recipients of Population Services International (PSI) interventions were wealthier than national populations. Both measures indicated that desirable health outcomes were usually concentrated among wealthier populations. Positive and significant concentration indices in all three surveys indicated that wealth and program exposure were correlated; however this relationship was not necessarily linear. In analyzing the equity of modern contraceptive use stratified by exposure to family planning messages in Nepal, the outcome was equitable (concentration index = 0.006, p = 0.68) among the exposed, while the wealthy were more likely to use modern contraceptives (concentration index = 0.071, p < 0.01) among the unexposed. Conclusions Using wealth quintiles and concentration indices together for equity monitoring improves usability of findings for decision making. Applying both metrics, and analyzing equity of exposure along with health outcomes, provides results that have statistical and programmatic significance. Benchmarking equity data against national data improves generalizability. This approach benefits social marketers and global health implementers to improve strategic decision making and programs' ability to reach the poor. PMID:23902715

Ethnic differences in the utilization of mental health services in Lombardy (Italy): an epidemiological analysis.

PubMed

Spinogatti, Franco; Civenti, Graziella; Conti, Valentino; Lora, Antonio

2015-01-01

To analyze the differences in mental health service utilization by immigrant and native populations of Lombardy, an Italian region that hosts one-fourth of the immigrants living in Italy. The data are drawn from the regional mental health information system (based on the case register model), which supplies information on the users and mental health activities of the Departments of Mental Health, Lombardy, a region of about 10 million people; 139,775 adult users were treated in mental health services in 2010. Mental health services are used by 11.3 immigrant users out of 1,000 immigrants (with marked differences depending on country of origin) compared with 17.0 native users. Acute mental health services are used more frequently by immigrant patients; the types of intervention provided to immigrants differ from those provided to the native population (mainly as far as psychotherapeutic interventions is concerned), while gender differences are substantial. The number of immigrant users using mental health services has increased notably in recent years, and in Lombardy it has been observed that the use of such services differs from service unit to service unit. This raises the problem of how to increase the cultural awareness of mental health professionals dealing with the mental health needs of the immigrant population. On the whole, immigrants use community mental health services less than the native population; however, immigrants tend to be more frequently admitted to general hospital psychiatric units during acute phases and both the utilization rates and gender differ greatly, depending on the country of origin.

Challenges on the epidemiological and economic burden of diabetes and hypertension in Mexico.

PubMed

Arredondo, Armando; Orozco, Emanuel; Alcalde-Rabanal, Jaqueline; Navarro, Juan; Azar, Alejandra

2018-01-01

OBJECTIVE To analyze the epidemiological and economic burden of the health services demand due to diabetes and hypertension in Mexico. METHODS Evaluation study based on a time series study that had as a universe of study the assured and uninsured population that demands health services from the three main institutions of the Health System in Mexico: The Health Department, the Mexican Institute of Social Security, and Institute of Services and Social Security for State Workers. The financing method was based on instrumentation and consensus techniques for medium case management. In order to estimate the epidemiological changes and financial requirements, a time series of observed cases for diabetes and hypertension 1994-2013 was integrated. Probabilistic models were developed based on the Box-Jenkins technique for the period of 2013-2018 with 95% confidence intervals and p < 0.05. RESULTS Comparing results from 2013 versus 2018, in the five regions, different incremental trends of 14%-17% in epidemiological changes and 58%-66% in the economic burden for both diseases were observed. CONCLUSIONS If the risk factors and the different models of care remained as they currently are in the three institutions analyzed, the financial consequences would be of greater impact for the Mexican Institute of Social Security, following in order of importance the Institute of Services and Social Security for State Workers and lastly the Health Department. The financial needs for both diseases will represent approximately 13%-15% of the total budget allocated to the uninsured population and 15%-17% for the population insured depending on the region.

Challenges on the epidemiological and economic burden of diabetes and hypertension in Mexico

PubMed Central

Arredondo, Armando; Orozco, Emanuel; Alcalde-Rabanal, Jaqueline; Navarro, Juan; Azar, Alejandra

2018-01-01

ABSTRACT OBJECTIVE To analyze the epidemiological and economic burden of the health services demand due to diabetes and hypertension in Mexico. METHODS Evaluation study based on a time series study that had as a universe of study the assured and uninsured population that demands health services from the three main institutions of the Health System in Mexico: The Health Department, the Mexican Institute of Social Security, and Institute of Services and Social Security for State Workers. The financing method was based on instrumentation and consensus techniques for medium case management. In order to estimate the epidemiological changes and financial requirements, a time series of observed cases for diabetes and hypertension 1994–2013 was integrated. Probabilistic models were developed based on the Box-Jenkins technique for the period of 2013–2018 with 95% confidence intervals and p < 0.05. RESULTS Comparing results from 2013 versus 2018, in the five regions, different incremental trends of 14%–17% in epidemiological changes and 58%-66% in the economic burden for both diseases were observed. CONCLUSIONS If the risk factors and the different models of care remained as they currently are in the three institutions analyzed, the financial consequences would be of greater impact for the Mexican Institute of Social Security, following in order of importance the Institute of Services and Social Security for State Workers and lastly the Health Department. The financial needs for both diseases will represent approximately 13%–15% of the total budget allocated to the uninsured population and 15%–17% for the population insured depending on the region. PMID:29489993

Population health diagnosis with an ecohealth approach

PubMed Central

Arenas-Monreal, Luz; Cortez-Lugo, Marlene; Parada-Toro, Irene; Pacheco-Magaña, Lilian E; Magaña-Valladares, Laura

2015-01-01

OBJECTIVE To analyze the characteristics of health diagnosis according to the ecohealth approach in rural and urban communities in Mexico. METHODS Health diagnosis were conducted in La Nopalera, from December 2007 to October 2008, and in Atlihuayan, from December 2010 to October 2011. The research was based on three principles of the ecohealth approach: transdisciplinarity, community participation, gender and equity. To collect information, a joint methodology and several techniques were used to stimulate the participation of inhabitants. The diagnostic exercise was carried out in five phases that went from collecting information to prioritization of problems. RESULTS The constitution of the transdisciplinary team, as well as the participation of the population and the principle of gender/equity were differentials between the communities. In the rural community, the active participation of inhabitants and authorities was achieved and the principles of transdisciplinarity and gender/equity were incorporated. CONCLUSIONS With all the difficulties that entails the boost in participation, the incorporation of gender/equity and transdisciplinarity in health diagnosis allowed a holistic public health approach closer to the needs of the population. PMID:26538099

Stable or improved health status in the population 65 years and older in Stockholm, Sweden - an 8-year follow-up of self-reported health items.

PubMed

Modig, Karin; Virtanen, Suvi; Ahlbom, Anders; Agahi, Neda

2016-07-01

Previous studies have reached different conclusions about whether health is improving in the ageing population. More studies with narrow age groups analyzed separately for men and women will contribute to the literature. To describe trends in self-reported indicators of health and health-related quality of life between 2002 and 2010, focusing on differences between gender and age groups. A population-based survey of individuals 65+ in the Stockholm County was used. Prevalence of health problems increased with age both among men and women. Men generally reported having no health problems to a larger extent than women, but the proportions reporting severe problems were similar. The larger picture is one of stability in health-related quality of life, even if several items developed for the better, especially among women. While the proportions reporting no health/functional problems increased for many items, the proportions reporting severe problems remained unchanged among men and improved only for two items among women. CONCLUSIONS OVERALL, IMPROVEMENTS WERE SEEN IN MANY OF THE HEALTH-RELATED QUALITY OF LIFE ITEMS AS WELL AS FOR SELF-RATED HEALTH AMONG WOMEN THE PROPORTIONS REPORTING LONG-TERM ILLNESS OR PERSISTENT HEALTH PROBLEMS INCREASED, BUT FEWER SEEM TO BE LIMITED IN THEIR DAILY ACTIVITIES BY THESE PROBLEMS THE STABLE PROPORTIONS OF POOR SELF-RATED HEALTH INDICATES THAT WHILE HEALTH AND FUNCTIONING SEEM TO BE IMPROVING FOR THE MAJORITY OF THE OLDER POPULATION, SOME GROUPS MAY BE LAGGING BEHIND FUTURE STUDIES SHOULD PAY ATTENTION TO CHANGES BOTH IN THE UPPER AND LOWER ENDS OF THE HEALTH SPECTRUM. © 2016 the Nordic Societies of Public Health.

HEALTH SURVEY INCLUDING SELECTED BLOOD PARAMETERS IN THE AFRICAN SLENDER SNOUTED CROCODILE (MECISTOPS CATAPHRACTUS) AT THE ABIDJAN ZOO IN CÔTE D'IVOIRE.

PubMed

Bradford, Carol; Eschenbrenner, Matt

2017-06-01

The Zoo National d'Abidjan (Abidjan Zoo) in Côte d'Ivoire, West Africa, holds the world's largest captive population of African slender-snouted crocodiles (Mecistops cataphractus, formerly Crocodylus cataphractus), at 36 adults, 16 yearlings, and 23 hatchlings. Twelve yearling and 12 adult slender-snouted crocodiles at the Abidjan Zoo were restrained for physical exam, body condition scoring, and venipuncture in September 2015. Blood samples collected from the supravertebral venous sinus were analyzed using a handheld blood analyzer (Abaxis® I-stat, Abaxis, Inc., Union City, California 94587, USA) with Chem8+ cartridges (CLIAwaived, Inc., San Diego, California 92130, USA). The adult crocodiles appeared in good general health and demonstrated blood values similar to those of other reptiles. The yearlings had low, ionized calcium values and low hematocrit and hemoglobin levels compared with the adult crocodiles and to other crocodile reference ranges. These findings may dramatically improve the health of the crocodiles and help to ensure a thriving captive population of this critically endangered species.

Geospatial Modeling of Asthma Population in Relation to Air Pollution

NASA Technical Reports Server (NTRS)

Kethireddy, Swatantra R.; Tchounwou, Paul B.; Young, John H.; Luvall, Jeffrey C.; Alhamdan, Mohammad

2013-01-01

Current observations indicate that asthma is growing every year in the United States, specific reasons for this are not well understood. This study stems from an ongoing research effort to investigate the spatio-temporal behavior of asthma and its relatedness to air pollution. The association between environmental variables such as air quality and asthma related health issues over Mississippi State are investigated using Geographic Information Systems (GIS) tools and applications. Health data concerning asthma obtained from Mississippi State Department of Health (MSDH) for 9-year period of 2003-2011, and data of air pollutant concentrations (PM2.5) collected from USEPA web resources, and are analyzed geospatially to establish the impacts of air quality on human health specifically related to asthma. Disease mapping using geospatial techniques provides valuable insights into the spatial nature, variability, and association of asthma to air pollution. Asthma patient hospitalization data of Mississippi has been analyzed and mapped using quantitative Choropleth techniques in ArcGIS. Patients have been geocoded to their respective zip codes. Potential air pollutant sources of Interstate highways, Industries, and other land use data have been integrated in common geospatial platform to understand their adverse contribution on human health. Existing hospitals and emergency clinics are being injected into analysis to further understand their proximity and easy access to patient locations. At the current level of analysis and understanding, spatial distribution of Asthma is observed in the populations of Zip code regions in gulf coast, along the interstates of south, and in counties of Northeast Mississippi. It is also found that asthma is prevalent in most of the urban population. This GIS based project would be useful to make health risk assessment and provide information support to the administrators and decision makers for establishing satellite clinics in future.

Health insurance drop-out among adult population: findings from a study in a Health and demographic surveillance system in Northern Vietnam 2006-2013.

PubMed

Minh, Hoang Van; Anh, Tran Quynh; Nga, Nguyen Thi Thuy

2016-01-01

The coverage of health insurance as measured by enrollment rates has increased significantly in Vietnam. However, maintaining health insurance to the some groups such as the farmer, the borderline poor and informal workers, etc. has been very challenging. This paper examines the situation of health insurance drop-out among the adult population in sub-rural areas of Northern Vietnam from 2006 to 2013, and analyzes several socio-economic correlates of the health insurance drop-out situation. Data used in this paper were obtained from Health and Demographic Surveillance System located in Chi Linh district, an urbanizing area, in a northern province of Vietnam. Descriptive analyses were used to describe the level and distribution of the health insurance drop-out status. Multiple logistic regressions were used to assess associations between the health insurance drop-out status and the independent variables. A total of 32 561 adults were investigated. We found that the cumulative percentage of health insurance drop-out among the study participants was 21.2%. Health insurance drop-out rates were higher among younger age groups, people with lower education, and those who worked as small trader and other informal jobs, and belonged to the non-poor households. Given the findings, further attention toward health insurance among these special populations is needed.

[Discourses and practices concerning the social participation process in health education activities: community mobilization in the PCDEN/PE. Programa de Controle das Doenças Endêmicas do Nordeste/Pernambuco].

PubMed

Acioli, M D; de Carvalho, E F

1998-01-01

This study analyzes and compares several social participation concepts in health education processes to practical experiences with schistosomiasis prevention measures under the Northeast Endemic Disease Control Program (Brazilian Ministry of Health/World Bank, 1987). Using qualitative methods, institutional documents and discourses were interpreted (Sucam, FNS, and Ministry of Health). A field study was also performed (using interviews with community-based health agents and the general population) in the Zona da Mata region of Pernambuco (a historically endemic area for schistosomiasis), focused in the county of Amaraji. Comparing discourses and educational practices, we found factors that explain respective points of convergence and divergence, as well as elements linked to the social and historical process of the target population which systematically limit the efficacy of such educational measures.

Planning of public healthcare facility using a location allocation modelling: A case study

NASA Astrophysics Data System (ADS)

Shariff, S. Sarifah Radiah; Moin, Noor Hasnah; Omar, Mohd

2014-09-01

Finding the correct location of any facility and determining the demands which are to be assigned to it is very crucial in public health service. This is to ensure that the public gain maximum benefits. This article analyzes the previous location decisions of public primary healthcare (PHC) facilities in the district of Kuala Langat, Malaysia. With total population of 220214 (in 2010), the PHC in the district is currently served by 28 facilities. The percentages of total population covered (in 2007) within the maximum allowable distance of 3km and 5km are 69.7 percent and 77.8 percent respectively. This is very low compared to the Malaysian National Health Policy of Health for All or 100 percent coverage. The determination of health facility location should be planned carefully to further increase effective primary health service to the nation that is required for economic sustainability.

Emerging Infections Program Efforts to Address Health Equity

PubMed Central

Vugia, Duc J.; Bennett, Nancy M.; Moore, Matthew R.

2015-01-01

The Emerging Infections Program (EIP), a collaboration between (currently) 10 state health departments, their academic center partners, and the Centers for Disease Control and Prevention, was established in 1995. The EIP performs active, population-based surveillance for important infectious diseases, addresses new problems as they arise, emphasizes projects that lead to prevention, and develops and evaluates public health practices. The EIP has increasingly addressed the health equity challenges posed by Healthy People 2020. These challenges include objectives to increase the proportion of Healthy People–specified conditions for which national data are available by race/ethnicity and socioeconomic status as a step toward first recognizing and subsequently eliminating health inequities. EIP has made substantial progress in moving from an initial focus on monitoring social determinants exclusively through collecting and analyzing data by race/ethnicity to identifying and piloting ways to conduct population-based surveillance by using area-based socioeconomic status measures. PMID:26291875

[In times of racialization: the case of the 'health of the black population' in Brazil].

PubMed

Maio, Marcos Chor; Monteiro, Simone

2005-01-01

The article analyzes initiatives aimed at creating a field of reflection and political intervention called the 'health of the black population,' which occurred between 1996 and 2004, that is, under the administration of Fernando Henrique Cardoso and part of Luis Inácio Lula da Silva's administration. During this period, the process of discussing and enacting affirmative action policies in Brazil gained greater visibility, especially following the UN-sponsored Third World Conference on Racism, Racial Discrimination, Xenophobia, and Related Intolerance (Durban, South Africa, September, 2001). The article describes the emergence of a proposal of compensatory policy within the Brazilian public health system. It then addresses the contemporary debate on race and health, especially the U.S. biomedical literature, and explores how this discussion has been appropriated by agencies and agents concerned with drawing up a 'racial policy' for the public health sector in Brazil.

Evaluating the Impact of an Accountable Care Organization on Population Health: The Quasi-Experimental Design of the German Gesundes Kinzigtal.

PubMed

Pimperl, Alexander; Schulte, Timo; Mühlbacher, Axel; Rosenmöller, Magdalena; Busse, Reinhard; Groene, Oliver; Rodriguez, Hector P; Hildebrandt, Helmut

2017-06-01

A central goal of accountable care organizations (ACOs) is to improve the health of their accountable population. No evidence currently links ACO development to improved population health. A major challenge to establishing the evidence base for the impact of ACOs on population health is the absence of a theoretically grounded, robust, operationally feasible, and meaningful research design. The authors present an evaluation study design, provide an empirical example, and discuss considerations for generating the evidence base for ACO implementation. A quasi-experimental study design using propensity score matching in combination with small-scale exact matching is implemented. Outcome indicators based on claims data were constructed and analyzed. Population health is measured by using a range of mortality indicators: mortality ratio, age at time of death, years of potential life lost/gained, and survival time. The application is assessed using longitudinal data from Gesundes Kinzigtal, one of the leading population-based ACOs in Germany. The proposed matching approach resulted in a balanced control of observable differences between the intervention (ACO) and control groups. The mortality indicators used indicate positive results. For example, 635.6 fewer years of potential life lost (2005.8 vs. 2641.4; t-test: sig. P < 0.05*) in the ACO intervention group (n = 5411) attributable to the ACO, also after controlling for a potential (indirect) immortal time bias by excluding the first half year after enrollment from the outcome measurement. This empirical example of the impact of a German ACO on population health can be extended to the evaluation of ACOs and other integrated delivery models of care.

Corruption and population health outcomes: an analysis of data from 133 countries using structural equation modeling.

PubMed

Factor, Roni; Kang, Minah

2015-09-01

The current study aims to develop a theoretical framework for understanding the antecedents of corruption and the effects of corruption on various health indicators. Using structural equation models, we analyzed a multinational dataset of 133 countries that included three main groups of variables--antecedents of corruption, corruption measures, and health indicators. Controlling for various factors, our results suggest that corruption rises as GDP per capita falls and as the regime becomes more autocratic. Higher corruption is associated with lower levels of health expenditure as a percentage of GDP per capita, and with poorer health outcomes. Countries with higher GDP per capita and better education for women have better health outcomes regardless of health expenditures and regime type. Our results suggest that there is no direct relationship between health expenditures and health outcomes after controlling for the other factors in the model. Our study enhances our understanding of the conceptual and theoretical links between corruption and health outcomes in a population, including factors that may mediate how corruption can affect health outcomes.

Health-Related Quality of Life of the General German Population in 2015: Results from the EQ-5D-5L.

PubMed

Huber, Manuel B; Felix, Julia; Vogelmann, Martin; Leidl, Reiner

2017-04-16

The EQ-5D-5L is a widely used generic instrument to measure health-related quality of life. This study evaluates health perception in a representative sample of the general German population from 2015. To compare results over time, a component analysis technique was used that separates changes in the description and valuation of health states. The whole sample and also subgroups, stratified by sociodemographic parameters as well as disease affliction, were analyzed. In total, 2040 questionnaires (48.4% male, mean age 47.3 year) were included. The dimension with the lowest number of reported problems was self-care (93.0% without problems), and the dimension with the highest proportion of impairment was pain/discomfort (71.2% without problems). Some 64.3% of the study population were identified as problem-free. The visual analog scale (VAS) mean for all participants was 85.1. Low education was connected with significantly lower VAS scores, but the effect was small. Depression, heart disease, and diabetes had a strong significant negative effect on reported VAS means. Results were slightly better than those in a similar 2012 survey; the most important driver was the increase in the share of the study population that reported to be problem-free. In international comparisons, health perception of the general German population is relatively high and, compared with previous German studies, fairly stable over recent years. Elderly and sick people continue to report significant reductions in perceived health states.

Supporting global health goals with information and communications technology

PubMed Central

Boman, Magnus; Kruse, Erik

2017-01-01

ABSTRACT The objective of this study is to critically assess the possible roles of information and communications technology (ICT) in supporting global health goals. This is done by considering privilege and connectibility. In short, ICT can contribute by providing health information via four different kinds of access, each with its own history and prospective future. All four are analyzed here, in two perspectives: business-as-usual and disruptive. Health data analytics is difficult since the digital representation of past, current, and future health information is lacking. The flow of analytics that may prove beneficial to the individual and not just meet abstract population-level goals or ambitions is analyzed in detail. Sensemaking is also needed, to meet the minimum requirement of making prospective future services understandable to policymakers. Drivers as well as barriers for areas in which policy decisions have the potential to drive positive developments for meeting the Sustainable Development Goals are identified. PMID:28838300

Supporting global health goals with information and communications technology.

PubMed

Boman, Magnus; Kruse, Erik

2017-06-01

The objective of this study is to critically assess the possible roles of information and communications technology (ICT) in supporting global health goals. This is done by considering privilege and connectibility. In short, ICT can contribute by providing health information via four different kinds of access, each with its own history and prospective future. All four are analyzed here, in two perspectives: business-as-usual and disruptive. Health data analytics is difficult since the digital representation of past, current, and future health information is lacking. The flow of analytics that may prove beneficial to the individual and not just meet abstract population-level goals or ambitions is analyzed in detail. Sensemaking is also needed, to meet the minimum requirement of making prospective future services understandable to policymakers. Drivers as well as barriers for areas in which policy decisions have the potential to drive positive developments for meeting the Sustainable Development Goals are identified.

Health related quality of life in patients with neuroendocrine tumors compared with the general Norwegian population.

PubMed

Haugland, Trude; Vatn, Morten H; Veenstra, Marijke; Wahl, Astrid Klopstad; Natvig, Gerd Karin

2009-08-01

Health related quality of life (HRQoL) was characterized among patients with neuroendocrine tumor (NET) and compared with the general Norwegian population. A cross sectional, comparative design was chosen, and the samples comprised 196 NET patients and 5,258 individuals from the general Norwegian population. We used Chi-square cross tab calculations to evaluate sociodemographic characteristics, T-tests for independent samples and Analysis of Variance (ANOVA) in order to compare HRQoL (SF-36) scores across a range of background variables. Furthermore, T-tests were used to analyze differences in HRQoL scores between the samples. NET patients demonstrated significantly lower on all HRQoL subscales when compared with the general population with the lowest values on general health, physical limitation and vitality. Individuals above 70 years reported lower scores on physical functioning and physical limitations compared with those who were younger. Individuals with higher levels of education reported increased physical functioning compared with those with less education and full-time or part-time workers described higher physical functioning and less physical limitations compared with those who were retired. All SF-36 HRQoL scores were significantly lower among the NET patients when compared with the general population. Assistance from health personnel to NET patients should focus on those domains.

Demographic and health situation of children in conditions of economic destabilization in the Ukraine.

PubMed

Pantyley, Viktoriya

2014-01-01

In new conditions of socio-economic development in the Ukraine, the health of the population of children is considered as the most reliable indicator of socio-economic development of the country. The primary goal of the study was analysis of the effect of contemporary socio-economic transformations, their scope, and strength of effect on the demographic and social situation of children in various regions of the Ukraine. The methodological objectives of the study were as follows: development of a synthetic measure of the state of health of the population of children, based on the Hellwig's method, and selection of districts in the Ukraine according to the present health-demographic situation of children. The study was based on statistical data from the State Statistics Service of Ukraine, Centre of Medical Statistics in Kiev, Ukrainian Ministry of Defence, as well as Ministry of Education and Science, Youth and Sports of Ukraine. The following research methods were used: analysis of literature and Internet sources, selection and analysis of statistical materials, cartographic and statistical methods. Basic indices of the demographic and health situation of the population of children were analyzed, as well as factors of a socio-economic nature which affect this situation. A set of variables was developed for the synthetic evaluation of the state of health of the population of children. The typology of the Ukrainian districts was performed according to the state of health of the child population, based on the Hellwig's taxonomic method. Deterioration was observed of selected quality parameters, as well as a change in the strength and directions of effect of factors of organizational-institutional, socioeconomic, historical and cultural nature on the population of children potential.

The impact of economic crises on social inequalities in health: what do we know so far?

PubMed

Bacigalupe, Amaia; Escolar-Pujolar, Antonio

2014-07-25

Since 2008, Western countries are going through a deep economic crisis whose health impacts seem to be fundamentally counter-cyclical: when economic conditions worsen, so does health, and mortality tends to rise. While a growing number of studies have presented evidence on the effect of crises on the average population health, a largely neglected aspect of research is the impact of crises and the related political responses on social inequalities in health, even if the negative consequences of the crises are primarily borne by the most disadvantaged populations. This commentary will reflect on the results of the studies that have analyzed the effect of economic crises on social inequalities in health up to 2013. With some exceptions, the studies show an increase in health inequalities during crises, especially during the Southeast Asian and Japanese crises and the Soviet Union crisis, although it is not always evident for both sexes or all health or socioeconomic variables. In the Nordic countries during the nineties, a clear worsening of health equity did not occur. Results about the impacts of the current economic recession on health equity are still inconsistent. Some of the factors that could explain this variability in results are the role of welfare state policies, the diversity of time periods used in the analyses, the heterogeneity of socioeconomic and health variables considered, the changes in the socioeconomic profile of the groups under comparison in times of crises, and the type of measures used to analyze the magnitude of social inequalities in health. Social epidemiology should further collaborate with other disciplines to help produce more accurate and useful evidence about the relationship between crises and health equity.

[Influence of work conditions on health of working population in Rostov region].

PubMed

Piktushanskaia, T E; Bykovskaia, T Iu

2011-01-01

The authors analyzed work conditions and occupational morbidity among working population of Rostov region. Miners and agricultural workers appeared to lead in exposure to occupational hazards, but occupational morbidity among the miners is the highest, but that among the agricultural workers was proved to be the lowest. A conclusion covered necessity to improve periodic medical examination system for workers exposed to occupational hazards, including the agricultural workers.

The relationship between changes in employment status and mortality risk based on the Korea Labor and Income Panel Study (2003-2008).

PubMed

Kim, Ji Man; Son, Nak-Hoon; Park, Eun-Cheol; Nam, Chung Mo; Kim, Tae Hyun; Cho, Woo-Hyun

2015-03-01

The aim of this study was to analyze the relationship between the mortality rate and changes in employment status. This study used mortality data from the Korean Labor and Income Panel Study. To analyze the relationship between the mortality rate and changes in employment status, the population was classified into employed, unemployed, or economically inactive. Demographic and socioeconomic variables such as gender, age, educational level, annual household income, marital status, and self-rated health status were controlled. In this study, the generalized estimating equations were used to analyze the relationship between the morality rate and the changes in employment status. The mortality rate was higher (odds ratio = 4.31) among the population that experienced a change in economic status from employed to unemployed than those who maintained employment. The mortality rate for the population who became unemployed or economically inactive was higher (odds ratio = 5.05) in cases of death by disease. © 2013 APJPH.

Health Indicators and Geographic Mobility among Young Rural-to-Urban Migrants in China.

PubMed

Li, Xiaoming; Stanton, Bonita; Chen, Xinguang; Hong, Yan; Fang, Xiaoyi; Lin, Danhua; Mao, Rong; Wang, Jin

2006-01-01

The process of rural-to-urban migration in China is accelerating with increased modernization and industrialization. To address the issues of health outcomes and geographic mobility among this population, data from 4,208 rural-to-urban migrants in two major metropolitans of China were analyzed. Results indicate that average duration of migration was 4.3 years, with younger migrants being more mobile than their older counterparts. After controlling for possible confounders, increases in mobility were associated with unstable living arrangements, substandard employment conditions, suboptimal health status, inferior health-seeking behaviour, elevated level of substance use, depressive symptoms and expression of dissatisfaction with life and work. The findings in the present study underscore the need for improved living and employment conditions and increased healthcare services available to rural-to-urban migratory population.

Tracking Biocultural Pathways to Health Disparities: The Value of Biomarkers

PubMed Central

Worthman, Carol M.; Costello, E. Jane

2009-01-01

Background Cultural factors and biomarkers are emerging emphases in social epidemiology that readily ally with human biology and anthropology. Persistent health challenges and disparities have established biocultural roots, and environment plays an integral role in physical development and function that form the bases of population health. Biomarkers have proven to be valuable tools for investigating biocultural bases of health disparities. Aims We apply recent insights from biology to consider how culture gets under the skin and evaluate the construct of embodiment. We analyze contrasting biomarker models and applications, and propose an integrated model for biomarkers. Three examples from the Great Smoky Mountains Study (GSMS) illustrate these points. Subjects and methods The longitudinal developmental epidemiological GSMS comprises a population-based sample of 1420 children with repeated measures including mental and physical health, life events, household conditions, and biomarkers for pubertal development and allostatic load. Results Analyses using biomarkers resolved competing explanations for links between puberty and depression, identified gender differences in stress at puberty, and revealed interactive effects of birthweight and postnatal adversity on risk for depression at puberty in girls. Conclusion An integrated biomarker model can both enrich epidemiology and illuminate biocultural pathways in population health. PMID:19381986

The health care reform in Mexico: before and after the 1985 earthquakes.

PubMed Central

Soberón, G; Frenk, J; Sepúlveda, J

1986-01-01

The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary. PMID:3706595

The health care reform in Mexico: before and after the 1985 earthquakes.

PubMed

Soberón, G; Frenk, J; Sepúlveda, J

1986-06-01

The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary.

[Use of health services by a population of 60-year olds and older in Mexico].

PubMed

Borges-Yáñez, S A; Gómez-Dantés, H

1998-01-01

To describe the sociodemographic characteristics and determinants of health services utilization by the Mexican population of 60 years of age or more. Information obtained from the National Health Survey II (ENSA-II) allowed analysis of 4,628 elderly people. Prevalence of chronic diseases was analyzed and the determinants of individuals who had used the health services in the two weeks prior to the interview. The chronic diseases most frequently reported were: hypertension, diabetes and heart disease. The utilization and hospitalization rates of that age group were 11.4 and 5.5%, respectively. The services most frequently used were: the private physician, social security (IMSS, ISSSTE) welfare services (Ministry of Health--SSA- and IMSS-Solidaridad). Interestingly, 25 to 45% of social security insurance holders did not use the services, instead they consulted a private physician. The most important explanatory variables for health services utilization were: the perceived illness, not having worked for the previous week and being a social security insurance holder. Gender, area of residence and level of education were not significant in the explanation of health services utilization. This study demonstrates the need to strengthen preventive and support programs for the elderly population, since they only demand health services when they feel sick.

A population-based study on health-related quality of life among urban community residents in Shenyang, Northeast of China.

PubMed

Song, Tian; Ding, Yan-wei; Sun, Yan; He, Yi-Ni; Qi, Dian-Jun; Wu, Ying; Wu, Bin; Lang, Lang; Yu, Kai; Zhao, Xin; Zhu, Liang-liang; Wang, Shuang; Yu, Xiao-Song

2015-09-19

Due to the rising standard of living environment and advances in public health and medical care in China, it has been a tendency in recent years that health-related quality of life (HRQoL) has been increasingly acknowledged in community health management. However, large-scale population-based study on evaluating HQRoL in northeast of China was not conducted. This article aims to investigate the HRQoL in community residents in Northeast China and explore the associated factors. Stratified multiple-stage sampling method was used in the cross-sectional survey to investigate HRQoL of community residents in northeast of China. Univariate analysis and multiple linear regressions were used to analyze the factors associated to HRQoL of the community residents. The results were confirmed that HRQoL in general population was well performed for the first time in northeast of China in a large scale population. Community residents had better mental health than physical health. The factors influencing HRQoL included gender, age, educational level, marital status, ethnic group, chronic disease status, having breakfast frequency weekly and sleep quality. However, drinking and smoking habits did not affect residents' HRQoL. In this study, the result of the large-scale survey was satisfactory in northeast of China, providing HRQoL status of community residents. Policies on specific health management in community public health would emphasize on lifestyle behaviors especially eating habits in order to improving HRQoL.

The financial implications of employer-sponsored health insurance.

PubMed

Natvig, Deborah; Tolbert, Sam

2005-01-01

The purpose of this study was to analyze utilization and costs of employer-sponsored health insurance in select businesses in a rural community in South Carolina. The study was conducted under the auspices of the HR Roundtable of the local Chamber of Commerce, composed of human resources directors from the larger area businesses. Twenty one companies were invited to participate and eight submitted information that was sufficiently complete to analyze. The participating companies employed 6,265 people, of which 5,712 were insured. The data represents a total of 13,057 covered lives. Although the findings cannot be generalized to a broader population, the descriptive data was sufficient to generate a discussion about health care issues for this community and for the group to make preliminary recommendations for collaborative work that may affect the costs of health care coverage for this community.

Health indicators 1991.

PubMed

Dawson, N

1991-01-01

This is the second edition of a database developed by the Canadian Centre for Health Information (CCHI). It features 49 health indicators, under one cover containing the most recent data available from a variety of national surveys. This information may be used to establish health goals for the population and to offer objective measures of their success. The database can be accessed through CANSIM, Statistics Canada's socio-economic electronic database and retrieval system, or through a personal computer package which enables the user to retrieve and analyze the 1.2 million data points in the system.

Individual and contextual factors associated to the self-perception of oral health in Brazilian adults.

PubMed

Silva, Janmille Valdivino da; Oliveira, Angelo Giuseppe Roncalli da Costa

2018-04-09

To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the "oral health perception" outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. Biological factors, individual and contextual social determinants were associate synergistically with the population's perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.

Transforming Public Health Systems: Using Data to Drive Organizational Capacity for Quality Improvement and Efficiency

PubMed Central

Steinwachs, Donald M.

2014-01-01

Introduction: This paper examines the organization, services, and priorities of public health agencies and their capacity to be learning public health systems (LPHS). An LPHS uses data to measure population health and health risks and to evaluate its services and programs, and then integrates its own research with advances in scientific knowledge to innovate and improve its efficiency and effectiveness. Public Health Agencies and Impact for LPHS: Public health agencies’ (PHA) organizational characteristics vary across states, as does their funding per capita. Variations in organization, services provided, and expenditures per capita may reflect variations in community needs or may be associated with unmet needs. The status of legal statutes defining responsibilities and authorities and their relationships to other public and private agencies also vary. Little information is available on the efficiency and effectiveness of state and local PHAs, in part due to a lack of information infrastructure to capture uniform data on services provided. There are almost no data on the relationship of quality of services, staff performance, and resources to population health outcomes. By building a capacity to collect and analyze data on population health within and across communities, and by becoming a continuous learning PHA, the allocation of resources can more closely match population health needs and improve health outcomes. Accreditation of every PHA is an important first step toward becoming a learning PHA. Conclusions: Public Health Services and Systems Research (PHSSR) is beginning to shed light on some of these issues, particularly by investigating variation across PHAs. As this emerging discipline grows, there is a need to enhance the collection and use of data in support of building organized, effective, and efficient LPHSs with the PHA capacity to continually improve the public’s health. PMID:25995990

Experimental design and quantitative analysis of microbial community multiomics.

PubMed

Mallick, Himel; Ma, Siyuan; Franzosa, Eric A; Vatanen, Tommi; Morgan, Xochitl C; Huttenhower, Curtis

2017-11-30

Studies of the microbiome have become increasingly sophisticated, and multiple sequence-based, molecular methods as well as culture-based methods exist for population-scale microbiome profiles. To link the resulting host and microbial data types to human health, several experimental design considerations, data analysis challenges, and statistical epidemiological approaches must be addressed. Here, we survey current best practices for experimental design in microbiome molecular epidemiology, including technologies for generating, analyzing, and integrating microbiome multiomics data. We highlight studies that have identified molecular bioactives that influence human health, and we suggest steps for scaling translational microbiome research to high-throughput target discovery across large populations.

[Health and disability in the elderly: old paradigms and future prospects].

PubMed

Liotta, Giuseppe; Mancinelli, Sandro; Scarcella, Paola; Pompei, Daniela; Mastromattei, Antonio; Cutini, Rita; Marazzi, Maria Cristina; Buonomo, Ersilia; Palombi, Leonardo; Gilardi, Francesco

2012-01-01

The projections regarding the ageing of the Italian population are cause for great concern; however, the ageing scenario may actually be interpreted in a more optimistic way. Theories formulated in the 80s envisaging a decline of mortality, morbidity and disability in the elderly are now confirmed and prefigure an unexpected decrease in disability rates in the elderly population. The aim of this review is to attempt to explain the reasons for this by analyzing the role played by the various determinants of health, in particular social isolation, which are likely to play an important role in the future as well.

[Terrorism and mental health (problem's scale, population tolerance, management of care)].

PubMed

Iastrebov, V S

2004-01-01

The consequences of terrorist threat and terrorist acts for mental health of the individual, groups of individuals and community in general are analyzed. Mental disorders emerging in the victims of terrorism is described. The problem of terrorist threats use as a psychic weapon is discussed. Tolerance of population to terrorism can be divided into two types--psychophysiological and socio-psychological. The ways for elevating tolerability to terrorist threat and terrorist acts are suggested. Help in the centers of terrorist act must be of the complex character, being provided by different specialists including psychologists and psychiatrists. The importance of state structures and community support in this work is emphasized.

The demographic changes of menopausal and geripausal women in Korea.

PubMed

Kim, Mi Young; Im, Sun-Wha; Park, Hyoung Moo

2015-02-01

Osteoporosis and resultant fracture seems to be the most common skeletal disease, affecting female exclusively. Osteoporosis increases exponentially with menopause and age. Therefore the demographic data seems to be the most important & fundamental for the study of osteoporosis epidemiology. This study was to analyzed population projection from 1960 to 2060. We evaluated the demographic change of female, postmenopausal and elderly geripausal population in South Korea using Korean statistical information service database as basic fundamental data for osteoporosis epidemiology. According to population projection, the total female population will be exceeds the total male population since 2015 and maximize up to 2030. In 2030, nearly half of female will become postmenopausal and one fourth of women elderly will be geripausal. Of total female population in 2060, the proportion of postmenopausal women will be increased up to 59.8%. According to population projection in South Korea, six of ten women in 2060 will be postmenopausal and seven of ten postmenopausal women geripausal. As expected to increase proportion of elderly women, dramatic rise of osteoporosis and osteoporotic fracture also expected. Health providers pay more attention to postmenopausal and geripausal women health care.

TB in Vulnerable Populations

PubMed Central

Ugarte-Gil, César; Caro, Godofredo; Aylas, Rula; Castro, César; Lema, Claudia

2016-01-01

Abstract This article analyzes the factors associated with vulnerability of the Ashaninka, the most populous indigenous Peruvian Amazonian people, to tuberculosis (TB). By applying a human rights-based analytical framework that assesses public policy against human rights standards and principles, and by offering a step-by-step framework for a full assessment of compliance, it provides evidence of the relationship between the incidence of TB among the Ashaninka and Peru’s poor level of compliance with its human rights obligations. The article argues that one of the main reasons for the historical vulnerability of the Ashaninka to diseases such as TB is a lack of political will on the part of the national government to increase public health spending, ensure that resources reach the most vulnerable population, and adopt and invest in a culturally appropriate health system. PMID:27780999

Caloric and Selected Nutrient Values for Persons 1-74 Years of Age: First Health and Nutrition Examination Survey, United States, 1971-1974. Vital and Health Statistics, Data from the National Health Survey, Series ll, Number 209.

ERIC Educational Resources Information Center

Abraham, Sidney; And Others

This report presents data on dietary intake obtained to assess the nutritional status of the United States population, aged 1-74 years. Age, sex, race, and income level differences in dietary intake are among the variables considered. Data are analyzed for certain groups at high risk of malnutrition (e.g., the poor, preschool children, women of…

Health Resources in a 200,000 Urban Indian Population Argues the Need for a Policy on Private Sector Health Services

PubMed Central

Furtado, Kheya Melo; Kar, Anita

2014-01-01

Background: There are limited primary data on the number of urban health care providers in private practice in developing countries like India. These data are needed to construct and test models that measure the efficacy of public stewardship of private sector health services. Objective: This study reports the number and characteristics of health resources in a 200 000 urban population in Pune. Materials and Methods: Data on health providers were collected by walking through the 15.46 sq km study area. Enumerated data were compared with existing data sources. Mapping was carried out using a Global Positioning System device. Metrics and characteristics of health resources were analyzed using ArcGIS 10.0 and Statistical Package for the Social Sciences, Version 16.0 software. Results: Private sector health facilities constituted the majority (424/426, 99.5%) of health care services. Official data sources were only 39% complete. Doctor to population ratios were 2.8 and 0.03 per 1000 persons respectively in the private and public sector, and the nurse to doctor ratio was 0.24 and 0.71, respectively. There was an uneven distribution of private sector health services across the area (2-118 clinics per square kilometre). Bed strength was forty-fold higher in the private sector. Conclusions: Mandatory registration of private sector health services needs to be implemented which will provide an opportunity for public health planners to utilize these health resources to achieve urban health goals. PMID:24963226

Health resources in a 200,000 urban Indian population argues the need for a policy on private sector health services.

PubMed

Furtado, Kheya Melo; Kar, Anita

2014-04-01

There are limited primary data on the number of urban health care providers in private practice in developing countries like India. These data are needed to construct and test models that measure the efficacy of public stewardship of private sector health services. This study reports the number and characteristics of health resources in a 200 000 urban population in Pune. Data on health providers were collected by walking through the 15.46 sq km study area. Enumerated data were compared with existing data sources. Mapping was carried out using a Global Positioning System device. Metrics and characteristics of health resources were analyzed using ArcGIS 10.0 and Statistical Package for the Social Sciences, Version 16.0 software. Private sector health facilities constituted the majority (424/426, 99.5%) of health care services. Official data sources were only 39% complete. Doctor to population ratios were 2.8 and 0.03 per 1000 persons respectively in the private and public sector, and the nurse to doctor ratio was 0.24 and 0.71, respectively. There was an uneven distribution of private sector health services across the area (2-118 clinics per square kilometre). Bed strength was forty-fold higher in the private sector. Mandatory registration of private sector health services needs to be implemented which will provide an opportunity for public health planners to utilize these health resources to achieve urban health goals.

Climate change impact on microclimate of work environment related to occupational health and productivity.

PubMed

Marchetti, Enrico; Capone, Pasquale; Freda, Daniela

2016-01-01

Climate change is a global emergency that influences human health and occupational safety. Global warming characterized by an increase in temperature of the ambience and humidity affects human health directly impairing body thermoregulation with serious consequences: dehydration, fatigue, heat stroke and even death. Several studies have demonstrated negative effects of climate change on working populations in a wide variety of workplaces with particular regard to outdoor and uncooled indoor workplaces. Most vulnerable workers are outdoor workers in tropical and subtropical countries usually involved in heavy labor during hot seasons. Many of the consequences therefore, regarding working people are possible, even without health symptoms by reducing work productivity. The scope of this review is to investigate effects of climate change on workers both in relation to health and work productivity. This study has been realized by analyzing recent international literature. In order to reduce negative effects of climate change on working populations it is essential to implement preventive measures with a multidisciplinary strategy limiting health risks and improving work productivity.

Usability of a Novel Mobile Health iPad App by Vulnerable Populations.

PubMed

Miller, David P; Weaver, Kathryn E; Case, L Doug; Babcock, Donald; Lawler, Donna; Denizard-Thompson, Nancy; Pignone, Michael P; Spangler, John G

2017-04-11

Recent advances in mobile technologies have created new opportunities to reach broadly into populations that are vulnerable to health disparities. However, mobile health (mHealth) strategies could paradoxically increase health disparities, if low socioeconomic status individuals lack the technical or literacy skills needed to navigate mHealth programs. The aim of this study was to determine whether patients from vulnerable populations could successfully navigate and complete an mHealth patient decision aid. We analyzed usability data from a randomized controlled trial of an iPad program designed to promote colorectal cancer (CRC) screening. The trial was conducted in six primary care practices and enrolled 450 patients, aged 50-74 years, who were due for CRC screening. The iPad program included a self-survey and randomly displayed either a screening decision aid or a video about diet and exercise. We measured participant ability to complete the program without assistance and participant-rated program usability. Two-thirds of the participants (305/450) were members of a vulnerable population (limited health literacy, annual income < US $20,000, or black race). Over 92% (417/450) of the participants rated the program highly on all three usability items (90.8% for vulnerable participants vs 96.6% for nonvulnerable participants, P=.006). Only 6.9% (31/450) of the participants needed some assistance to complete the program. In multivariable logistic regression, being a member of a vulnerable population was not associated with needing assistance. Only older age, less use of text messaging (short message service, SMS), and lack of Internet use predicted needing assistance. Individuals who are vulnerable to health disparities can successfully use well-designed mHealth programs. Future research should investigate whether mHealth interventions can reduce health disparities. ©David P Miller Jr, Kathryn E Weaver, L Doug Case, Donald Babcock, Donna Lawler, Nancy Denizard-Thompson, Michael P Pignone, John G Spangler. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 11.04.2017.

Big Data: Implications for Health System Pharmacy

PubMed Central

Stokes, Laura B.; Rogers, Joseph W.; Hertig, John B.; Weber, Robert J.

2016-01-01

Big Data refers to datasets that are so large and complex that traditional methods and hardware for collecting, sharing, and analyzing them are not possible. Big Data that is accurate leads to more confident decision making, improved operational efficiency, and reduced costs. The rapid growth of health care information results in Big Data around health services, treatments, and outcomes, and Big Data can be used to analyze the benefit of health system pharmacy services. The goal of this article is to provide a perspective on how Big Data can be applied to health system pharmacy. It will define Big Data, describe the impact of Big Data on population health, review specific implications of Big Data in health system pharmacy, and describe an approach for pharmacy leaders to effectively use Big Data. A few strategies involved in managing Big Data in health system pharmacy include identifying potential opportunities for Big Data, prioritizing those opportunities, protecting privacy concerns, promoting data transparency, and communicating outcomes. As health care information expands in its content and becomes more integrated, Big Data can enhance the development of patient-centered pharmacy services. PMID:27559194

Big Data: Implications for Health System Pharmacy.

PubMed

Stokes, Laura B; Rogers, Joseph W; Hertig, John B; Weber, Robert J

2016-07-01

Big Data refers to datasets that are so large and complex that traditional methods and hardware for collecting, sharing, and analyzing them are not possible. Big Data that is accurate leads to more confident decision making, improved operational efficiency, and reduced costs. The rapid growth of health care information results in Big Data around health services, treatments, and outcomes, and Big Data can be used to analyze the benefit of health system pharmacy services. The goal of this article is to provide a perspective on how Big Data can be applied to health system pharmacy. It will define Big Data, describe the impact of Big Data on population health, review specific implications of Big Data in health system pharmacy, and describe an approach for pharmacy leaders to effectively use Big Data. A few strategies involved in managing Big Data in health system pharmacy include identifying potential opportunities for Big Data, prioritizing those opportunities, protecting privacy concerns, promoting data transparency, and communicating outcomes. As health care information expands in its content and becomes more integrated, Big Data can enhance the development of patient-centered pharmacy services.

The impact of an integrated population health enhancement and disease management program on employee health risk, health conditions, and productivity.

PubMed

Loeppke, Ron; Nicholson, Sean; Taitel, Michael; Sweeney, Matthew; Haufle, Vince; Kessler, Ronald C

2008-12-01

This study evaluated the impact of an integrated population health enhancement program on employee health risks, health conditions, and productivity. Specifically, we analyzed changes in these measures among a cohort of 543 employees who completed a health risk assessment in both 2003 and 2005. We compared these findings with 2 different sets of employees who were not offered health enhancement programming. We found that the DIRECTV cohort showed a significant reduction in health risks after exposure to the program. Relative to a matched comparison group, the proportion of low-risk employees at DIRECTV in 2005 was 8.2 percentage points higher; the proportion of medium-risk employees was 7.1 percentage points lower; and the proportion of high-risk employees was 1.1 percentage points lower (p < 0.001). The most noticeable changes in health risk were a reduction in the proportion of employees with high cholesterol; an improvement in diet; a reduction of heavy drinking; management of high blood pressure; improved stress management; increased exercise; fewer smokers; and a drop in obesity rates. We also found that a majority of employees who improved their risk levels from 2003 to 2005 maintained their gains in 2006. Employees who improved their risks levels also demonstrated relative improvement in absenteeism. Overall, this study provides additional evidence that integrated population health enhancement positively impacts employees' health risk and productivity; it also reinforces the view that "good health is good business."

Use of GIS Mapping as a Public Health Tool—From Cholera to Cancer

PubMed Central

Musa, George J.; Chiang, Po-Huang; Sylk, Tyler; Bavley, Rachel; Keating, William; Lakew, Bereketab; Tsou, Hui-Chen; Hoven, Christina W.

2013-01-01

The field of medical geographic information systems (Medical GIS) has become extremely useful in understanding the bigger picture of public health. The discipline holds a substantial capacity to understand not only differences, but also similarities in population health all over the world. The main goal of marrying the disciplines of medical geography, public health and informatics is to understand how countless health issues impact populations, and the trends by which these populations are affected. From the 1990s to today, this practical approach has become a valued and progressive system in analyzing medical and epidemiological phenomena ranging from cholera to cancer. The instruments supporting this field include geographic information systems (GIS), disease surveillance, big data, and analytical approaches like the Geographical Analysis Machine (GAM), Dynamic Continuous Area Space Time Analysis (DYCAST), cellular automata, agent-based modeling, spatial statistics and self-organizing maps. The positive effects on disease mapping have proven to be tremendous as these instruments continue to have a great impact on the mission to improve worldwide health care. While traditional uses of GIS in public health are static and lacking real-time components, implementing a space-time animation in these instruments will be monumental as technology and data continue to grow. PMID:25114567

Use of GIS Mapping as a Public Health Tool-From Cholera to Cancer.

PubMed

Musa, George J; Chiang, Po-Huang; Sylk, Tyler; Bavley, Rachel; Keating, William; Lakew, Bereketab; Tsou, Hui-Chen; Hoven, Christina W

2013-01-01

The field of medical geographic information systems (Medical GIS) has become extremely useful in understanding the bigger picture of public health. The discipline holds a substantial capacity to understand not only differences, but also similarities in population health all over the world. The main goal of marrying the disciplines of medical geography, public health and informatics is to understand how countless health issues impact populations, and the trends by which these populations are affected. From the 1990s to today, this practical approach has become a valued and progressive system in analyzing medical and epidemiological phenomena ranging from cholera to cancer. The instruments supporting this field include geographic information systems (GIS), disease surveillance, big data, and analytical approaches like the Geographical Analysis Machine (GAM), Dynamic Continuous Area Space Time Analysis (DYCAST), cellular automata, agent-based modeling, spatial statistics and self-organizing maps. The positive effects on disease mapping have proven to be tremendous as these instruments continue to have a great impact on the mission to improve worldwide health care. While traditional uses of GIS in public health are static and lacking real-time components, implementing a space-time animation in these instruments will be monumental as technology and data continue to grow.

Income inequality, disinvestment in health care and use of dental services.

PubMed

Bhandari, Bishal; Newton, Jonathan T; Bernabé, Eduardo

2015-01-01

To explore the interrelationships between income inequality, disinvestment in health care, and use of dental services at country level. This study pooled national estimates for use of dental services among adults aged 18 years or older from the 70 countries that participated in the World Health Survey from 2002 to 2004, together with aggregate data on national income (GDP per capita), income inequality (Gini coefficient), and disinvestment in health care (total health expenditure and dentist-to-population ratio) from various international sources. Use of dental services was defined as having had dental problems in the last 12 months and having received any treatment to address those needs. Associations between variables were explored using Pearson correlation coefficients and linear regression. Data from 63 countries representing the six WHO regions were analyzed. Use of dental services was negatively correlated with Gini coefficient (Pearson correlation coefficient -0.48, P < 0.001) and positively correlated with GDP per capita (0.40, P < 0.05), total health expenditure (0.45, P < 0.001), and dentist-to-population ratio (0.67, P < 0.001). The association between Gini coefficient and use of dental services was attenuated but remained significant after adjustments for GDP per capita, total health expenditure, and dentist-to-population ratio (regression coefficient -0.36; 95% CI -0.57, -0.15). This study shows an inverse relationship between income inequality and use of dental services. Of the two indicators of disinvestment in health care assessed, only dentist-to-population ratio was associated with income inequality and use of dental services. © 2014 American Association of Public Health Dentistry.

Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations

PubMed Central

Andrulis, Dennis P.; Brach, Cindy

2016-01-01

Objective To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection. Methods Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed. Results Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP). The lack of integration results in health care that is unresponsive to some vulnerable groups’ needs. A vision for integrated care is presented. Conclusion Clinicians, the health care team, and health care organizations have important roles to play in addressing challenges related to literacy, culture, and language. PMID:17931131

Ethics, effectiveness and population health information interventions: a Canadian analysis.

PubMed

Greyson, Devon; Knight, Rod; Shoveller, Jean A

2018-02-19

Population health information interventions (PHIIs) use information in efforts to promote health. PHIIs may push information to a target audience (communication), pull information from the public (surveillance), or combine both in a bidirectional intervention. Although PHIIs have often been framed as non-invasive and ethically innocuous, in reality they may be intrusive into people's lives, affecting not only their health but their senses of security, respect, and self-determination. Ethical acceptability of PHIIs may have impacts on intervention effectiveness, potentially giving rise to unintended consequences. This article examines push, pull, and bidirectional PHIIs using empirical data from an ethnographic study of young mothers in Greater Vancouver, Canada. Data were collected from October 2013 to December 2014 via naturalistic observation and individual interviews with 37 young mothers ages 16-22. Transcribed interviews and field notes were analyzed using inductive qualitative thematic analysis. Both push and pull interventions were experienced as non-neutral by the target population, and implementation factors on a structural and individual scale affected intervention ethics and effectiveness. Based on our findings, we suggest that careful ethical consideration be applied to use of PHIIs as health promotion tools. Advancing the 'ethics of PHIIs' will benefit from empirical data that is informed by information and computer science theory and methods. Information technologies, digital health promotion services, and integrated surveillance programs reflect important areas for investigation in terms of their effects and ethics. Health promotion researchers, practitioners, and ethicists should explore these across contexts and populations.

[Interventions to improve access to health services by indigenous peoples in the Americas].

PubMed

Araujo, Miguel; Moraga, Cecilia; Chapman, Evelina; Barreto, Jorge; Illanes, Eduardo

2016-11-01

Synthesize evidence on effectiveness of interventions designed to improve access to health services by indigenous populations. Review of systematic reviews published as of July 2015, selecting and analyzing only studies in the Region of the Americas. The bibliographic search encompassed MEDLINE, Lilacs, SciELO, EMBASE, DARE, HTA, The Cochrane Library, and organization websites. Two independent reviewers selected studies and analyzed their methodological quality. A narrative summary of the results was produced. Twenty-two reviews met the inclusion criteria. All selected studies were conducted in Canada and the United States of America. The majority of the interventions were preventive, to surmount geographical barriers, increase use of effective measures, develop human resources, and improve people's skills or willingness to seek care. Topics included pregnancy, cardiovascular risk factors, diabetes, substance abuse, child development, cancer, mental health, oral health, and injuries. Some interventions showed effectiveness with moderate or high quality studies: educational strategies to prevent depression, interventions to prevent childhood caries, and multicomponent programs to promote use of child safety seats. In general, results for chronic non-communicable diseases were negative or inconsistent. Interventions do exist that have potential for producing positive effects on access to health services by indigenous populations in the Americas, but available studies are limited to Canada and the U.S. There is a significant research gap on the topic in Latin America and the Caribbean.

Economic Impact of a Medicaid Population Health Management Program

PubMed Central

Strothers, Harry; Miller, William Johnson; McLaren, Susan; Moore, Barbara; Sambamoorthi, Usha

2011-01-01

Abstract A population health management program was implemented to assess growth in health care expenditures for the disabled segment of Georgia's Medicaid population before and during the first year of a population health outcomes management program, and to compare those expenditures with projected costs based on various cost inflation trend assumptions. A retrospective, nonexperimental approach was used to analyze claims data from Georgia Medicaid claims files for all program-eligible persons for each relevant time period (intent-to-treat basis). These included all non-Medicare, noninstitutionalized Medicaid aged-blind-disabled adults older than 18 years of age. Comparisons of health care expenditures and utilization were made between base year (2003–2004) and performance year one (2006–2007), and of the difference between actual expenditures incurred in the performance year vs. projected expenditures based on various cost inflation assumptions. Demographic characteristics and clinical complexity of the population (as measured by the Chronic Illness and Disability Payment System risk score) actually increased from baseline to implementation. Actual expenditures were less than projected expenditures using any relevant medical inflation assumption. Actual expenditures were less than projected expenditures by $9.82 million when using a conservative US general medical inflation rate, by $43.6 million using national Medicaid cost trends, and by $106 million using Georgia Medicaid's own cost projections for the non-dually eligible disabled segment of Medicaid enrollees. Quadratic growth curve modeling also demonstrated a lower rate of increase in total expenditures. The rate of increase in expenditures was lower over the first year of program implementation compared with baseline. Weighted utilization rates were also lower in high-cost categories, such as inpatient days, despite increases in the risk profile of the population. Varying levels of cost avoidance could be inferred from differences between actual and projected expenditures using each of the health-related inflation assumptions. (Population Health Management 2011;14:215–222) PMID:21506728

Improving Population Health Through an Innovative Collaborative: The Be There San Diego Data for Quality Group.

PubMed

Fremont, Allen; Kranz, Ashley M; Phillips, Jessica; Garber, Chandra

2017-06-01

In 2012, leaders from disparate health care organizations established a data group aligned around a regional goal of preventing heart attacks and strokes in San Diego. The group---now named the Be There San Diego Data for Quality (DFQ) Group---is a safe venue for medical directors and other quality-improvement leaders to share performance data on quality-of-care measures for diabetes, hypertension, and cardiovascular disease, as well as insights, lessons learned, and challenges faced by each organization in treating these conditions. The DFQ Group has focused its efforts on improving the quality of services provided by each participating health care organization, and has placed a strong emphasis on analyzing trends in combined quality data to better understand the health of the entire San Diego population. By fostering collaboration among organizations that collectively serve a large portion of the local population and other key community stakeholders, the DFQ Group has helped form the foundation of a unique, multifaceted, multi-stakeholder, regional effort that is gaining national attention and funding for its community-driven approach.

Financial Burden of Health Care Expenditures: Turkey

PubMed Central

Sulku, S Nur; Bernard, D Minbay

2012-01-01

In this study, we examine whether and to what extent the health insurance system in Turkey provided adequate protection against high out of pocket expenditures in the period prior to “The Health Transformation Programme”. Furthermore, we examine the distribution of out of pocket expenditures by demographic characteristics, poverty status, health service type, access to health care and self-reported health status. We employ the 2002/03 National Household Health Expenditure Survey data to analyze financial burden of health care expenditure. Following the literature, we define high burdens as expenses above 10 and 20% of income. We find that 19% of the nonelderly population were living in families spending more than 10% of family income and that 14% of the nonelderly population were living in families spending more than 20% of family income on health care. Furthermore, the poor and those living in economically less developed regions had the greatest risk of high out of pocket burdens. The risk of high financial burdens varied by the type of insurance among the insured due to differences in benefits among the five separate public schemes that provided health insurance in the pre-reform period. Our results are robust to three alternative specifications of the burden measure and including elderly adults in the sample population. We see that prior to the reforms there were not adequate protection against high health expenditures. Our study provides a baseline against which policymakers can measure the success of the health care reform in terms of providing financial protection. PMID:23113149

Multitarget survey on the Finance Police personnel: assessment of the health condition.

PubMed

Barraco, Giancarlo; Pagano, Stefano; Lupoli, Grazia; Dolci, Alessandro; Colagrosso, Beniamino

2014-01-01

Over the past 10-15 years, Italy has undergone a social transformation, and the class of employees and workers has become more economically stable with a higher buying power. Along with the increased expectations of patients on the quality of life, it has now become a priority to make health and social services ready to face users bearing new requirements and different needs. To provide a description of the state of health of the operating personnel of the Finance Police (Guardia di Finanza), including elements for planning the most appropriate interventions for health promotion and prevention. The study analyzed the health condition of a group of soldiers (178 subjects, divided into different age classes) by evaluating the effectiveness of a training and information program and subsequently the level of benefit. The study population showed a good state of health correlated to the quality of life. Although the population voluntarily submitted to health assessment, the rigour of the calls and briefings carried out in the military health unit and the attention of the group to follow instructions on prevention underlined a positive trend, even in behaviours considered as health-risky. Socio-cultural components and the work environment influence the quality of life. In the case of military health care, the specific military organization was useful to monitor the health condition of the population, maximizing the effectiveness of services, enhancing the information and carrying out prevention strategies and demand of care, which should be an example for the public health services.

Channel morphology [Chapter 5

Treesearch

Jonathan W. Long; Alvin L. Medina; Daniel G. Neary

2012-01-01

Channel morphology has become an increasingly important subject for analyzing the health of rivers and associated fish populations, particularly since the popularization of channel classification and assessment methods. Morphological data can help to evaluate the flows of sediment and water that influence aquatic and riparian habitat. Channel classification systems,...

[Falls in the elderly: knowing to act].

PubMed

Séculi Sánchez, E; Brugulat Guiteras, P; March Llanes, J; Medina Bustos, A; Martínez Beneyto, V; Tresserras Gaju, R

2004-09-15

To study the prevalence of falls and to analyze the associated factors in non institutionalized population aged 65 or older in Catalonia. Data were collected from the 2002 Health Survey of Catalonia. Information on self reported falls according age, sex, educational level, social class, suffering chronic diseases and disabilities in people aged 65 or older (542 men and 665 women) was analyzed. Multivariate logistic analysis was applied. 17.9% of the population aged 65 or older reported falls during the last twelve months. The frequency increases with ageing. To be women, to have university studies, having three or more chronic diseases and two disabilities is associated to a high risk of falling. Comparing 1994 and 2002 Health Surveys of Catalonia, the proportion of elderly people who reported falls has significantly increased. Although it is necessary to advance on the knowledge of the risk factors and interventions addressed to prevent and reduce the occurrence of falls in the elderly people, a multifactorial and intersectorial approach seems the most adequate.

Dried Blood Spot Collection of Health Biomarkers to Maximize Participation in Population Studies

PubMed Central

Ostler, Michael W.; Porter, James H.; Buxton, Orfeu M.

2014-01-01

Biomarkers are directly-measured biological indicators of disease, health, exposures, or other biological information. In population and social sciences, biomarkers need to be easy to obtain, transport, and analyze. Dried Blood Spots meet this need, and can be collected in the field with high response rates. These elements are particularly important in longitudinal study designs including interventions where attrition is critical to avoid, and high response rates improve the interpretation of results. Dried Blood Spot sample collection is simple, quick, relatively painless, less invasive then venipuncture, and requires minimal field storage requirements (i.e. samples do not need to be immediately frozen and can be stored for a long period of time in a stable freezer environment before assay). The samples can be analyzed for a variety of different analytes, including cholesterol, C-reactive protein, glycosylated hemoglobin, numerous cytokines, and other analytes, as well as provide genetic material. DBS collection is depicted as employed in several recent studies. PMID:24513728

[Disease prevention in the elderly: misconceptions in current models].

PubMed

Veras, Renato Peixoto

2012-10-01

The Brazilian population is aging significantly within a context of gradual improvement in the country's social and economic indicators. Increased longevity leads to increased use of health services, pressuring the public and social welfare health services, generating higher costs, and jeopardizing the system's sustainability. The alternative to avoid overburdening the system is to invest in policies for disease prevention, stabilization of chronic diseases, and maintenance of functional capacity. The current article aims to analyze the difficulties in implementing preventive programs and the reasons for the failure of various programs in health promotion, prevention, and management of chronic diseases in the elderly. There can be no solution to the crisis in financing and restructuring the health sector without implementing a preventive logic. Scientific research has already correctly identified the risk factors for the elderly population, but this is not enough. We must use such knowledge to promote the necessary transition from a healthcare-centered model to a preventive one.

A pilot examination of social context and everyday physical activity among adults receiving Community Mental Health Services.

PubMed

McCormick, B P; Frey, G C; Lee, C-T; Gajic, T; Stamatovic-Gajic, B; Maksimovic, M

2009-03-01

Community mental health center (CMHC) clients include a variety of people with moderate to severe mental illnesses who also report a number of physical health problems. Physical activity (PA) has been identified as one intervention to improve health among this population; however, little is known about the role of social context in PA. The purpose of this study was to examine the role of social context in everyday PA among CMHC clients. Data were collected from CMHC clients in two cultures using accelerometery and experience sampling methods. Data were analyzed using hierarchical linear modeling. Independence in housing nor culture was significantly associated with levels of PA. Being alone was significantly negatively related to PA level. Social isolation appears to be negatively related to PA at the level of everyday life. Physical activity interventions with this population should consider including social components as a part of PA.

Unhealthy lifestyle, poor mental health, and its correlation among adolescents: a nationwide cross-sectional survey.

PubMed

Tanihata, Takeo; Kanda, Hideyuki; Osaki, Yoneatsu; Ohida, Takashi; Minowa, Masumi; Wada, Kiyoshi; Suzuki, Kenji; Hayashi, Kenji

2015-03-01

The objective was to study the relationship between mental health and lifestyles of adolescents using samples representative of Japanese adolescents nationwide. The survey was conducted between December 2004 and January 2005 among students enrolled in randomly selected junior and senior high schools. Self-administered questionnaires addressed lifestyles, sleeping habits, and mental health status. Of 103 650 questionnaires collected, 85 158 were analyzed. Population characteristics associated with poor mental health were being female, being a senior high school student, skipping breakfast, not participating in extracurricular activities, not consulting parents about personal matters, parental smoking, students' smoking or alcohol use, poor subjective sleep assessment, and short or long sleeping duration. Smoking and anxiety disorders are associated with an elevation in acculturative stress in adolescents. Prepossessing adolescents are in subclinical depression. Results suggest that lifestyles approaches in preventions that target students can be effective in reaching high-risk populations. © 2012 APJPH.

Internet and social media for health-related information and communication in health care: preferences of the Dutch general population.

PubMed

Van de Belt, Tom H; Engelen, Lucien J L P G; Berben, Sivera A A; Teerenstra, Steven; Samsom, Melvin; Schoonhoven, Lisette

2013-10-02

Health care is increasingly featured by the use of Web 2.0 communication and collaborative technologies that are reshaping the way patients and professionals interact. These technologies or tools can be used for a variety of purposes: to instantly debate issues, discover news, analyze research, network with peers, crowd-source information, seek support, and provide advice. Not all tools are implemented successfully; in many cases, the nonusage attrition rates are high. Little is known about the preferences of the Dutch general population regarding the use of the Internet and social media in health care. To determine the preferences of the general population in the Netherlands regarding the use of the Internet and social media in health care. A cross-sectional survey was disseminated via a popular Dutch online social network. Respondents were asked where they searched for health-related information, how they qualified the value of different sources, and their preferences regarding online communication with health care providers. Results were weighed for the Dutch population based on gender, age, and level of education using official statistics. Numbers and percentages or means and standard deviations were presented for different subgroups. One-way ANOVA was used to test for statistical differences. The survey was completed by 635 respondents. The Internet was found to be the number one source for health-related information (82.7%), closely followed by information provided by health care professionals (71.1%). Approximately one-third (32.3%) of the Dutch population search for ratings of health care providers. The most popular information topics were side effects of medication (62.5%) and symptoms (59.7%). Approximately one-quarter of the Dutch population prefer to communicate with a health care provider via social media (25.4%), and 21.2% would like to communicate via a webcam. The Internet is the main source of health-related information for the Dutch population. One in 4 persons wants to communicate with their physician via social media channels and it is expected that this number will further increase. Health care providers should explore new ways of communicating online and should facilitate ways for patients to connect with them. Future research should aim at comparing different patient groups and diseases, describing best practices, and determining cost-effectiveness.

Internet and Social Media For Health-Related Information and Communication in Health Care: Preferences of the Dutch General Population

PubMed Central

Engelen, Lucien JLPG; Berben, Sivera AA; Teerenstra, Steven; Samsom, Melvin; Schoonhoven, Lisette

2013-01-01

Background Health care is increasingly featured by the use of Web 2.0 communication and collaborative technologies that are reshaping the way patients and professionals interact. These technologies or tools can be used for a variety of purposes: to instantly debate issues, discover news, analyze research, network with peers, crowd-source information, seek support, and provide advice. Not all tools are implemented successfully; in many cases, the nonusage attrition rates are high. Little is known about the preferences of the Dutch general population regarding the use of the Internet and social media in health care. Objective To determine the preferences of the general population in the Netherlands regarding the use of the Internet and social media in health care. Methods A cross-sectional survey was disseminated via a popular Dutch online social network. Respondents were asked where they searched for health-related information, how they qualified the value of different sources, and their preferences regarding online communication with health care providers. Results were weighed for the Dutch population based on gender, age, and level of education using official statistics. Numbers and percentages or means and standard deviations were presented for different subgroups. One-way ANOVA was used to test for statistical differences. Results The survey was completed by 635 respondents. The Internet was found to be the number one source for health-related information (82.7%), closely followed by information provided by health care professionals (71.1%). Approximately one-third (32.3%) of the Dutch population search for ratings of health care providers. The most popular information topics were side effects of medication (62.5%) and symptoms (59.7%). Approximately one-quarter of the Dutch population prefer to communicate with a health care provider via social media (25.4%), and 21.2% would like to communicate via a webcam. Conclusions The Internet is the main source of health-related information for the Dutch population. One in 4 persons wants to communicate with their physician via social media channels and it is expected that this number will further increase. Health care providers should explore new ways of communicating online and should facilitate ways for patients to connect with them. Future research should aim at comparing different patient groups and diseases, describing best practices, and determining cost-effectiveness. PMID:24088272

Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds

PubMed Central

Hong, Mi-Kyung; Varghese, Reshma E.; Jindal, Charulata; Efird, Jimmy T.

2017-01-01

Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful, in many cases, encounter overwhelming obstacles, inadequate resources, and a complex system of legal barriers. Travel restrictions based on equivocal health concerns and a drop in refugee admittance ceilings have complicated the situation. The authors retrieved and analyzed peer-reviewed journal articles, government agency press releases, media postings, epidemiologic factsheets, and relevant lay publications to critically assess U.S. policy regarding refugee resettlement based on health-related grounds. While refugees arguably exhibit an increased incidence of measles and tuberculosis compared with the U.S. population, the legitimacy of the medical examination will be undermined if other diseases that are endemic to refugee populations, yet currently deemed admissible, are used to restrict refugees from entering the U.S. This paper addressees the historic refugee policy of the U.S. and its consequent effect on the health of this vulnerable population. The needs of refugees should be carefully considered in the context of increased disease burden and the associated health care challenges of the country as a whole. PMID:28946650

Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds.

PubMed

Hong, Mi-Kyung; Varghese, Reshma E; Jindal, Charulata; Efird, Jimmy T

2017-09-24

Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful, in many cases, encounter overwhelming obstacles, inadequate resources, and a complex system of legal barriers. Travel restrictions based on equivocal health concerns and a drop in refugee admittance ceilings have complicated the situation. The authors retrieved and analyzed peer-reviewed journal articles, government agency press releases, media postings, epidemiologic factsheets, and relevant lay publications to critically assess U.S. policy regarding refugee resettlement based on health-related grounds. While refugees arguably exhibit an increased incidence of measles and tuberculosis compared with the U.S. population, the legitimacy of the medical examination will be undermined if other diseases that are endemic to refugee populations, yet currently deemed admissible, are used to restrict refugees from entering the U.S. This paper addressees the historic refugee policy of the U.S. and its consequent effect on the health of this vulnerable population. The needs of refugees should be carefully considered in the context of increased disease burden and the associated health care challenges of the country as a whole.

Hypertension in Germany.

PubMed

Neuhauser, Hannelore; Diederichs, Claudia; Boeing, Heiner; Felix, Stephan B; Jünger, Claus; Lorbeer, Roberto; Meisinger, Christine; Peters, Annette; Völzke, Henry; Weikert, Cornelia; Wild, Philipp; Dörr, Marcus

2016-12-02

Hypertension is a key risk factor. However, population data based on blood pressure measurements in Germany are scarce. Standardized blood pressure (BP) measurements and medication data from seven population-based studies conducted in Germany between 1994 and 2012 (66 845 participants, 25-74 years) were analyzed: the EPICPotsdam study (1994-1998, EPIC), the KORA-S4 Study (1999-2001) in Augsburg, and the Gutenberg Health Study (2007-2012, GHS) in Mainz/Mainz-Bingen provided data for descriptive comparisons. Time trends were analyzed based on identical study regions for the German National Health Interview and Examination Survey 1998 (BGS98) and the German Health Examination Survey for Adults (2008-11, DEGS1) as well as the Study of Health in Pomerania (SHIP) in Northeast Germany (1997-2001) and the SHIP-TREND study (2008-2012). BP data were adjusted for study-specific measurement devices based on calibration studies. After adjustment for study-specific measurement devices, mean systolic and diastolic BP values were lower and treatment proportions higher in recent (2007-2012) compared to older (1994-2001) studies. Mean BP decrease was most pronounced (systolic ≥ 10 mmHg) in the elderly (55-74 years). The regional SHIP-TREND data for Northeast Germany showed a decrease in mean systolic BP in young men aged 25 to 34 years; on a national level according to the DEGS1 data, however, no such decrease was observed for this group. New data add evidence for lower BP in Germany. However, the prevention potential remains high. Future research based on population-based data should place a special focus on blood pressure data in young men.

Investment in online self-evaluation tests: A theoretical approach.

PubMed

de Gara, Francesco; Gallo, William T; Bisson, Jonathan I; Endrass, Jerome; Vetter, Stefan

2008-04-15

Large-scale traumatic events may burden any affected public health system with consequential charges. One major post-disaster, expense factor emerges form early psychological interventions and subsequent, posttraumatic mental health care. Due to the constant increase in mental health care costs, also post-disaster public mental health requires best possible, cost-effective care systems. Screening and monitoring the affected population might be one such area to optimize the charges. This paper analyzes the potential cost-effectiveness of monitoring a psychologically traumatized population and to motivate individuals at risk to seek early treatment. As basis for our model served Grossman's health production function, which was modified according to fundamental concepts of cost-benefit analyzes, to match the basic conditions of online monitoring strategies. We then introduce some fundamental concepts of cost-benefit analysis. When performing cost-benefit analyses, policy makers have to consider both direct costs (caused by treatment) and indirect costs (due to non-productivity). Considering both costs sources we find that the use of Internet-based psychometric screening instruments may reduce the duration of future treatment, psychological burden and treatment costs. The identification of individuals at risk for PTSD following a disaster may help organizations prevent both the human and the economic costs of this disease. Consequently future research on mental health issues should put more emphasis on the importance of monitoring to detect early PTSD and focus the most effective resources within early treatment and morbidity prevention.

[The provision of population of the Russian Federation with basic personnel resource of public health care system].

PubMed

Schepin, V O

2013-01-01

The article presents the results of complex scientific analysis of number and structure of physicians and paramedical personnel of public and municipal health care system of the Russian Federation. The provision of country population, its federal okrugs and federation subjects with physicians and paramedical personnel of various specialties are analyzed too, including ratio of physicians and paramedical personnel and territorial differentiation of provision of population with basic medical personnel. The study results demonstrate that in 2012 provision of population (per 10 000 of population) with physicians increased from 43.9 to 44.7. At the same time provision with paramedical personnel decreased from 92.3 to 90.8. in the Russian Federation are preserved significant territorial disproportions of provision of population with medical personnel resource. The provision of population with physicians and paramedical personnel is 4.3 times and 1.9 times higher in cities than in rural area. The differences between extreme indicators of provision of population of the Russian Federation with physicians and paramedical personnel are 2.9 and 2.4 times correspondingly. The differences between indicators of provision with physicians of clinical specialties are 2.6 times. The average ratio between physician and paramedical personnel is 1:2.03. The structure of medical manpower corresponds to the need of population in medical care in incomplete measure. The materials substantiate necessity to continue modernization, optimization and development of manpower support of public health care system in the Russian Federation.

Health service use in a population covered by the Estratégia de Saúde da Família (Family Health Strategy).

PubMed

Fernandes, Léia Cristiane L; Bertoldi, Andréa D; Barros, Aluísio J D

2009-08-01

To analyze health service use patterns in communities covered by the Estratégia de Saúde da Família (Family Health Strategy). Population-based cross-sectional study with a sample of 2,988 individuals, of all ages, living in areas covered by the Estratégia de Saúde da Família, in the city of Porto Alegre, Southern Brazil, between July and September 2003. Pre-coded questionnaires about demographic, socioeconomic and health information were applied to all residents of selected households. Prevalence ratios and 95% confidence intervals were calculated and chi-square tests were applied in the analyses. Poisson regression was used in the multivariable analysis to control for potential confounding factors. Females, persons aged 60 years or older, white, with better socioeconomic level, without health care plan coverage and with poor health self-perception were more likely to use the local family health unit. Regarding users of other health services, a similar pattern for sex, age and health self-perception was observed. However, greater use was found among people with better socioeconomic level and with health care plan coverage. Use of a local family health unit was greater among people from a lower socioeconomic level and without health care plan coverage, revealing the poorer individuals to be the priority of governmental actions. Model changes made to health care with the implementation of the Estratégia Saúde da Família tend to progressively improve the health conditions of the poorer population, with consequent reduction of health inequalities.

Menu labeling perception and health behaviors among immigrant and US born minority populations: assessment in two Los Angeles public markets.

PubMed

Vargas-Bustamante, Arturo

2013-01-01

To analyze menu labeling perception and food choices/health behaviors in two Los Angeles public markets. Labels with food caloric content were displayed in the food court of one of these markets. Bivarate means analyses compared the surveyed population by market and by nativity status. The main predictors of menu-labeling influence were identified in the sample from the market that displayed labels. A separate analysis investigated food choices/health behaviors among immigrant cohorts by time of US residence. Reading labels when shopping was one of the main predictors associated with menu labeling influence. Longer-stayed immigrants were more likely to afford "balanced meals", but they were also more likely to eat in fast food restaurants and less likely to engage into moderate/intense physical activity. While nativity was not a significant predictor of menu labeling influence on food choices, our findings suggest food choices/behaviors convergence among immigrant and US-born populations.

Racialized geography, corporate activity, and health disparities: tobacco industry targeting of inner cities.

PubMed

Yerger, Valerie B; Przewoznik, Jennifer; Malone, Ruth E

2007-11-01

Industry has played a complex role in the rise of tobacco-related diseases in the United States. The tobacco industry's activities, including targeted marketing, are arguably among the most powerful corporate influences on health and health policy. We analyzed over 400 internal tobacco industry documents to explore how, during the past several decades, the industry targeted inner cities populated predominantly by low-income African American residents with highly concentrated menthol cigarette marketing. We study how major tobacco companies competed against one another in menthol wars fought within these urban cores. Little previous work has analyzed the way in which the inner city's complex geography of race, class, and place shaped the avenues used by tobacco corporations to increase tobacco use in low-income, predominantly African American urban cores in the 1970s-1990s. Our analysis shows how the industry's activities contributed to the racialized geography of today's tobacco-related health disparities.

Keeping the “Public” in Schools of Public Health

PubMed Central

Klitzman, Susan; Diamond, Catherine; El-Mohandes, Ayman

2015-01-01

In this article, we compared the characteristics of public and private accredited public health training programs. We analyzed the distinct opportunities and challenges that publicly funded schools of public health face in preparing the nation’s public health workforce. Using our experience in creating a new, collaborative public school of public health in the nation’s largest urban public university system, we described efforts to use our public status and mission to develop new approaches to educating a workforce that meets the health needs of our region and contributes to the goal of reducing health inequalities. Finally, we considered policies that could protect and strengthen the distinct contributions that public schools of public health make to improving population health and reducing health inequalities. PMID:25706006

The self-reported health of U.S. flight attendants compared to the general population

PubMed Central

2014-01-01

Background Few studies have examined the broad health effects of occupational exposures in flight attendants apart from disease-specific morbidity and mortality studies. We describe the health status of flight attendants and compare it to the U.S. population. In addition, we explore whether the prevalence of major health conditions in flight attendants is associated with length of exposure to the aircraft environment using job tenure as a proxy. Methods We surveyed flight attendants from two domestic U.S. airlines in 2007 and compared the prevalence of their health conditions to contemporaneous cohorts in the National Health and Nutrition Survey (NHANES), 2005-2006 and 2007-2008. We weighted the prevalence of flight attendant conditions to match the age distribution in the NHANES and compared the two populations stratified by gender using the Standardized Prevalence Ratio (SPR). For leading health conditions in flight attendants, we analyzed the association between job tenure and health outcomes in logistic regression models. Results Compared to the NHANES population (n =5,713), flight attendants (n = 4,011) had about a 3-fold increase in the age-adjusted prevalence of chronic bronchitis despite considerably lower levels of smoking. In addition, the prevalence of cardiac disease in female flight attendants was 3.5 times greater than the general population while their prevalence of hypertension and being overweight was significantly lower. Flight attendants reported 2 to 5.7 times more sleep disorders, depression, and fatigue, than the general population. Female flight attendants reported 34% more reproductive cancers. Health conditions that increased with longer job tenure as a flight attendant were chronic bronchitis, heart disease in females, skin cancer, hearing loss, depression and anxiety, even after adjusting for age, gender, body mass index (BMI), education, and smoking. Conclusions This study found higher rates of specific diseases in flight attendants than the general population. Longer tenure appears to explain some of the higher disease prevalence. Conclusions are limited by the cross-sectional design and recall bias. Further study is needed to determine the source of risk and to elucidate specific exposure-disease relationships over time. PMID:24612632

Which Triple Aim related measures are being used to evaluate population management initiatives? An international comparative analysis.

PubMed

Hendrikx, Roy J P; Drewes, Hanneke W; Spreeuwenberg, Marieke; Ruwaard, Dirk; Struijs, Jeroen N; Baan, Caroline A

2016-05-01

Population management (PM) initiatives are introduced in order to create sustainable health care systems. These initiatives should focus on the continuum of health and well-being of a population by introducing interventions that integrate various services. To be successful they should pursue the Triple Aim, i.e. simultaneously improve population health and quality of care while reducing costs per capita. This study explores how PM initiatives measure the Triple Aim in practice. An exploratory search was combined with expert consultations to identify relevant PM initiatives. These were analyzed based on general characteristics, utilized measures and related selection criteria. In total 865 measures were used by 20 PM initiatives. All quality of care domains were included by at least 11 PM initiatives, while most domains of population health and costs were included by less than 7 PM initiatives. Although their goals showed substantial overlap, the measures applied showed few similarities between PM initiatives and were predominantly selected based on local priority areas and data availability. Most PM initiatives do not measure the full scope of the Triple Aim. Additionally, variety between measures limits comparability between PM initiatives. Consensus on the coverage of Triple Aim domains and a set of standardized measures could further both the inclusion of the various domains as well as the comparability between PM initiatives. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Willingness to pay for health insurance among the elderly population in Germany.

PubMed

Bock, Jens-Oliver; Heider, Dirk; Matschinger, Herbert; Brenner, Hermann; Saum, Kai-Uwe; Haefeli, Walter E; König, Hans-Helmut

2016-03-01

All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans. Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57-84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals' WTP was elicited based on a contingent valuation method with a payment card. Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20% of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly. The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.

Noncommunicable diseases and the use of health services: analysis of the National Health Survey in Brazil

PubMed Central

Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Lima, Margareth Guimarães; de Araújo, Silvânia Suely Caribé; da Silva, Marta Maria Alves; Freitas, Maria Imaculada de Fátima; Barros, Marilisa Berti de Azevedo

2017-01-01

ABSTRACT OBJECTIVE To assess whether sex, education level, and health insurance affect the use of health services among the adult Brazilian population with chronic noncommunicable diseases (NCD). METHODS Data from a cross-sectional survey were analyzed, the National Health Survey (PNS). Frequency of use of services in the population that referred at least one NCD were compared with the frequency from a population that did not report NCD, according to sex, education level, health insurance, and NCD number (1, 2, 3, 4, or more). The prevalence and prevalence ratios were calculated crude and adjusted for sex, age, region, and 95% confidence intervals. RESULTS The presence of a noncommunicable disease was associated with increase in hospitalizations in the last 12 months, in 1.7 times (95%CI 1.53–1.9). Failing to perform usual activities in the last two weeks for health reasons was 3.1 times higher in NCD carriers (95%CI 2.78–3.46); while the prevalence of medical consultation in the last 12 months was 1.26 times higher (95%CI 1.24–1.28). NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level. CONCLUSIONS NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level. PMID:28591353

Bayesian nonparametric estimation of EQ-5D utilities for United States using the existing United Kingdom data.

PubMed

Kharroubi, Samer A

2017-10-06

Valuations of health state descriptors such as EQ-5D or SF6D have been conducted in different countries. There is a scope to make use of the results in one country as informative priors to help with the analysis of a study in another, for this to enable better estimation to be obtained in the new country than analyzing its data separately. Data from 2 EQ-5D valuation studies were analyzed using the time trade-off technique, where values for 42 health states were devised from representative samples of the UK and US populations. A Bayesian non-parametric approach has been applied to predict the health utilities of the US population, where the UK results were used as informative priors in the model to improve their estimation. The findings showed that employing additional information from the UK data helped in the production of US utility estimates much more precisely than would have been possible using the US study data alone. It is very plausible that this method would serve useful in countries where the conduction of large evaluation studies is not very feasible.

Geographic variation in public health spending: correlates and consequences.

PubMed

Mays, Glen P; Smith, Sharla A

2009-10-01

To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation. Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources. A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics. The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending. The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities.

Timing of the breath analyzer: does it make a difference?

PubMed

Cherpitel, C J

1993-09-01

The purpose of this article is to examine in an emergency room (ER) population the concordance of self-reports of no alcohol consumption prior to injury with breath-analyzer readings in two groups: (1) those patients from whom reports were obtained after they were breath analyzed compared to (2) patients from whom reports were obtained prior to obtaining the breath-analyzer reading. Data were collected on a probability sample of patients attending three health maintenance organization ERs. Among those sampled were 159 patients admitted for initial treatment of an injury, who were breath analyzed within 6 hours of the event and reported no drinking following the event that lead to injury. Of these, 119 were breath analyzed prior to the interview, and none who reported not drinking were positive on the breath analyzer, while of the 37 breath analyzed after the interview, only one was positive who had reported not drinking. Obtaining the breath-analyzer reading following the interview was not found to affect the rate of refusal to provide a breath-analyzer reading; however, it was found to adversely affect obtaining the breath-analyzer reading for other reasons. The data suggest that the concordance of negative self-reports of consumption with breath-analyzer readings remains high in ER populations regardless of when the breath-analyzer reading is obtained; however, it appears best to obtain the reading prior to interviewing the patient for reasons explained below.

Mental health and physical health of family caregivers for persons with dementia: a comparison of African American and white caregivers.

PubMed

Knight, B G; Longmire, C V Flynn; Dave, J; Kim, J H; David, S

2007-09-01

This investigation analyzed the differences between African American and white caregivers in the effects of family caregiving for a person with dementia on mental health and physical health variables (including subjective health, reported diseases and cardiovascular measures). A population-based sample of 102 caregivers is compared with 102 non-caregivers matched on ethnicity, gender and age. There were no significant group differences for mental health effects. Most significant physical health effects were attributable to main effects of ethnicity rather than caregiving status. However, African American caregivers had higher diastolic blood pressure than all other groups, a finding consistent with group-specific risk for circulatory system disorders.

Estimating the health consequences of flight attendant work: comparing flight attendant health to the general population in a cross-sectional study.

PubMed

McNeely, Eileen; Mordukhovich, Irina; Tideman, Samuel; Gale, Sara; Coull, Brent

2018-03-23

Flight attendants are an understudied occupational group, despite undergoing a wide and unique range of adverse job-related exposures. In our study, we aimed to characterize the health profile of cabin crew relative to the U.S. general population. In 2014-2015, we surveyed participants of the Harvard Flight Attendant Health Study. We compared the prevalence of their health conditions to a contemporaneous cohort in the National Health and Nutrition Examination Survey (NHANES 2013-2014) using age-weighted standardized prevalence ratios (SPRs). We also analyzed associations between job tenure and selected health outcomes, using logistic regression and adjusting for potential confounders. Compared to the NHANES population (n = 2729), flight attendants (n = 5366) had a higher prevalence of female reproductive cancers (SPR = 1.66, 95% CI: 1.18-2.33), cancers at all sites (SPR = 2.15, 95% CI: 1.73-2.67 among females), as well as sleep disorders, fatigue, and depression, with SPRs ranging between 1.98 and 5.57 depending on gender and the specific condition examined. In contrast, we observed a decreased prevalence of cardiac and respiratory outcomes among flight crew relative to NHANES. Health conditions that increased with longer job tenure were sleep disorders, anxiety/depression, alcohol abuse, any cancer, peripheral artery disease, sinusitis, foot surgery, infertility, and several perinatal outcomes. We observed higher rates of specific adverse health outcomes in U.S. flight attendants compared to the general population, as well as associations between longer tenure and health conditions, which should be interpreted in light of recall bias and a cross-sectional design. Future longitudinal studies should evaluate specific exposure-disease associations among flight crew.

The World Health Organization (WHO) dataset for guiding suicide prevention policies: A 3-decade French national survey.

PubMed

Fond, Guillaume; Zendjidjian, Xavier; Boucekine, Mohamed; Brunel, Lore; Llorca, Pierre-Michel; Boyer, Laurent

2015-12-01

Public health policies aim to prevent suicide in the general population. Assessing their effectiveness is required to further guide public health policies. The present article focuses on the French paradox. The French health care system was classified as the best in the world according the World Health Organization (WHO). However, suicide rates in France remain high compared to other European countries. The aim of the present article was to analyze (i) the evolution of suicide Age-Standardized Death (ASDRs) in France during the last three decades and the associations with socio-economic parameters and (ii) to understand which populations may specifically benefit from further targeted suicide prevention policies. The database of the World Health Organization (WHO), freely available, was explored in April 2015. ASDRs were calculated each year by ratio between the number of deaths by suicide and the total population (per 100,000 inhabitants). Number of deaths by gender and age were also analyzed. Overall, ASDR suicide has decreased since 1987 in France (-32.8% between 1987 and 2010). However, France kept the same rank (10/26) when compared to other European countries between 1987 and 2010. The relative burden of suicide in all-causes mortality increased during the same period (+28.2%) while the total number of deaths by suicide increased only slightly (+3.9%). More specifically, the number of deaths by suicide increased substantially in [35-54] years old (+40%) and 75+ years old (+27%) males, and in [35-54] (+41%) years old females. Between 2000 and 2010, suicide rates significantly decreased when yearly mean income increased, and when general and psychiatric care beds decreased. Although ASDR suicide has decreased in France since 1987, this decline is quite modest when considering its universal access to care, the prevention of depression and suicide public policies. Suicide prevention public policies should focus on evaluation and improvement of prevention and care in the [35-54] years old population, and in the males aged 75+. Copyright © 2015 Elsevier B.V. All rights reserved.

[To be better informed: the population problem in Rwanda and the scope of its solution].

PubMed

Gakwaya, D

1993-12-01

As part of its IEC program, Rwanda's National Office of Population (ONAPO) produced a 4-volume work entitled "The Demographic problem in Rwanda and the framework of its solution". The work places Rwanda's population problem in historical context by noting the progressive acceleration of the growth rate beginning in 1940. The population increased from 1,913,000 in 1940 to 3,735,000 in 1970 and 7,149,215 in 1991. The strategies initially proposed for maintaining balance between population and production included resettlement schemes to reduce population pressure in crowded zones and increase production. ONAPO was created to address the problem more directly. The first and most important of the volumes analyzes the relationship between population problems and national development. The problems discussed in relation to population include agriculture and food supply, nutrition, health and health care, education and school attendance, employment, migration and urbanization, environment, integration of women into development, changing attitudes and customs, and family planning. The second volume discusses food production and food self-sufficiency at a time when population is increasing rapidly but food production is declining. A model produced by ONAPO attempts to analyze the interrelationships between population and food production. Population factors included in the model are fertility, mortality, and migration. Twelve vegetable crops and 7 animal products evolve in the model according to area devoted to them, yield, soil quality, fallow, deforestation, and erosion. Agricultural products are transformed in the model to calories, protein, and fats. Different scenarios result from the combination of different factors, and their effect is to reduce or increase the volume of population and consequently the number f calories available per person and per day. Volume 3, on costs and benefits of family planning in Rwanda, compares 3 situations; no family planning, realistic family planning, and optimistic family planning. It demonstrates the savings in health, education, agriculture, and elsewhere that would result from a lower rate of population growth. Volume 4, on Rwanda's population policy and plan of action, summarizes the population policy and its components of family planning, reduction of early childhood mortality, promotion of family welfare, training and research, and migration. Specific objectives include increasing contraceptive prevalence from 12% in 1990 to 48.4% in 2000, reducing the growth rate from 3.6% in 1990 to 2% in 2000, and increasing life expectancy at birth from 49 years in 1985 to 53.5 in 2000.

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 population, respectively. These health inequalities were independent of socioeconomic status. The prevalence of poor mental health was higher among individuals in the non-payment stage of foreclosure than among those who were up to date with their payments (e.g., PRc = 1.16 [95 % CI 1.04-1.28]). In contrast, self-reported poor health was more prominent in later stages of foreclosure, such as in post-eviction without dation in payment stage in men (PRc = 2.24 [95 %CI = 1.35-3.72]). We observed a considerably higher prevalence of poor mental and self-reported health among male and female PAH members than in the general population. Public policies that tackle housing instability and its consequences are urgently needed in Spain.

Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis †

PubMed Central

Garcia-Subirats, Irene; Vargas, Ingrid; Sanz-Barbero, Belén; Malmusi, Davide; Ronda, Elena; Ballesta, Mónica; Vázquez, María Luisa

2014-01-01

Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012. PMID:25272078

A Carotenoid Health Index Based on Plasma Carotenoids and Health Outcomes

PubMed Central

Donaldson, Michael S.

2011-01-01

While there have been many studies on health outcomes that have included measurements of plasma carotenoids, this data has not been reviewed and assembled into a useful form. In this review sixty-two studies of plasma carotenoids and health outcomes, mostly prospective cohort studies or population-based case-control studies, are analyzed together to establish a carotenoid health index. Five cutoff points are established across the percentiles of carotenoid concentrations in populations, from the tenth to ninetieth percentile. The cutoff points (mean ± standard error of the mean) are 1.11 ± 0.08, 1.47 ± 0.08, 1.89 ± 0.08, 2.52 ± 0.13, and 3.07 ± 0.20 µM. For all cause mortality there seems to be a low threshold effect with protection above every cutoff point but the lowest. But for metabolic syndrome and cancer outcomes there tends to be significant positive health outcomes only above the higher cutoff points, perhaps as a triage effect. Based on this data a carotenoid health index is proposed with risk categories as follows: very high risk: <1 µM, high risk: 1-1.5 µM, moderate risk: 1.5-2.5 µM, low risk: 2.5-4 µM, and very low risk: >4 µM. Over 95 percent of the USA population falls into the moderate or high risk category of the carotenoid health index. PMID:22292108

Helping the healer: population-informed workplace wellness recommendations for physician well-being.

PubMed

Brooks, E; Early, S R; Gendel, M H; Miller, L; Gundersen, D C

2018-05-23

The need to keep physicians healthy and in practice is critical as demand for doctors grows faster than the supply. Workplace wellness programmes can improve employee health and retain skilled workers. To broaden our understanding about ways to help doctors coping with mental health problems and to develop population-informed workplace wellness recommendations for physician populations. Researchers surveyed physicians to document potential warning signs and prevention strategies. A survey was issued to doctors who presented to a physician health programme with mental health complaints. The survey captured respondents' feedback about how to identify and prevent mental health problems. Data were analyzed using simple descriptive statistics. There were 185 participants. Half of respondents believed their problems could have been recognized sooner and 60% said they exhibited signs that could aid in earlier detection. Potential warnings included fluctuations in mood (67%), increased comments about stress/burnout (49%) and behavioural changes (32%). To improve detection, prevention and care-seeking for mental health problems, doctors endorsed multiple items related to the use of interpersonal supports, personal factors and organizational dynamics throughout the survey. The findings confirmed earlier work demonstrating the value of social and organizational support in maintaining physician health. It further indicated that earlier identification and/or prevention of mental health problems is not only possible, but that medical organizations are uniquely situated to carry out this work.

Implications of Peer Pressure for Adolescent Nursing Research: A Concept Analysis Approach.

PubMed

Pittman, Alison F

2018-01-02

The influence of peers is widely held as a significant factor in child and adolescent development. As health care providers seek ways to improve the health of children and adolescents, peer pressure must be examined. This article analyzes peer pressure and its relationship to the health of children and adolescents. Defining attributes of peer pressure are discussed, including incomplete identity formation, the presence of a peer influence, and a need for approval. Antecedents and consequences of peer pressure are also explored. Methods of measuring peer pressure are discussed, along with implications for health care research in the pediatric population.

Dissecting health care markets: large versus small businesses.

PubMed

Sherwood, P K; Stevens, R E; Warren, W E

1988-01-01

This article reports the results of a mail survey of businesses in Tulsa, Oklahoma (population 377,900 in the city and 745,300 in the surrounding metropolitan area). The purpose of the research was to analyze differences in health care provision and perspectives between large and small businesses. The survey of 3,200 members of the city's chamber of commerce yielded 640 responses. Analysis of the data revealed distinct differences between the two segments of the health care industry. The findings suggest that market opportunities exist for the development of health care delivery system programs aimed at small businesses.

SELECTED PESTICIDE RESIDUES AND METABOLITES IN URINE FROM A SURVEY OF THE U.S. GENERAL POPULATION

EPA Science Inventory

Residues of toxic chemicals in human tissues and fluids can be important indicators of exposure. Urine collected from a subsample of the second National Health and Nutrition Examination Survey was analyzed for organochlorine, organophosphorus, and chlorophenoxy pesticides or the...

The Migrant - A Human Perspective.

ERIC Educational Resources Information Center

Genesee / Finger Lakes Regional Planning Board, Rochester, NY.

Inventorying and analyzing the housing needs of the region's migrant population, the report is presented in 2 sections. Part I introduces the migrant, staygrant, and rural agricultural worker. Part 2 addresses the particular needs of the agricultural worker, including the rural poor. Attention is given to education, training, health, social…

Factor structure and internal reliability of an exercise health belief model scale in a Mexican population.

PubMed

Villar, Oscar Armando Esparza-Del; Montañez-Alvarado, Priscila; Gutiérrez-Vega, Marisela; Carrillo-Saucedo, Irene Concepción; Gurrola-Peña, Gloria Margarita; Ruvalcaba-Romero, Norma Alicia; García-Sánchez, María Dolores; Ochoa-Alcaraz, Sergio Gabriel

2017-03-01

Mexico is one of the countries with the highest rates of overweight and obesity around the world, with 68.8% of men and 73% of women reporting both. This is a public health problem since there are several health related consequences of not exercising, like having cardiovascular diseases or some types of cancers. All of these problems can be prevented by promoting exercise, so it is important to evaluate models of health behaviors to achieve this goal. Among several models the Health Belief Model is one of the most studied models to promote health related behaviors. This study validates the first exercise scale based on the Health Belief Model (HBM) in Mexicans with the objective of studying and analyzing this model in Mexico. Items for the scale called the Exercise Health Belief Model Scale (EHBMS) were developed by a health research team, then the items were applied to a sample of 746 participants, male and female, from five cities in Mexico. The factor structure of the items was analyzed with an exploratory factor analysis and the internal reliability with Cronbach's alpha. The exploratory factor analysis reported the expected factor structure based in the HBM. The KMO index (0.92) and the Barlett's sphericity test (p < 0.01) indicated an adequate and normally distributed sample. Items had adequate factor loadings, ranging from 0.31 to 0.92, and the internal consistencies of the factors were also acceptable, with alpha values ranging from 0.67 to 0.91. The EHBMS is a validated scale that can be used to measure exercise based on the HBM in Mexican populations.

Health insurance coverage among women in Indonesia's major cities: A multilevel analysis.

PubMed

Christiani, Yodi; Byles, Julie E; Tavener, Meredith; Dugdale, Paul

2017-03-01

We examined women's access to health insurance in Indonesia. We analyzed IFLS-4 data of 1,400 adult women residing in four major cities. Among this population, the health insurance coverage was 24%. Women who were older, involved in paid work, and with higher education had greater access to health insurance (p < .05). We also found there were disparities in the probability of having health insurance across community levels (Median Odds Ratios = 3.40). Given the importance of health insurance for women's health, strategies should be developed to expand health insurance coverage among women in Indonesia, including the disparities across community levels. Such problems might also be encountered in other developing countries with low health insurance coverage.

Mental health literacy as a mediator in use of mental health services among older korean adults.

PubMed

Kim, Young Sun; Rhee, T Greg; Lee, Hee Yun; Park, Byung Hyun; Sharratt, Monica L

2017-02-01

Existing literature suggests that mental health literacy is positively associated with mental health services utilization. Despite an aging population that faces significant mental health concerns in Korea, the role of mental health literacy on mental health services utilization is not known among older adults in Korea. This study aimed to (1) identify whether mental health literacy mediates the association between population characteristics and mental health services utilization and (2) identify an optimal path model for mental health services utilization among Korean older adults. Using a cross-sectional survey with a quota sampling strategy, we collected and analyzed responses from 596 community-dwelling individuals ages 65 years and older. We used structural equation modeling (SEM) to estimate the effect of mental health literacy as a mediator. When controlling for other relevant covariates in the optimal path model, mental health literacy mediated the relationships between three socio-demographic factors (education, general literacy, and health status) and mental health services utilization. The model fit index shows that the SEM fits very well (CFI = 0.92, NFI = 0.90, RMSEA = 0.07). Efforts to improve mental health literacy through community-based education programs may need to particularly target Korean older adults with the relevant socio-demographic characteristics to enhance their utilization of appropriate mental health services.

We need to "ikarar the kutipados": intercultural understanding and health care in the Peruvian Amazon.

PubMed

Yajahuanca, Rosário Avellaneda; Diniz, Carmen Simone Grilo; Cabral, Cristiane da Silva

2015-09-01

The scope of this qualitative research was to describe and analyze how the Kukamas Kukamirias indigenous population from the Peruvian Amazon perceives and evaluates the healthcare offered by health workers at the local San Regis health post. An ethnographic-based study was conducted among the San Regis community on the Marañon River in the Loreto district of Peru, including interviews and participative observations with female and male patients as well as with traditional healers and professional health workers. An intercultural perspective is adopted to discuss the evaluations made by the Kukamas Kukamirias about the healthcare offered by professionals at their local health post. Issues examined include the intercultural matches and mismatches that affect vulnerable groups of the population in their interactions with the health services. The frequent preference shown for traditional treatment implies a close relationship between the healer and the person who is sick. This means that conventional forms of healthcare should be seen from an intercultural perspective and taken into account when organizing and articulating health services.

Hospitalizations owing to ambulatory care sensitive conditions in Florianopolis, Santa Catarina - an ecological study, 2001-2011.

PubMed

Brasil, Vinicius Paim; Costa, Juvenal Soares Dias da

2016-01-01

to evaluate trends in rates of hospitalizations owing to ambulatory care sensitive conditions in the municipality of Florianópolis, Santa Catarina, Brazil, from 2001 to 2011, and to assess correlation with the public health expendutures Family Health Strategy (FHS) population coverage. this was an ecological study using Ministry of Health secondary data; data were analyzed using Poisson Regression. the regression coefficient was 0.97, showing a decrease of 3% per year in hospitalizations owing to ambulatory care sensitive conditions, a three-fold increase in FHS coverage and seven times more financial investment per capita in health services, from R$67.65 in 2001 to R$471.03 in 2011; FHS investments per capita in health and population coverage were negatively correlated to the rate of hospitalizations owing to ambulatory care sensitive conditions. financial investment and FHS expansion had led to major reductions in the rate of hospitalizations owing to ambulatory care sensitive conditions.

Stress, mental health, and job performance among active duty military personnel: findings from the 2002 Department of Defense Health-Related Behaviors Survey.

PubMed

Hourani, Laurel L; Williams, Thomas V; Kress, Amii M

2006-09-01

This study examined the extent to which high levels of occupational and family stress were associated with mental health problems and productivity loss among active duty military personnel. We analyzed data from the 2002 Department of Defense Survey of Health-Related Behaviors among Military Personnel, which provided extensive population-based information on 12,756 active duty personnel in all branches of the military worldwide. Military personnel reported higher levels of stress at work than in their family life. The personnel reporting the highest levels of occupational stress were those 25 or younger, those who were married with spouses not present, and women. Personnel with high levels of stress had significantly higher rates of mental health problems and productivity loss than those with less stress. We recommend that prevention and intervention efforts geared toward personnel reporting the highest levels of stress be given priority for resources in this population.

Gender differences in beliefs about health: a comparative qualitative study with Ghanaian and Indian migrants living in the United Kingdom.

PubMed

Alidu, Lailah; Grunfeld, Elizabeth A

2017-03-20

There is a well-established association between migration to high income countries and health status, with some groups reporting poorer health outcomes than the host population. However, processes that influence health behaviours and health outcomes across minority ethnic groups are complex and in addition, culture ascribes specific gender roles for men and women, which can further influence perspectives of health. The aim of this study was to undertake a comparative exploration of beliefs of health among male and female Ghanaian and Indian migrants and White British participants residing in an urban area within the UK. Thirty-six participants (12 each Ghanaian, Indian and White British) were recruited through community settings and participated in a semi-structured interview focusing on participant's daily life in the UK, perceptions of their own health and how they maintained their health. Interviews were analyzed using a Framework approach. Three super ordinate themes were identified and labelled (a) beliefs about health; (b) symptom interpretation and (c) self-management and help seeking. Gender differences in beliefs and health behaviour practices were apparent across participants. This is the first study to undertake a comparative exploration of health beliefs among people who have migrated to the UK from Ghana and India and to compare with a local (White British) population. The results highlight a need to consider both cultural and gender-based diversity in guiding health behaviours, and such information will be useful in the development of interventions to support health outcomes among migrant populations.

Angry, Scared, and Unsure: Mental Health Consequences of Contaminated Water in Flint, Michigan.

PubMed

Cuthbertson, Courtney A; Newkirk, Cathy; Ilardo, Joan; Loveridge, Scott; Skidmore, Mark

2016-12-01

Natural and manmade crises impact community-level behavioral health, including mental health and substance use. This article shares findings from a larger project about community behavioral health, relevant to the ongoing water crisis in Flint, Michigan, using data from a larger study, involving monthly surveys of a panel of key informants from Genesee County. The data come from open-response questions and are analyzed as qualitative data using grounded theory techniques. Although respondents were not asked about the water issues in Flint, participants commented that the water situation was increasing stress, anxiety, and depression among the city's population. Participants thought these mental health issues would affect the entire community but would be worse among low-income, African American populations in the city. Mental health consequences were related not only to the water contamination but to distrust of public officials who are expected and have the authority to resolve the issues. The mental health effects of this public health crisis are significant and have received inadequate attention in the literature. Public health response to situations similar to the water issues in Flint should include sustained attention mental health.

Modeling of road traffic noise and estimated human exposure in Fulton County, Georgia, USA.

PubMed

Seong, Jeong C; Park, Tae H; Ko, Joon H; Chang, Seo I; Kim, Minho; Holt, James B; Mehdi, Mohammed R

2011-11-01

Environmental noise is a major source of public complaints. Noise in the community causes physical and socio-economic effects and has been shown to be related to adverse health impacts. Noise, however, has not been actively researched in the United States compared with the European Union countries in recent years. In this research, we aimed at modeling road traffic noise and analyzing human exposure in Fulton County, Georgia, United States. We modeled road traffic noise levels using the United States Department of Transportation Federal Highway Administration Traffic Noise Model implemented in SoundPLAN®. After analyzing noise levels with raster, vector and façade maps, we estimated human exposure to high noise levels. Accurate digital elevation models and building heights were derived from Light Detection And Ranging survey datasets and building footprint boundaries. Traffic datasets were collected from the Georgia Department of Transportation and the Atlanta Regional Commission. Noise level simulation was performed with 62 computers in a distributed computing environment. Finally, the noise-exposed population was calculated using geographic information system techniques. Results show that 48% of the total county population [N=870,166 residents] is potentially exposed to 55 dB(A) or higher noise levels during daytime. About 9% of the population is potentially exposed to 67 dB(A) or higher noises. At nighttime, 32% of the population is expected to be exposed to noise levels higher than 50 dB(A). This research shows that large-scale traffic noise estimation is possible with the help of various organizations. We believe that this research is a significant stepping stone for analyzing community health associated with noise exposures in the United States. Copyright © 2011 Elsevier Ltd. All rights reserved.

Rethinking library service to distance education students: analyzing the embedded librarian model.

PubMed

Sullo, Elaine; Harrod, Tom; Butera, Gisela; Gomes, Alexandra

2012-01-01

Since fall 2009, reference librarians at The George Washington University's Himmelfarb Health Sciences Library have been embedded in online classes through Blackboard within the School of Nursing and School of Medicine and Health Sciences. The authors sought to determine the types of questions asked of the librarian, with the goal of informing future interactions with distance education classes to help develop a standard "protocol" for working with this population of students. Eighty-two questions were categorized and qualitatively analyzed. The findings have prompted librarians to explore tools such as Elluminate Live!, a tool that allows librarians to provide synchronous instruction within the Blackboard environment. Copyright © Taylor & Francis Group, LLC

Trends in health-care costs and utilization for inflammatory bowel disease from 2010 to 2014 in Korea: A nationwide population-based study.

PubMed

Kim, Jung-Wook; Lee, Chang Kyun; Rhee, Sang Youl; Oh, Chi Hyuck; Shim, Jae-Jun; Kim, Hyo Jong

2018-04-01

Data regarding health-care costs and utilization for inflammatory bowel disease (IBD) at the population level are limited in Asia. We aimed to investigate the nationwide prevalence and health-care cost and utilization of IBD in Korea. We tracked the IBD-attributable health-care costs and utilization from 2010 to 2014 using the public dataset obtained from Korean National Health Insurance Service claims. We estimated the nationwide prevalence of IBD using population census data from Statistics Korea during the same period. In total, 236 106 IBD patients were analyzed. The estimated IBD prevalence significantly increased from 85.1/100 000 in 2010 to 106/100 000 in 2014. The overall annual health-care costs for IBD increased from $23.2 million (US dollars) in 2010 to $49.7 million in 2014 (P < 0.001). During the same period, the health-care cost per capita also increased from $572.3 to $983.7 (P < 0.001). The outpatient to total cost ratio increased from 45.5% in 2010 to 66.6% in 2014. Regarding health-care utilization, the outpatient to total days of service use ratio increased from 73.1% in 2010 to 76.9% in 2014. Of the total days of service used, the proportions of tertiary, general, and community hospitals increased significantly with a concomitant decrease in that of primary clinics (all P values < 0.001). This population-based study confirmed the steadily rising rate of prevalence of IBD in Korea. It also demonstrated that the shifting to outpatient care and advanced care settings are drivers for the dramatic increase in IBD-related health-care costs in Korea. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Impact of Preoperative Radiotherapy on General and Disease-Specific Health Status of Rectal Cancer Survivors: A Population-Based Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thong, Melissa S.Y., E-mail: M.Thong@uvt.nl; Comprehensive Cancer Centre South, Eindhoven; Mols, Floortje

Purpose: To date, few studies have evaluated the impact of preoperative radiotherapy (pRT) on long-term health status of rectal cancer survivors. Using a population-based sample, we assessed the impact of pRT on general and disease-specific health status of rectal cancer survivors up to 10 years postdiagnosis. The health status of older ({>=}75 years old at diagnosis) pRT survivors was also compared with that of younger survivors. Methods and Materials: Survivors identified from the Eindhoven Cancer Registry treated with surgery only (SU) or with pRT between 1998 and 2007 were included. Survivors completed the Short Form-36 (SF-36) health survey questionnaire andmore » the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal 38 (EORTC QLQ-CR38) questionnaire. The SF-36 and EORTC QLQ-CR38 (sexuality subscale) scores of the survivors were compared to an age- and sex-matched Dutch normal population. Results: A total of 340 survivors (response, 85%; pRT survivors, 71%) were analyzed. Overall, survivors had similar general health status. Both short-term (<5 years) and long-term ({>=}5 years) pRT survivors had significantly poorer body image and more problems with gastrointestinal function, male sexual dysfunction, and defecation than SU survivors. Survivors had comparable general health status but greater sexual dysfunction than the normal population. Older pRT survivors had general and disease-specific health status comparable to that of younger pRT survivors. Conclusions: For better survivorship care, rectal cancer survivors could benefit from increased clinical and psychological focus on the possible long-term morbidity of treatment and its effects on health status.« less

Women's reproductive health in slum populations in India: evidence from NFHS-3.

PubMed

Hazarika, Indrajit

2010-03-01

The urban population in India is one of the largest in the world. Its unprecedented growth has resulted in a large section of the population living in abject poverty in overcrowded slums. There have been limited efforts to capture the health of people in urban slums. In the present study, we have used data collected during the National Family Health Survey-3 to provide a national representation of women's reproductive health in the slum population in India. We examined a sample of 4,827 women in the age group of 15-49 years to assess the association of the variable slum with selected reproductive health services. We have also tried to identify the sociodemographic factors that influence the utilization of these services among women in the slum communities. All analyses were stratified by slum/non-slum residence, and multivariate logistic regression was used to analyze the strength of association between key reproductive health services and relevant sociodemographic factors. We found that less than half of the women from the slum areas were currently using any contraceptive methods, and discontinuation rate was higher among these women. Sterilization was the most common method of contraception (25%). Use of contraceptives depended on the age, level of education, parity, and the knowledge of contraceptive methods (p < 0.05). There were significant differences in the two populations based on the timing and frequency of antenatal visits. The probability of ANC visits depended significantly on the level of education and economic status (p < 0.05). We found that among slum women, the proportion of deliveries conducted by skilled attendants was low, and the percentage of home deliveries was high. The use of skilled delivery care was found to be significantly associated with age, level of education, economic status, parity, and prior antenatal visits (p < 0.05). We found that women from slum areas depended on the government facilities for reproductive health services. Our findings suggest that significant differences in reproductive health outcomes exist among women from slum and non-slum communities in India. Efforts to progress towards the health MDGs and other national or international health targets may not be achieved without a focus on the urban slum population.

Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam

PubMed Central

2012-01-01

Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance. PMID:22376290

Availability of information in Public Health on the Internet: An analysis of national health authorities in the Spanish-speaking Latin American and Caribbean countries.

PubMed

Novillo-Ortiz, David; Hernández-Pérez, Tony; Saigí-Rubió, Francesc

2017-04-01

Access to reliable and quality health information and appropriate medical advice can contribute to a dramatic reduction in the mortality figures of countries. The governments of the Americas are faced with the opportunity to continue working on this challenge, and their institutional presence on their websites should play a key role in this task. In a setting where the access to information is essential to both health professionals and citizens, it is relevant to analyze the role of national health authorities. Given that search engines play such a key role in the access to health information, it is important to specifically know - in connection to national health authorities - whether health information offered is easily available to the population, and whether this information is well-ranked in search engines. Quantitative methods were used to gather data on the institutional presence of national health authorities on the web. An exploratory and descriptive research served to analyze and interpret data and information obtained quantitatively from different perspectives, including an analysis by country, and also by leading causes of death. A total of 18 web pages were analyzed. Information on leading causes of death was searched on websites of national health authorities in the week of August 10-14, 2015. The probability of finding information of national health authorities on the 10 leading causes of death in a country, among the top 10 results on Google, is 6.66%. Additionally, ten out the 18 countries under study (55%) do not have information ranked among the top results in Google when searching for the selected terms. Additionally, a total of 33 websites represent the sources of information with the highest visibility for all the search strategies in each country on Google for the ten leading causes of death in a country. Two websites, the National Library of Medicine and Wikipedia, occur as a result with visibility in the total of eighteen countries of the sample. Taking into consideration that providing reliable and quality information on these topics to the population should be one of the priorities of national health authorities, these results suggest that national health authorities need to take measures to try to better position their contents. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Improving Health Promotion to American Indians in the Midwest United States: Preferred Sources of Health Information and Its Use for the Medical Encounter

PubMed Central

Geana, Mugur V.; Greiner, K. Allen; Cully, Angelia; Talawyma, Myrietta; Daley, Christine Makosky

2014-01-01

American Indians and Alaska Natives suffer significant health disparities for many infectious and chronic diseases as compared to the general population. Providing accurate and culturally tailored health information to underserved groups has been shown to influence health behaviors and health outcomes. Little prior research has explored American Indians health information use and preferences. National representative sample surveys such as the Health Information National Trends Survey provide some data on minority groups but are underpowered to provide useful information on American Indians. The present study analyzes data from a survey of over 900 American Indians from the Midwest United States and explores their sources of health information, their preferences for information presentation, and their use of health information prior to and during medical encounters. We conclude that campaigns targeting Natives should be narrowly focused and be community driven or employing community resources. American Indians use a diversity of media sources to obtain health information, with the Internet being underutilized compared to the general population. Partnership with Indian Health Service providers and pharmacists, as well as traditional healers, in the development and dissemination of new health information for Natives may provide the “expert” tone needed to promote health improvements in American Indians. PMID:22477671

Urinary cadmium in the 1999–2008 U.S. National Health and Nutrition Examination Survey (NHANES)

EPA Science Inventory

Chronic low-level cadmium (Cd) exposure is linked to kidney and cardiovascular disease, fractures, and cancer. Diet and smoking are primary sources of exposure in the general population. We analyzed urinary Cd in NHANES 1999-2008 to determine whether levels declined significantly...

Analyzing Clinical Presentation, Service Utilization, and Clinical Outcome of Female Sexual Minority College Students

ERIC Educational Resources Information Center

Kay, Heather C.

2013-01-01

Researchers examining clinically-relevant trends for sexual minority women have found evidence of psychological distress and greater utilization of mental health services compared to heterosexually-identified women. However, the results of many research studies with this population have methodological limitations surrounding recruitment of…

Sociological Factors Affecting Childhood Obesity

ERIC Educational Resources Information Center

Forster-Scott, Latisha

2007-01-01

According to data from the National Center for Health Statistics, childhood obesity rates are highest among ethnic minorities. It is very helpful to consider the role of culture when attempting to analyze and explain obesity rates in ethnic minority populations. Culture influences the attitudes and beliefs toward exercise, food and nutrition, and…

Breast cancer screening among shift workers: a nationwide population-based survey in Korea.

PubMed

Son, Heesook; Kang, Youngmi

2017-04-01

We aimed to examine the association between shift work types and participation in breast cancer screening (BCS) programs by comparing rates of participation for BCS among regular daytime workers and alternative shift workers using data from a nationally representative, population-based survey conducted in Korea. In addition, the results were analyzed according to sociodemographic factors, including occupation, education, income, private health insurance, age, and number of working hours a week. This secondary cross-sectional analysis used data from the 2012 Korean National Health and Nutritional Examination Survey. The target population included women aged ≥ 40 years who responded as to whether they had undergone BCS in the previous year. Accordingly, we analyzed survey data for a total of 1,193 women and used a multivariate logistic regression analysis to evaluate the differences in factors affecting BCS between regular daytime and alternative shift workers. A logistic regression analysis was performed considering private health insurance as a significant sociodemographic factor for BCS among regular daytime shift workers. In contrast, none of the tested variables could significantly predict adherence to BCS among alternative shift workers. The results of this study suggest the need for the development of comprehensive workplace breast cancer prevention programs by considering shift work types. More attention should be given to female workers with low education levels, those who are uninsured, and young workers to improve the participation rate for BCS at the workplace.

Association between cardiovascular disease and socioeconomic level in Portugal.

PubMed

Ribeiro, Sónia; Furtado, Cláudia; Pereira, João

2013-11-01

Cardiovascular disease is the leading cause of morbidity, mortality and disability in Portugal. Socioeconomic level is known to influence health status but there is scant evidence on socioeconomic inequalities in cardiovascular disease in Portugal. To analyze the distribution of cardiovascular disease in the Portuguese population according to socioeconomic status. We conducted a cross-sectional study using data from the fourth National Health Survey on a representative sample of the Portuguese population. Socioeconomic inequalities in cardiovascular disease, risk factors and number of medical visits were analyzed using odds ratios according to socioeconomic status (household equivalent income) in the adult population (35-74 years). Comparisons focused on the top and bottom 50% and 10% of household income distribution. Of the 21 807 individuals included, 53.3% were female, and mean age was 54 ± 11 years. Cardiovascular disease, stroke, ischemic heart disease, hypertension, diabetes, obesity and physical inactivity were associated with lower socioeconomic status, while smoking was associated with higher status; number of medical visits and psychological distress showed no association. When present, inequality was greater at the extremes of income distribution. The results reveal an association between morbidity, lifestyle and socioeconomic status. They also suggest that besides improved access to effective medical intervention, there is a need for a comprehensive strategy for health promotion and disease prevention that takes account of individual, cultural and socioeconomic characteristics. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

[Changes in behaviors and indicators of mental health between 2006 and 2010 in the French working population].

PubMed

Malard, L; Chastang, J-F; Niedhammer, I

2017-08-01

The 2008 economic crisis may have had an impact on mental health but the studies on this topic are sparse, in particular among the working population. However, mental health at work is a crucial issue involving substantial costs and consequences. The aim of the study was to assess changes in behaviors and indicators of mental health in the French working population between 2006 and 2010, and to explore the differential changes according to age, origin, occupation, activity sector, public/private sector, self-employed/employee status and work contract. The data came from the prospective national representative Santé et itinéraire professionnel (SIP) survey, including a sample of 5600 French workers interviewed in 2006 and 2010. The behaviors and indicators of mental health studied were excessive alcohol consumption, smoking, sleep problems (sleep disorders and/or insufficient sleep duration), psychotropic drug use (antidepressants, anxiolytics and/or hypnotics), and poor self-reported health. Generalized estimating equations were used to analyze changes in behaviors and indicators of mental health, and the analyses were adjusted for age. Covariates (age, origin, occupation, activity sector, public/private sector, self-employed/employee status and type of contract) were added separately to assess differential changes. Increases in excessive alcohol consumption among women, sleep problems among men, and smoking, insufficient sleep duration and poor self-reported health for both genders were observed in the French working population between 2006 and 2010. Some differential changes were observed, negative changes being more likely to affect young workers and workers with a permanent contract. Prevention policies should consider that behavior and indicators of mental health may deteriorate in times of economic crisis, especially among some sub-groups of the working population, such as young workers and workers with a permanent contract. These changes might foreshadow a forthcoming increase in mental disorders. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Public health consequences of terrorism on maternal-child health in New York City and Madrid.

PubMed

Sherrieb, Kathleen; Norris, Fran H

2013-06-01

Past research provides evidence for trajectories of health and wellness among individuals following disasters that follow specific pathways of resilience, resistance, recovery, or continued dysfunction. These individual responses are influenced by event type and pre-event capacities. This study was designed to utilize the trajectories of health model to determine if it translates to population health. We identified terrorist attacks that could potentially impact population health rather than only selected individuals within the areas of the attacks. We chose to examine a time series of population birth outcomes before and after the terrorist events of the New York City (NYC) World Trade Center (WTC) attacks of 2001 and the Madrid, Spain train bombings of 2004 to determine if the events affected maternal-child health of those cities and, if so, for how long. For percentages of low birth weight (LBW) and preterm births, we found no significant effects from the WTC attacks in NYC and transient but significant effects on rates of LBW and preterm births following the bombings in Madrid. We did find a significant positive and sustained effect on infant mortality rate in NYC following the WTC attacks but no similar effect in Madrid. There were no effects on any of the indicator variables in the comparison regions of New York state and the remainder of Spain. Thus, population maternal-health in New York and Madrid showed unique adverse effects after the terrorist attacks in those cities. Short-term effects on LBW and preterm birth rates in Madrid and long-term effects on infant mortality rates in NYC were found when quarterly data were analyzed from 1990 through 2008/2009. These findings raise questions about chronic changes in the population's quality of life following catastrophic terrorist attacks. Public health should be monitored and interventions designed to address chronic stress, environmental, and socioeconomic threats beyond the acute aftermath of events.

Preventing Filipino Mental Health Disparities: Perspectives from Adolescents, Caregivers, Providers, and Advocates

PubMed Central

Javier, Joyce R.; Supan, Jocelyn; Lansang, Anjelica; Beyer, William; Kubicek, Katrina; Palinkas, Lawrence A.

2014-01-01

Filipino Americans are the second largest immigrant population and second largest Asian ethnic group in the U.S. Disparities in youth behavioral health problems and the receipt of mental health services among Filipino youth have been documented previously. However, few studies have elicited perspectives from community stakeholders regarding how to prevent mental health disparities among Filipino youth. The purpose of the current study is to identify intervention strategies for implementing mental health prevention programs among Filipino youth. We conducted semi-structured interviews (n=33) with adolescents, caregivers, advocates, and providers and focus groups (n=18) with adolescents and caregivers. Interviews were audio taped and transcribed verbatim. Transcripts were analyzed using a methodology of “coding consensus, co-occurrence, and comparison” and was rooted in grounded theory. Four recommendations were identified when developing mental health prevention strategies among Filipino populations: address the intergenerational gap between Filipino parents and children, provide evidence-based parenting programs, collaborate with churches in order to overcome stigma associated with mental health, and address mental health needs of parents. Findings highlight the implementation of evidence-based preventive parenting programs in faith settings as a community-identified and culturally appropriate strategy to prevent Filipino youth behavioral health disparities. PMID:25667725

Preventing Filipino Mental Health Disparities: Perspectives from Adolescents, Caregivers, Providers, and Advocates.

PubMed

Javier, Joyce R; Supan, Jocelyn; Lansang, Anjelica; Beyer, William; Kubicek, Katrina; Palinkas, Lawrence A

2014-12-01

Filipino Americans are the second largest immigrant population and second largest Asian ethnic group in the U.S. Disparities in youth behavioral health problems and the receipt of mental health services among Filipino youth have been documented previously. However, few studies have elicited perspectives from community stakeholders regarding how to prevent mental health disparities among Filipino youth. The purpose of the current study is to identify intervention strategies for implementing mental health prevention programs among Filipino youth. We conducted semi-structured interviews (n=33) with adolescents, caregivers, advocates, and providers and focus groups (n=18) with adolescents and caregivers. Interviews were audio taped and transcribed verbatim. Transcripts were analyzed using a methodology of "coding consensus, co-occurrence, and comparison" and was rooted in grounded theory. Four recommendations were identified when developing mental health prevention strategies among Filipino populations: address the intergenerational gap between Filipino parents and children, provide evidence-based parenting programs, collaborate with churches in order to overcome stigma associated with mental health, and address mental health needs of parents. Findings highlight the implementation of evidence-based preventive parenting programs in faith settings as a community-identified and culturally appropriate strategy to prevent Filipino youth behavioral health disparities.

Public Health Aspects of Global Population Health and Well-being in the 21st Century Regarding Determinants of Health.

PubMed

Masic, Izet

2018-01-01

Why did I recall the details about public health aspects of global population and well-being in the 21 st century regarding the determinants of health? Most of all because today, at the end of 2017, we are talking about the same principles from the "Declaration on Primary Health Care" from 1978, and the same goals as those in "Health for all" which are still current or perhaps even more current than when they were published for the first time in scientific and professional literature. This is a notorious fact, even though we are talking about "Global Health" and its determinants, in all countries of the world, regardless of their social wealth, and all existing resources, especially those, intended to organize health care. In the field of practice, public health has advanced in knowledge and methodology. Biomedical scientists have identified many causes of infectious diseases and developed methods to put them under control. Epidemiologists have identified risk factors that favor many chronic illnesses and information that can be used to reduce the risk of disease. Efforts to cleanse the environment have resulted in air and water that are far safer than half a century ago. Intensive educational efforts have convinced the health-care organizers to improve their health behavior that is to quit tobacco use, and a combination of drinking and driving. The ability to assess the populations' health behaviors and assess the share of health interventions has also significantly improved the availability of health-care databases and computer software capable of analyzing them. However, much of the targets from the World Health Organization declarations are not improved or in some countries provided by official institutions responsible for public health activities.

[Intake of vitamins D and K, and their impact on health in female population].

PubMed

Navia Lombán, Beatriz; Cuadrado Soto, Esther; Ortega, Rosa M

2015-07-18

Vitamins D and K are essential for maintaining bone and its deficiency has been associated with several chronic diseases. To know the intake of vitamins D and K in female population and analyze their involvement on health. Literature research regarding the topic. Intake of vitamin D in the Spanish female population from 17 to 60 years is lower than the estimated average requirement in the 95.5% of the studied participants and 30.2% of the Spanish population does not meet the established adequate intake for vitamin K. Several studies have emphasized the importance of maintaining optimal nutrition status of vitamin D for its role in the maintenance of bone, but also for its involvement in body weight control and prevention of diseases (cardiovascular disease, type 2 diabetes, cancer). Vitamin K deficiency is also associated with decreased bone density and increased cardiovascular risk besides exerting a protective effect against type 2 diabetes. In female population, the intake of vitamin K, but especially vitamin D, is often lower than recommended. Since a worse nutritional status in these vitamins is associated with damage in bone health, weight control, as well as an increased risk of several diseases, it seems appropriate to monitor and improve their intake. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Baseline participation in a health examination survey of the population 65 years and older: who is missed and why?

PubMed

Gaertner, Beate; Seitz, Ina; Fuchs, Judith; Busch, Markus A; Holzhausen, Martin; Martus, Peter; Scheidt-Nave, Christa

2016-01-19

Public health monitoring depends on valid health and disability estimates in the population 65+ years. This is hampered by high non-participation rates in this age group. There is limited insight into size and direction of potential baseline selection bias. We analyzed baseline non-participation in a register-based random sample of 1481 inner-city residents 65+ years, invited to a health examination survey according to demographics available for the entire sample, self-report information as available and reasons for non-participation. One year after recruitment, non-responders were revisited to assess their reasons. Five groups defined by participation status were differentiated: participants (N = 299), persons who had died or moved (N = 173), those who declined participation, but answered a short questionnaire (N = 384), those who declined participation and the short questionnaire (N = 324), and non-responders (N = 301). The results confirm substantial baseline selection bias with significant underrepresentation of persons 85+ years, persons in residential care or from disadvantaged neighborhoods, with lower education, foreign citizenship, or lower health-related quality of life. Finally, reasons for non-participation could be identified for 78% of all non-participants, including 183 non-responders. A diversity in health problems and barriers to participation exists among non-participants. Innovative study designs are needed for public health monitoring in aging populations.

Determinants of neonatal mortality in rural Haryana: a retrospective population based study.

PubMed

Upadhyay, R P; Dwivedi, P R; Rai, S K; Misra, P; Kalaivani, M; Krishnan, A

2012-04-01

To identify the determinants of neonatal mortality. Nested case-control study. 28 villages under the intensive field practice area of Comprehensive Rural Health Services Project, Ballabgarh, Haryana serving a population of 87,016, as on 31st December 2009. The study period was from 2005 to 2009. The data were obtained from Health Management Information System and analyzed using multivariate logistic regression analysis. A hierarchical approach was used to analyze the factors associated with neonatal deaths, using community level factors, socio-economic status and biological determinants. The population attributable fractions were estimated for significant variables. The total live births during the study period were 10392 and neonatal deaths were 248. The infant and neonatal mortality rates during the study period were 45.6 and 23.8 per 1000 live births, respectively. Socio-economic determinants (Low educational status of parents [OR 2.1, 95% CI; 1.4, 3.3]; fathers occupation [OR 1.8, 95% CI; 1.0, 3.0]; Rajput caste [OR 2.0, 95% CI; 1.2, 3.4] appeared to explain a major fraction (45.7%) of neonatal deaths. Community level factors (villages with no health facility [OR 1.5, 95% CI; 1.0, 2.1]; villages with population >6000 [OR 1.7, 95% CI; 1.2, 2.5]) were associated with 27.3% of all neonatal deaths. Proximate determinants (early childbearing age of mother (<20 years) [OR 2.0, 95% CI; 1.2, 3.2]) were least important. All the three level of variables seemed to act independently with little mediation among them. Neonatal mortality is affected by socioeconomic, community level and proximate biological determinants.

Leadership lessons in global nursing and health from the Nightingale Letter Collection at the University of Alabama at Birmingham.

PubMed

Harper, Doreen C; Davey, Kimberly S; Fordham, Pamela N

2014-03-01

This article analyzes the components of Florence Nightingale's visionary leadership for global health and nursing within the historical context of Great Britain's colonization of India. The descriptive study used the qualitative approach of narrative analysis to analyze selected letters in the Nightingale Letter Collection at the University of Alabama at Birmingham that Nightingale wrote to or about Dr. Thomas Gillham Hewlett, a physician and health officer in Bombay, India. The authors sought to increase understanding of Nightingale's visionary leadership for global nursing and health through a study of the form and content of the letters analyzed as temporally contextualized data, focusing on how the narratives are composed and what is conveyed. Several recurring themes central to Nightingale's leadership on global nursing and health emerge throughout these letters, including health and sanitation reform, collaborative partnerships, data-driven policy development, and advocacy for public health. These themes are illustrated through her letters to and testimony about Dr. Thomas Gillham Hewlett in her vivid descriptions of health education and promotion, data-driven policy documents, public health and sanitation advice, and collaboration with citizens, medicine, policy makers, and governments to improve the health and welfare of the people of India. The focus on leadership in nursing as a global construct highlights the lessons learned from University of Alabama at Birmingham's Nightingale Letter Collection that has relevance for the future of nursing and health care, particularly Nightingale's collaboration with policy leaders, her analysis of data to set policy agendas, and public health reform centered on improving the health and well-being of underserved populations.

Hematological reference values of healthy Malaysian population.

PubMed

Roshan, T M; Rosline, H; Ahmed, S A; Rapiaah, M; Wan Zaidah, A; Khattak, M N

2009-10-01

Health and disease can only be distinguished by accurate and reliable reference values of a particular laboratory test. It is now a proven fact that there is considerable variation in hematology reference intervals depending on the demographic and preanalytical variables. There are evidences that values provided by manufacturers do not have appropriate application for all populations. Moreover, reference ranges provided by different laboratory manuals and books also do not solve this problem. We are presenting here normal reference ranges of Malaysian population. These values were determined by using Sysmex XE-2100 and ACL 9000 hematology and coagulation analyzers. Results from this study showed that there were considerable differences in the reference values from manufacturers, western population or laboratory manuals compared with those from the local population.

Multitarget survey on the Finance Police personnel: assessment of the health condition

PubMed Central

Barraco, Giancarlo; Pagano, Stefano; Lupoli, Grazia; Dolci, Alessandro; Colagrosso, Beniamino

2014-01-01

Summary Introduction Over the past 10–15 years, Italy has undergone a social transformation, and the class of employees and workers has become more economically stable with a higher buying power. Along with the increased expectations of patients on the quality of life, it has now become a priority to make health and social services ready to face users bearing new requirements and different needs. Objectives To provide a description of the state of health of the operating personnel of the Finance Police (Guardia di Finanza), including elements for planning the most appropriate interventions for health promotion and prevention. Methods The study analyzed the health condition of a group of soldiers (178 subjects, divided into different age classes) by evaluating the effectiveness of a training and information program and subsequently the level of benefit. Results The study population showed a good state of health correlated to the quality of life. Although the population voluntarily submitted to health assessment, the rigour of the calls and briefings carried out in the military health unit and the attention of the group to follow instructions on prevention underlined a positive trend, even in behaviours considered as health-risky. Conclusions Socio-cultural components and the work environment influence the quality of life. In the case of military health care, the specific military organization was useful to monitor the health condition of the population, maximizing the effectiveness of services, enhancing the information and carrying out prevention strategies and demand of care, which should be an example for the public health services. PMID:25774246

The state of racial/ethnic diversity in North Carolina's health workforce.

PubMed

McGee, Victoria; Fraher, Erin

2012-01-01

Increasing the racial and ethnic diversity of the health care workforce is vital to achieving accessible, equitable health care. This study provides baseline data on the diversity of health care practitioners in North Carolina compared with the diversity of the state's population. We analyzed North Carolina health workforce diversity using licensure data from the respective state boards of selected professions from 1994-2009; the data are stored in the North Carolina Health Professions Data System. North Carolina's health care practitioners are less diverse than is the state's population as a whole; only 17% of the practitioners are nonwhite, compared with 33% of the state's population. Levels of diversity vary among the professions, which are diversifying slowly over time. Primary care physicians are diversifying more rapidly than are other types of practitioners; the percentage who are nonwhite increased by 14 percentage points between 1994 and 2009, a period during which 1,630 nonwhite practitioners were added to their ranks. The percentage of licensed practical nurses who are nonwhite increased by 7 percentage points over the same period with the addition of 1,542 nonwhite practitioners to their ranks. Nonwhite health professionals cluster regionally throughout the state, and 79% of them practice in metropolitan counties. This study reports on only a selected number of health professions and utilizes race/ethnicity data that were self-reported by practitioners. Tracking the diversity among North Carolina's health care practitioners provides baseline data that will facilitate future research on barriers to health workforce entry, allow assessment of diversity programs, and be useful in addressing racial and ethnic health disparities.

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

PubMed

Whitehead, J; Shaver, John; Stephenson, Rob

2016-01-01

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

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

PubMed Central

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

2016-01-01

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

[Use of indicators of geographical accessibility to primary health care centers in addressing inequities].

PubMed

De Pietri, Diana; Dietrich, Patricia; Mayo, Patricia; Carcagno, Alejandro; de Titto, Ernesto

2013-12-01

Characterize geographical indicators in relation to their usefulness in measuring regional inequities, identify and describe areas according to their degree of geographical accessibility to primary health care centers (PHCCs), and detect populations at risk from the perspective of access to primary care. Analysis of spatial accessibility using geographic information systems (GIS) involved three aspects: population without medical coverage, distribution of PHCCs, and the public transportation network connecting them. The development of indicators of demand (real, potential, and differential) and analysis of territorial factors affecting population mobility enabled the characterization of PHCCs with regard to their environment, thereby contributing to local and regional analysis and to the detection of different zones according to regional connectivity levels. Indicators developed in a GIS environment were very useful in analyzing accessibility to PHCCs by vulnerable populations. Zoning the region helped identify inequities by differentiating areas of unmet demand and fragmentation of spatial connectivity between PHCCs and public transportation.

The effects on population health status of using dedicated property taxes to fund local public health agencies

PubMed Central

2011-01-01

Background In the United States, a dedicated property tax describes the legal authority given to a local jurisdiction to levy and collect a tax for a specific purpose. We investigated for an association of locally dedicated property taxes to fund local public health agencies and improved health status in the eight states designated as the Mississippi Delta Region. Methods We analyzed the difference in health outcomes of counties with and without a dedicated public health tax after adjusting for a set of control variables using regression models for county level data from 720 counties of the Mississippi Delta Region. Results Levying a dedicated public health tax for counties with per capita income above $28,000 is associated with improved health outcomes of those counties when compared to counties without a dedicated property tax for public health. Alternatively, levying a dedicated property tax in counties with lower per capita income is associated with poor health outcomes. Conclusions There are both positive and negative consequences of using dedicated property taxes to fund public health. Policymakers should carefully examine both the positive association of improved health outcomes and negative impact of taxation on poor populations before authorizing the use of dedicated local property tax levies to fund public health agencies. PMID:21672231

Trend in distribution of primary health care professionals in Jiangsu province of eastern China.

PubMed

Xu, Kang; Zhang, Kaijin; Wang, Dan; Zhou, Ling

2014-11-28

Since the late 1990 s, the Chinese government has carried out several reforms on the primary health care, which is greatly improved but still left much to be desired, especially for the health workforces. The aim of this study was to analyze the number of health workforces and the trends in distribution of health workforces in Jiangsu province of eastern China from 2008 to 2012. The time trends in number and distribution of health professionals were compared in study period. Lorenz curves were plotted and Gini coefficient, Atkinson index and Theil index were calculated for inequalities in the distribution of health workforces to population and area. The number of health workforces increased every year and the inequality in the distribution of health workforces showed a decline trend from 2008 to 2012. After 2009, these trends changed more rapidly. There was the disproportionality between physicians and nurses. The values of three inequality indicators based on area were larger than those based on population. The health reform in 2009 might play an important role in increasing the number of health workforces and improving the distribution of health workforces in primary health care facilities. The disproportionality between physicians and nurses was related to the shortage of number of nurses.

The effects on population health status of using dedicated property taxes to fund local public health agencies.

PubMed

Honoré, Peggy A; Fos, Peter J; Wang, Xueyuan; Moonesinghe, Ramal

2011-06-14

In the United States, a dedicated property tax describes the legal authority given to a local jurisdiction to levy and collect a tax for a specific purpose. We investigated for an association of locally dedicated property taxes to fund local public health agencies and improved health status in the eight states designated as the Mississippi Delta Region. We analyzed the difference in health outcomes of counties with and without a dedicated public health tax after adjusting for a set of control variables using regression models for county level data from 720 counties of the Mississippi Delta Region. Levying a dedicated public health tax for counties with per capita income above $28,000 is associated with improved health outcomes of those counties when compared to counties without a dedicated property tax for public health. Alternatively, levying a dedicated property tax in counties with lower per capita income is associated with poor health outcomes. There are both positive and negative consequences of using dedicated property taxes to fund public health. Policymakers should carefully examine both the positive association of improved health outcomes and negative impact of taxation on poor populations before authorizing the use of dedicated local property tax levies to fund public health agencies.

Assessing health information technology in a national health care system--an example from Taiwan.

PubMed

Chi, Chunhuei; Lee, Jwo-Leun; Schoon, Rebecca

2012-01-01

The purpose of this article is to investigate one core research question: How can health information technology (HIT) be assessed in a national health care system context? We examine this question by taking a systematic approach within a national care system, in which the purpose of HIT is to contribute to a common national health care system's goal. to promote population health in an efficient way. Based on this approach we first develop a framework and our criteria of assessment, and then using Taiwan as a case study, demonstrate how one can apply this framework to assess a national system's HIT. The five criteria we developed are how well does the HIT (1) provide accessible and accurate public health and health care information to the population; (2) collect and provide population health and health care data for government and researchers to analyze population health and processes and outcomes of health care services, (3) provide accessible and timely information that helps to improve provision of cost-effective health care at an institutional level and promotes system-wide efficiency; (4) minimize transaction and administrative costs of the health care system; and (5) establish channels for population participation in governance while also protecting individual privacy. The results indicate that Taiwan has high levels of achievement in two criteria while falling short in the other three. Major lessons we learned from this study are that HIT exists to serve a health care system, and the national health care system context dictates how one assesses its HIT. There is a large body of literature published on the implementation of HIT and its impact on the quality and cost of health care delivery. The vast majority of the literature, however, is focused on a micro institutional level such as a hospital or a bit higher up, on an HMO or health insurance firm. Few have gone further to evaluate the implementation of HIT and its impact on a national health care system. The lack of such research motivated this study. The major contributions of this study are (i) to develop a framework that follows systems thinking principles and (ii) propose a process through which a nation can identify its objectives for HIT and systematically assess its national HIT system. Using Taiwan's national health care system as a case study, this paper demonstrated how it can be done.

The Structure and Effectiveness of Health Systems: Exploring the Impact of System Integration in Rural China.

PubMed

Wang, Xin; Birch, Stephen; Ma, Huifen; Zhu, Weiming; Meng, Qingyue

2016-08-12

Facing the challenges of aging populations, increasing chronic diseases prevalence and health system fragmentation, there have been several pilots of integrated health systems in China. But little is known about their structure, mechanism and effectiveness. The aim of this paper is to analyze health system integration and develop recommendations for achieving integration. Huangzhong and Hualong counties in Qinghai province were studied as study sites, with only Huangzhong having implemented health system integration. Questionnaires, interviews, and health insurance records were sources of data. Social network analysis was employed to analyze integration, through structure measurement and effectiveness evaluation. Health system integration in Huangzhong is higher than in Hualong, so is system effectiveness. The patient referral network in Hualong has more "leapfrog" referrals. The information sharing networks in both counties are larger than the other types of networks. The average distance in the joint training network of Huangzhong is less than in Hualong. Meanwhile, there are deficiencies common to both systems. Both county health systems have strengths and limitations regarding system integration. The use of medical consortia in Huangzhong has contributed to system effectiveness. Future research might consider alternative more context specific models of health system integration.

Healthcare-seeking Behaviour among the Tribal People of Bangladesh: Can the Current Health System Really Meet Their Needs?

PubMed Central

Kielmann, Tara; McPake, Barbara; Normand, Charles

2012-01-01

Despite the wealth of studies on health and healthcare-seeking behaviour among the Bengali population in Bangladesh, relatively few studies have focused specifically on the tribal groups in the country. This study aimed at exploring the context, reasons, and choices in patterns of healthcare-seeking behaviour of the hill tribal population of Bangladesh to present the obstacles and challenges faced in accessing healthcare provision in the tribal areas. Participatory tools and techniques, including focus-group discussions, in-depth interviews, and participant-observations, were used involving 218 men, women, adolescent boys, and girls belonging to nine different tribal communities in six districts. Data were transcribed and analyzed using the narrative analysis approach. The following four main findings emerged from the study, suggesting that the tribal communities may differ from the predominant Bengali population in their health needs and priorities: (a) Traditional healers are still very popular among the tribal population in Bangladesh; (b) Perceptions of the quality and manner of treatment and communication can override costs when it comes to provider-preference; (c) Gender and age play a role in making decisions in households in relation to health matters and treatment-seeking; and (d) Distinct differences exist among the tribal people concerning their knowledge on health, awareness, and treatment-seeking behaviour. The findings challenge the present service-delivery system that has largely been based on the needs and priorities of the plainland population. The present system needs to be reviewed carefully to include a broader approach that takes the sociocultural factors into account, if meaningful improvements are to be made in the health of the tribal people of Bangladesh. PMID:23082637

Future trends in dental benefits.

PubMed

Anderson, Maxwell H

2005-05-01

Dentistry and dental payment systems as we know them today will continue to evolve. Dentistry as practiced today and the prepayment systems of dentistry are substantially different than they were fifty years ago when dental insurance as we know it was first developed. Dentistry has always changed with the development of our science and the expression of dentistry's diseases in the populations we serve. The changes that are likely to occur in the future will be focused on improving health outcomes across risk-analyzed populations with the goals of providing optimal health outcomes at reasonable costs. Dentists will increasingly become engaged in the whole health of their patients. Where sufficient correlations can be leveraged between dentistry and overall health, medical plans will play an increasing role in dentistry's future for two reasons. Given favorably altered therapeutic outcomes for medical systems that preserve scarce resources, it will be an economic imperative to engage the dental system. It will also be the right thing to do from a total health perspective. In the final analysis, this elevates the role of dentistry and empowers the dentist to participate in the total health of their patients.

Expanded Scopes Of Practice For Dental Hygienists Associated With Improved Oral Health Outcomes For Adults.

PubMed

Langelier, Margaret; Continelli, Tracey; Moore, Jean; Baker, Bridget; Surdu, Simona

2016-12-01

Dental hygienists are important members of the oral health care team, providing preventive and prophylactic services and oral health education. However, scope-of-practice parameters in some states limit their ability to provide needed services effectively. In 2001 we developed the Dental Hygiene Professional Practice Index, a numerical tool to measure the state-level professional practice environment for dental hygienists. We used the index to score state-level scopes of practice in all fifty states and the District of Columbia in 2001 and 2014. The mean composite score on the index increased from 43.5 in 2001 to 57.6 in 2014, on a 100-point scale. We also analyzed the association of each state's composite score with an oral health outcome: tooth extractions among the adult population because of decay or disease. After we controlled for individual- and state-level factors, we found in multilevel modeling that more autonomous dental hygienist scope of practice had a positive and significant association with population oral health in both 2001 and 2014. Project HOPE—The People-to-People Health Foundation, Inc.

Modifiable Lifestyle Behaviors Are Associated With Metabolic Syndrome in a Taiwanese Population.

PubMed

Lin, Kuei-Man; Chiou, Jeng-Yuan; Ko, Shu-Hua; Tan, Jung-Ying; Huang, Chien-Ning; Liao, Wen-Chun

2015-11-01

To explore associations between metabolic syndrome and modifiable lifestyle behaviors among the adult population in Taiwan. This cross-sectional study analyzed data from a nationally representative sample that participated in the 2005-2008 Nutrition and Health Survey in Taiwan. The sample (2,337 participants older than 19 years) provided data on demographic characteristics, modifiable lifestyle behaviors, anthropometric measurements, and blood chemistry panel. These data were analyzed by descriptive statistics, univariate logistic regression, and multivariate logistic regression to determine factors associated with metabolic syndrome. Metabolic syndrome had a prevalence of 25.2%, and this prevalence increased with age. In univariate regression analysis, metabolic syndrome was associated with age, living with family members, educational level, and modifiable lifestyle behaviors (smoking, drinking, betel quid chewing, and physical activity). Individuals with a smoking history and currently chewing betel quid had the highest risk for metabolic syndrome. The risk for metabolic syndrome might be reduced by public health campaigns to encourage people to quit smoking cigarettes and chewing betel quid. Implementing more modifiable lifestyle behaviors in daily life will decrease metabolic syndrome in Taiwan. Considering that betel quid chewing and tobacco smoking interact to adversely affect metabolic syndrome risk, public health campaigns against both behaviors seem to be a cost-effective and efficient health promotion strategy to reduce the prevalence rate of metabolic syndrome. © 2015 Sigma Theta Tau International.

Factors associated with low adherence to medicine treatment for chronic diseases in Brazil

PubMed Central

Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Mengue, Sotero Serrate; Arrais, Paulo Sergio Dourado; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Ramos, Luiz Roberto; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal

2016-01-01

ABSTRACT OBJECTIVE To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil. METHODS Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test). RESULTS The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more. CONCLUSIONS Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients’ health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers. PMID:27982378

Synthesis: Deriving a Core Set of Recommendations to Optimize Diabetes Care on a Global Scale.

PubMed

Mechanick, Jeffrey I; Leroith, Derek

2015-01-01

Diabetes afflicts 382 million people worldwide, with increasing prevalence rates and adverse effects on health, well-being, and society in general. There are many drivers for the complex presentation of diabetes, including environmental and genetic/epigenetic factors. The aim was to synthesize a core set of recommendations from information from 14 countries that can be used to optimize diabetes care on a global scale. Information from 14 papers in this special issue of Annals of Global Health was reviewed, analyzed, and sorted to synthesize recommendations. PubMed was searched for relevant studies on diabetes and global health. Key findings are as follows: (1) Population-based transitions distinguish region-specific diabetes care; (2) biological drivers for diabetes differ among various populations and need to be clarified scientifically; (3) principal resource availability determines quality-of-care metrics; and (4) governmental involvement, independent of economic barriers, improves the contextualization of diabetes care. Core recommendations are as follows: (1) Each nation should assess region-specific epidemiology, the scientific evidence base, and population-based transitions to establish risk-stratified guidelines for diagnosis and therapeutic interventions; (2) each nation should establish a public health imperative to provide tools and funding to successfully implement these guidelines; and (3) each nation should commit to education and research to optimize recommendations for a durable effect. Systematic acquisition of information about diabetes care can be analyzed, extrapolated, and then used to provide a core set of actionable recommendations that may be further studied and implemented to improve diabetes care on a global scale. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Income-related inequalities and inequities in health and health care utilization in Mexico, 2000-2006.

PubMed

Barraza-Lloréns, Mariana; Panopoulou, Giota; Díaz, Beatriz Yadira

2013-02-01

To measure income-related inequalities and inequities in the distribution of health and health care utilization in Mexico. The National Health Survey (NHS) 2000 and the National Health and Nutrition Survey (NHNS) 2006 were used to estimate concentration indices for health outcomes and health care utilization variables before and after standardization. The study analyzed 110 460 individuals 18 years or older for NHS 2000 and 124 149 individuals for NHNS 2006. Health status variables were self-assessed health, physical limitations, and chronic illness. Health care utilization included curative visits and dental, hospital, and preventive care. Individuals were ranked by three standard-of-living measures: household income, wealth, and expenditure. Other independent variables were area of residence, geographic region, education, employment, ethnicity, and health insurance. Decomposition analysis allowed for assessing the contributions of independent variables to the distribution of health care among individuals. The worse-off population reports less good self-assessed health and more physical limitations, whereas better-off individuals report more chronic illnesses. Utilization of curative visits and hospitalization is more concentrated among the better-off population. No significant changes in these results can be established between 2000 and 2006. According to available evidence, standard of living, health insurance, and education largely contribute to the inequitable distribution of health care. Despite improvements in health care utilization patterns, income-related health and health care inequities prevail. Equity remains a challenge for Mexico.

Health care utilization in the elderly Mexican population: expenditures and determinants.

PubMed

González-González, César; Sánchez-García, Sergio; Juárez-Cedillo, Teresa; Rosas-Carrasco, Oscar; Gutiérrez-Robledo, Luis M; García-Peña, Carmen

2011-03-29

Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social) or because of the increase that comes with older age (individual). To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly. A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT), 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age. Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization. The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age. The projected increase in hospitalization and health care needs for this group requires immediate attention.

Health check-ups and family screening allow detection of hereditary hemochromatosis with less advanced liver fibrosis and survival comparable with the general population.

PubMed

Aleman, Soo; Endalib, Sanam; Stål, Per; Lööf, Lars; Lindgren, Stefan; Sandberg-Gertzén, Hanna; Almer, Sven; Olsson, Sigvard; Danielsson, Ake; Wallerstedt, Sven; Hultcrantz, Rolf

2011-09-01

The information concerning the morbidity and mortality of hereditary hemochromatosis is based primarily on clinical cohorts of symptomatic patients. The major aim of this study was to analyze the long-term prognosis for Swedish patients with this condition, with respect to both clinical features and survival, in relation to the route by which the disease was detected. 373 patients with hemochromatosis detected through routine health check-ups (n = 153), family screening (n = 44), symptoms of arthralgia (n = 23), investigation of other diseases/symptoms (n = 108) or signs of liver disease (n = 45) were monitored for a mean period of 11.9 ± 5.8 years. The degree of liver fibrosis and survival were analyzed. Overall survival among these patients was not significantly different from that of a matched normal population. The patients diagnosed through health check-ups and family screening were detected at an earlier age and had the highest rate of survival. Liver biopsy at the time of diagnosis revealed cirrhosis in 9% of those detected through the health check-ups and 5% in the case of family screening, compared with 13% for the group with arthralgia, 17% for other diseases/symptoms and 42% for liver disease. Health check-ups and family screening allow detection of hereditary hemochromatosis at an earlier age and with less advanced liver fibrosis, although a few of these patients have already developed cirrhosis. Our study indicates that iron indices should be included in health check-ups, and if abnormal, should lead to further investigation.

Health literacy interventions for immigrant populations: a systematic review.

PubMed

Fernández-Gutiérrez, M; Bas-Sarmiento, P; Albar-Marín, M J; Paloma-Castro, O; Romero-Sánchez, J M

2018-03-01

Health literacy is considered a social health determinant that influences improvement in health, patient empowerment and reduction in inequalities. There is a lack of health literacy interventions for vulnerable social groups (i.e. immigrants), and nurses have shown little familiarity with the concept. This study aimed to identify and analyse whether interventions directed at immigrant populations improve the functional (basic reading, writing and arithmetic skills), interactive (social and cognitive skills) and critical (advanced cognitive and social skills in critically analyzing information and making informed decisions) dimensions of health literacy, taking into account the role played by nursing in these interventions. A systematic review of four databases including PubMed, PsycINFO, the Cochrane Library and ERIC was conducted to identify relevant articles published between 2000 and 2015. Thirty-four articles met the inclusion criteria, and nine articles used a validated instrument. Few specific health literacy interventions for immigrant populations were found. The main findings of the studies showed positive changes in functional health literacy. However, the interventions were less effective in improving interactive and critical health literacy. Several of the findings of this review were based on studies that had their own limitations. The assessment of the articles was not blinded, and the review was restricted to articles written in Spanish and English. The interventions studied were reported as being effective in improving health literacy in immigrants, particularly the functional aspects. Regarding the role played by nursing, this review observed little involvement. It is important for educational strategies to include health literacy dimensions. The concept of health literacy should be included as a Nursing Outcomes Classification and in its subsequent validation taxonomy. To promote community health, health literacy must be a prioritized objective of health management and policies. © 2017 International Council of Nurses.

[Socio-demographic determinants of self-assessed health status and health complaints in the population employed in a large institution].

PubMed

Barański, Bogusław; Boczkowski, Andrzej

2009-01-01

Health and safety at work is frequently perceived as a domain to be protected exclusively against occupational hazards without taking into account socio-demographic determinants and non-occupational factors dependent on work culture and quality of life. This study aimed at evaluating the impact of socio-demographic determinants on self-assessed health status and frequency of health complaints in workers employed in a large institution as well as the perception of the influence of working conditions on their health and the occurrence of selected diseases and health complaints. The study was carried out in the entire population of employees of a large institution. Information that remained anonymous was collected using a questionnaire completed by the employees themselves. The strength of relationship was analyzed between the following three groups of variables: (1) self-assessed health status; (2) objectivized (based on reported facts) evaluation of health status; and (3) socio-demographic determinants. The socio-demographic determinants have considerable impact on self-reported health status and frequency of health complaints and diseases linked and not-linked by respondents with working conditions. The frequency of responses indicating the relationship between work and health complaints were dependent on gender and duration of employment in the institution. The number of reported diseases and health complaints was influenced by gender, age, duration of employment and the respondents' level of education. Summing up, the following groups of respondents evaluated their health as worse than that of others: (1) persons aged over 50 years; (2) persons working 16 or more years in the institution, (3) persons with other than university education; (4) person with overweight. The results indicate that the health policy of institutions and enterprises should take into account socio-demographic determinants in the working population.

Relationship between blood cadmium, lead, and serum thyroid measures in US adults - the National Health and Nutrition Examination Survey (NHANES) 2007-2010.

PubMed

Luo, Juhua; Hendryx, Michael

2014-04-01

Experimental studies have shown that both cadmium (Cd) and lead have potent endocrine disrupting activity. However, studies on whether these heavy metals disrupt thyroid system in humans, especially in general populations with low levels of exposure, are sparse. The study analyzed 6,231 participants aged 20 and older with measurements from 2007-2010 of the National Health and Nutrition Examination Survey (NHANES) to investigate whether whole blood Cd and lead level are associated with serum thyroid hormones measures. Our study suggests that thyroid function may be disrupted by both Cd and lead exposures in the general population and the specific roles of Cd and lead exposure on thyroid axis may differ by sex. However, the mechanisms by which these heavy metals may disrupt thyroid system function in general population needs to be further investigated.

Mortality of populations residing in geothermal areas of Tuscany during the period 2003-2012.

PubMed

Bustaffa, Elisa; Minichilli, Fabrizio; Nuvolone, Daniela; Voller, Fabio; Cipriani, Francesco; Bianchi, Fabrizio

2017-01-01

The limited scientific knowledge on the relationship between exposure and health effects in relation to geothermal activity motivated an epidemiologic investigation of Tuscan geothermal area. This study aims at describing mortality of populations living in Tuscan municipalities in the period 2003-2012. Sixteen municipalities were included in the study area: eight in the northern and eight in the southern area. Mortality data come from the Regional Mortality Registry of Tuscany. Fifty-four causes of death, considered of interest for population health status or consistent with "Project SENTIERI" criteria, are analyzed. Results show a worse mortality profile in the southern area, especially in males, for whom excesses of all cancers and some causes of cancer emerge, while in the northern area an excess of cerebrovascular diseases among females merits attention. Further and more appropriate studies are needed to clarify the etiology of some diseases and to better assess a potential cause-effect relationship.

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

PubMed

Dong, Xiaoxin; Liu, Ling; Cao, Shiyi; Yang, Huajie; Song, Fujian; Yang, Chen; Gong, Yanhong; Wang, Yunxia; Yin, Xiaoxu; Xu, Xing; Xie, Jun; Sun, Yi; Lu, Zuxun

2014-05-26

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

The Relationship of Housing and Population Health: A 30-Year Retrospective Analysis

PubMed Central

Jacobs, David E.; Wilson, Jonathan; Dixon, Sherry L.; Smith, Janet; Evens, Anne

2009-01-01

Objective We analyzed the relationship between health status and housing quality over time. Methods We combined data from two nationally representative longitudinal surveys of the U.S. population and its housing, the National Health and Nutrition Examination Survey and the American Housing Survey, respectively. We identified housing and health trends from approximately 1970 to 2000, after excluding those trends for which data were missing or where we found no plausible association or change in trend. Results Changes in housing include construction type, proportion of rental versus home ownership, age, density, size, moisture, pests, broken windows, ventilation and air conditioning, and water leaks. Changes in health measures include asthma, respiratory illness, obesity and diabetes, and lead poisoning, among others. The results suggest ecologic trends in childhood lead poisoning follow housing age, water leaks, and ventilation; asthma follows ventilation, windows, and age; overweight trends follow ventilation; blood pressure trends follow community measures; and health disparities have not changed greatly. Conclusions Housing trends are consistent with certain health trends over time. Future national longitudinal surveys should include health, housing, and community metrics within a single integrated design, instead of separate surveys, in order to develop reliable indicators of how housing changes affect population health and how to best target resources. Little progress has been made in reducing the health and housing disparities of disadvantaged groups, with the notable exception of childhood lead poisoning caused by exposure to lead-based paint hazards. Use of these and other data sets to create reliable integrated indicators of health and housing quality are needed. PMID:19440499

Analysis of Online Information Searching for Cardiovascular Diseases on a Consumer Health Information Portal

PubMed Central

Jadhav, Ashutosh; Sheth, Amit; Pathak, Jyotishman

2014-01-01

Since the early 2000’s, Internet usage for health information searching has increased significantly. Studying search queries can help us to understand users “information need” and how do they formulate search queries (“expression of information need”). Although cardiovascular diseases (CVD) affect a large percentage of the population, few studies have investigated how and what users search for CVD. We address this knowledge gap in the community by analyzing a large corpus of 10 million CVD related search queries from MayoClinic.com. Using UMLS MetaMap and UMLS semantic types/concepts, we developed a rule-based approach to categorize the queries into 14 health categories. We analyzed structural properties, types (keyword-based/Wh-questions/Yes-No questions) and linguistic structure of the queries. Our results show that the most searched health categories are ‘Diseases/Conditions’, ‘Vital-Sings’, ‘Symptoms’ and ‘Living-with’. CVD queries are longer and are predominantly keyword-based. This study extends our knowledge about online health information searching and provides useful insights for Web search engines and health websites. PMID:25954380

Understanding the potential of state-based public health genomics programs to mitigate disparities in access to clinical genetic services.

PubMed

Senier, Laura; Tan, Catherine; Smollin, Leandra; Lee, Rachael

2018-06-12

State health agencies (SHAs) have developed public health genomics (PHG) programs that play an instrumental role in advancing precision public health, but there is limited research on their approaches. This study examines how PHG programs attempt to mitigate or forestall health disparities and inequities in the utilization of genomic medicine. We compared PHG programs in three states: Connecticut, Michigan, and Utah. We analyzed 85 in-depth interviews with SHA internal and external collaborators and program documents. We employed a qualitative coding process to capture themes relating to health disparities and inequities. Each SHA implemented population-level approaches to identify individuals who carry genetic variants that increase risk of hereditary cancers. However, each SHA developed a unique strategy-which we label public health action repertoires-to reach specific subgroups who faced barriers in accessing genetic services. These strategies varied across states given demographics of the state population, state-level partnerships, and availability of healthcare services. Our findings illustrate the imperative of tailoring PHG programs to local demographic characteristics and existing community resources. Furthermore, our study highlights how integrating genomics into precision public health will require multilevel, multisector collaboration to optimize efficacy and equity.

Assessment of maternal health care quality: conceptual and methodologic issues.

PubMed

Lane, D S; Kelman, H R

1975-10-01

Past efforts in assessment of the quality of maternity care have been analyzed in order to develop an evaluation framework that will have utility and applicability beyond a specific program, population, or health discipline. Presently available evaluation approaches have focused attention on either "high risk" populations or upon women experiencing a complicated pregnancy or delivery. Quality has been defined as the extent to which normative or empirically derived standards of obstetrical care have been applied. An alternative approach is suggested which conceives of the pregnancy as a normal physiological event but with the potentiality of either causing or exacerbating social or health problems. Maternity care quality is viewed as the application of those necessary health and health-related services that are required to safeguard the health of the mother and offspring, minimize the noxious consequences of pre-existing or concurrent health hazards or conditions, and upgrade the health and social functioning of those women who require it. Additionally, the system of services should be functionally organized to optimize care. Indicators of quality are suggested which incorporate structural, process, and outcome variables, and which link medical and consumer criteria in a comprehensive community level approach to quality assessment.

Health Risk Behaviors and Mental Health Problems as Mediators of the Relationship Between Childhood Abuse and Adult Health

PubMed Central

Walker, John R.; Naimark, Barbara

2009-01-01

Objectives. We examined the relationship between childhood abuse and adult health risk behaviors, and we explored whether adult health risk behaviors or mental health problems mediated the relationship between childhood abuse and adult health problems and health care utilization. Methods. We used logistic regression to analyze data from the Mental Health Supplement of the Ontario Health Survey, a representative population sample (N = 8116) of respondents aged 15 to 64 years. Results. We found relationships between childhood sexual abuse and smoking (odds ratio [OR] = 1.52; 95% confidence interval [CI] = 1.16, 1.99), alcohol problems (OR = 2.44; 95% CI = 1.74, 3.44), obesity (OR = 1.61; 95% CI = 1.14, 2.27), having more than 1 sexual partner in the previous year (OR = 2.34; 95% CI = 1.44, 3.80), and mental health problems (OR = 2.26; 95% CI = 1.78. 2.87). We also found relationships between these factors (with the exception of obesity) and childhood physical abuse. Mediation analysis suggested that health risk behaviors and particularly mental health problems are partial mediators of the relationship between childhood abuse and adult health. Conclusions. Public health approaches that aim to decrease child abuse by supporting positive parent–child relationships, reducing the development of health risk behaviors, and addressing children's mental health are likely to improve long-term population health. PMID:18703446

Medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural latinos.

PubMed

López-Cevallos, Daniel F; Harvey, S Marie; Warren, Jocelyn T

2014-01-01

Little research has analyzed mistrust and discrimination influencing receipt of health care services among Latinos, particularly those living in rural areas. This study examined the associations between medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural Latinos. This cross-sectional study analyzed data from 387 young-adult Latinos (ages 18-25) living in rural Oregon. The Behavioral Model of Vulnerable Populations was utilized as the theoretical framework. Correlations were run to assess bivariate associations among variables included in the study. Ordered logistic regression models evaluated the associations between medical mistrust, perceived discrimination, and satisfaction with health care. On average, participants used health services 4 times in the past year. Almost half of the participants had health insurance (46%). The majority reported that they were moderately (32%) or very satisfied (41%) with health care services used in the previous year. In multivariable models, medical mistrust and perceived discrimination were significantly associated with satisfaction with health care. Medical mistrust and perceived discrimination were significant contributors to lower satisfaction with health care among young-adult Latinos living in rural Oregon. Health care reform implementation, currently under way, provides a unique opportunity for developing evaluation systems and interventions toward monitoring and reducing rural Latino health care disparities. © 2014 National Rural Health Association.

Exploring Public Health's roles and limitations in advancing food security in British Columbia.

PubMed

Seed, Barbara A; Lang, Tim M; Caraher, Martin J; Ostry, Aleck S

2014-07-22

This research analyzes the roles and limitations of Public Health in British Columbia in advancing food security through the integration of food security initiatives into its policies and programs. It asks the question, can Public Health advance food security? If so, how, and what are its limitations? This policy analysis merges findings from 38 key informant interviews conducted with government and civil society stakeholders involved in the development of food security initiatives, along with an examination of relevant documents. The Population Health Template is used to delineate and analyze Public Health roles in food security. Public Health was able to advance food security in some ways, such as the adoption of food security as a core public health program. Public Health's leadership role in food security is constrained by a restricted mandate, limited ability to collaborate across a wide range of sectors and levels, as well as internal conflict within Public Health between Food Security and Food Protection programs. Public Health has a role in advancing food security, but it also faces limitations. As the limitations are primarily systemic and institutional, recommendations to overcome them are not simple but, rather, require movement toward embracing the determinants of health and regulatory pluralism. The results also suggest that the historic role of Public Health in food security remains salient today.

Chilean population norms derived from the health-related quality of Life SF-6D.

PubMed

Garcia-Gordillo, Miguel A; Collado-Mateo, Daniel; Olivares, Pedro R; Adsuar, José C

2018-06-01

The Health-Related Quality of Life Short Form 6D (HRQoL SF-6D) provides utility values for health status. Utilities generated have a number of potentially valuable applications in economic evaluations and not only to ensure comparability between studies. Reference values can be useful to estimate the effect on patients' HRQoL as a result of interventions in the absence of control groups. Thus, the purpose of this study was to provide normative values in the SF-6D in relation to the Chilean population. A cross-sectional study was conducted evaluating 5293 people. SF-6D utilities were derived from the SF-12 questions. Mean SF-6D utility index for the whole sample was 0.74. It was better for men (0.78) than for women (0.71). The ceiling effect was much higher for men (11.16%) than for women (5.31%). Women were more likely to show problems in any dimension than were men. Chilean population norms for the SF-6D help in the decision-making process around health policies. Men reported higher health status than women in all subcategories analyzed. Likewise, men also reported higher scores than women in overall SF-6D dimensions.

Metabolic control in a nationally representative diabetic elderly sample in Costa Rica: patients at community health centers vs. patients at other health care settings

PubMed Central

Brenes-Camacho, Gilbert; Rosero-Bixby, Luis

2008-01-01

Background Costa Rica, like other developing countries, is experiencing an increasing burden of chronic conditions such as diabetes mellitus (DM), especially among its elderly population. This article has two goals: (1) to assess the level of metabolic control among the diabetic population age ≥ 60 years old in Costa Rica, and (2) to test whether diabetic elderly patients of community health centers differ from patients in other health care settings in terms of the level of metabolic control. Methods Data come from the project CRELES, a nationally representative study of people aged 60 and over in Costa Rica. This article analyzes a subsample of 542 participants in CRELES with self-reported diagnosis of diabetes mellitus. Odds ratios of poor levels of metabolic control at different health care settings are computed using logistic regressions. Results Lack of metabolic control among elderly diabetic population in Costa Rica is described as follows: 37% have glycated hemoglobin ≥ 7%; 78% have systolic blood pressure ≥ 130 mmHg; 66% have diastolic blood pressure ≥ 80 mmHg; 48% have triglycerides ≥ 150 mg/dl; 78% have LDL ≥ 100 mg/dl; 70% have HDL ≤ 40 mg/dl. Elevated levels of triglycerides and LDL were higher in patients of community health centers than in patients of other clinical settings. There were no statistical differences in the other metabolic control indicators across health care settings. Conclusion Levels of metabolic control among elderly population with DM in Costa Rica are not that different from those observed in industrialized countries. Elevated levels of triglycerides and LDL at community health centers may indicate problems of dyslipidemia treatment among diabetic patients; these problems are not observed in other health care settings. The Costa Rican health care system should address this problem, given that community health centers constitute a means of democratizing access to primary health care to underserved and poor areas. PMID:18447930

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

PubMed

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

2015-12-01

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

[Health and health-related behaviors according to sexual attraction and behavior].

PubMed

Pérez, Glòria; Martí-Pastor, Marc; Gotsens, Mercè; Bartoll, Xavier; Diez, Elia; Borrell, Carme

2015-01-01

to Describe perceived health, mental health and certain health-related behaviors according to sexual attraction and behavior in the population residing in Barcelona in 2011. Perceived health, mental health, chronic conditions and health-related behaviors were analyzed in 2675 people aged 15 to 64 years. The Barcelona Health Survey for 2011 was used, which included questions on sexual attraction and behavior. Multivariate robust Poisson regression models were fitted to obtain adjusted prevalence ratios. People feeling same-sex attraction reported a higher prevalence of worse perceived and mental health. These people and those who had had sex with persons of the same sex more frequently reported harmful health-related behaviors. Lesbian, gay, transgender and bisexual people may have health problems that should be explored in depth, prevented, and attended. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Who is where at risk for Chronic Obstructive Pulmonary Disease? A spatial epidemiological analysis of health insurance claims for COPD in Northeastern Germany

PubMed Central

Maier, Werner; Schweikart, Jürgen; Keste, Andrea; Moskwyn, Marita

2018-01-01

Background Chronic obstructive pulmonary disease (COPD) has a high prevalence rate in Germany and a further increase is expected within the next years. Although risk factors on an individual level are widely understood, only little is known about the spatial heterogeneity and population-based risk factors of COPD. Background knowledge about broader, population-based processes could help to plan the future provision of healthcare and prevention strategies more aligned to the expected demand. The aim of this study is to analyze how the prevalence of COPD varies across northeastern Germany on the smallest spatial-scale possible and to identify the location-specific population-based risk factors using health insurance claims of the AOK Nordost. Methods To visualize the spatial distribution of COPD prevalence at the level of municipalities and urban districts, we used the conditional autoregressive Besag–York–Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific ecological risk factors for COPD. Results The sex- and age-adjusted prevalence of COPD was 6.5% in 2012 and varied widely across northeastern Germany. Population-based risk factors consist of the proportions of insurants aged 65 and older, insurants with migration background, household size and area deprivation. The results of the GWR model revealed that the population at risk for COPD varies considerably across northeastern Germany. Conclusion Area deprivation has a direct and an indirect influence on the prevalence of COPD. Persons ageing in socially disadvantaged areas have a higher chance of developing COPD, even when they are not necessarily directly affected by deprivation on an individual level. This underlines the importance of considering the impact of area deprivation on health for planning of healthcare. Additionally, our results reveal that in some parts of the study area, insurants with migration background and persons living in multi-persons households are at elevated risk of COPD. PMID:29414997

Who is where at risk for Chronic Obstructive Pulmonary Disease? A spatial epidemiological analysis of health insurance claims for COPD in Northeastern Germany.

PubMed

Kauhl, Boris; Maier, Werner; Schweikart, Jürgen; Keste, Andrea; Moskwyn, Marita

2018-01-01

Chronic obstructive pulmonary disease (COPD) has a high prevalence rate in Germany and a further increase is expected within the next years. Although risk factors on an individual level are widely understood, only little is known about the spatial heterogeneity and population-based risk factors of COPD. Background knowledge about broader, population-based processes could help to plan the future provision of healthcare and prevention strategies more aligned to the expected demand. The aim of this study is to analyze how the prevalence of COPD varies across northeastern Germany on the smallest spatial-scale possible and to identify the location-specific population-based risk factors using health insurance claims of the AOK Nordost. To visualize the spatial distribution of COPD prevalence at the level of municipalities and urban districts, we used the conditional autoregressive Besag-York-Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific ecological risk factors for COPD. The sex- and age-adjusted prevalence of COPD was 6.5% in 2012 and varied widely across northeastern Germany. Population-based risk factors consist of the proportions of insurants aged 65 and older, insurants with migration background, household size and area deprivation. The results of the GWR model revealed that the population at risk for COPD varies considerably across northeastern Germany. Area deprivation has a direct and an indirect influence on the prevalence of COPD. Persons ageing in socially disadvantaged areas have a higher chance of developing COPD, even when they are not necessarily directly affected by deprivation on an individual level. This underlines the importance of considering the impact of area deprivation on health for planning of healthcare. Additionally, our results reveal that in some parts of the study area, insurants with migration background and persons living in multi-persons households are at elevated risk of COPD.

Fear and Loathing on the Campaign Trail: What the Election Means for U.S. Health Care, and the Health of American Democracy

PubMed Central

DOHERTY, ROBERT B.

2017-01-01

This paper analyzes four trends that are affecting the 2016 election: changing US demographics and the reaction to them, a growing distrust of government, increased polarization and government gridlock, and the rise of populism. It compares the views of candidates Hillary Rodham Clinton and Donald S. Trump on the Affordable Care Act, climate change, prescription drug pricing, prevention of injuries and deaths from firearms, and the opioids epidemic; and offers perspectives on the potential impact of the election not only on U.S. health care policy, but on the health of American democracy itself. PMID:28790510

Ties that bind: implications of social support for rural, partnered African American women's health functioning.

PubMed

Black, Angela R; Cook, Jennifer L; Murry, Velma McBride; Cutrona, Carolyn E

2005-01-01

Ecological theory was used to explore the pathways through which intimate relationship quality influenced health functioning among rural, partnered African American women. Structural equation modeling was used to analyze data from 349 women in Georgia and Iowa. Women's intimate relationship quality was positively associated with their psychological and physical health functioning. Support from community residents moderated this link, which was strongest for women who felt most connected with their neighbors and for women who believed their neighborhood to have a sense of communal responsibility. Future research should identify other factors salient to health functioning among members of this population.

Fear and Loathing on the Campaign Trail: What the Election Means for U.S. Health Care, and the Health of American Democracy.

PubMed

Doherty, Robert B

2017-01-01

This paper analyzes four trends that are affecting the 2016 election: changing US demographics and the reaction to them, a growing distrust of government, increased polarization and government gridlock, and the rise of populism. It compares the views of candidates Hillary Rodham Clinton and Donald S. Trump on the Affordable Care Act, climate change, prescription drug pricing, prevention of injuries and deaths from firearms, and the opioids epidemic; and offers perspectives on the potential impact of the election not only on U.S. health care policy, but on the health of American democracy itself.

Social inequalities in the prevalence of self-reported chronic non-communicable diseases in Brazil: national health survey 2013.

PubMed

Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; de Souza, Maria de Fatima Marinho; Szwarcwald, Celia Landman; Lima, Margareth Guimarães; Barros, Marilisa Berti de Azevedo

2016-11-17

Considering the high socioeconomic inequalities in Brazil related to occurrence of morbidity and premature mortality, the objective of this study was to analyze inequalities in self-reported prevalence of Non-Communicable Diseases (NCD) and in the physical limitations caused by these diseases, among the Brazilian adult population, according to sociodemographic variables. This was a population-based cross-sectional study that analyzed information on 60,202 individuals who formed a representative sample of Brazilian adults interviewed for the National Health Survey 2013. Disparities by schooling levels and possession of private health insurance were assessed by calculating the prevalence (P) and prevalence ratio (PR) of each of the 13 NCDs and any associated limitations, while controlling for other socioeconomic and demographic variables. 45 % of the Brazilian adult population reported having at least one NCD. The prevalence ratio was greater among women (1.24 CI 1.21-1.28), individuals over 55 years of age, individuals with low schooling levels (illiterate and incomplete elementary education) (1.08 CI 1.02-1.14) and people living in the Southeast (1.10 CI 1.04-1.16), South (1.26 CI 1.19-1.34) and Central-West (1.11 CI 1.05-1.18) regions of the country. Diseases such as diabetes (1.42 CI 1.13-1.47), hypertension (1.17 CI 1.06-1.28), stroke (2.52 CI 1.74-3.66), arthritis (1.4 CI 1.11-1.77), spinal problems (1.39 CI .1.25-1.56), and chronic renal failure (1.65 CI 1.10.2.46), were more prevalent among adults with low education. For most NCDs, greater reports of limitations were associated with lower schooling levels and lack of private health insurance. Populations with lower schooling levels and lack of private health insurance present higher prevalence of various NCD and greater degrees of limitation due to these diseases. Results reveal the extent of social inequalities that persist with regard to occurrence and the impact of NCDs in Brazil.

INTRODUCTION OF UNIVERSAL HEALTH PROGRAM IN GEORGIA: PROBLEMS AND PERSPECTIVES.

PubMed

Verulava, T; Jorbenadze, R; Barkalaia, T

2017-01-01

Since 2013, Georgia enacted Universal Healthcare (UHC) program. Inclusion of uninsured population in the UHC program will have a positive impact on their financial accessibility to the health services. The study aims to analyze the referral rate of the beneficiaries to the health service providers before introduction and after application of the UHC program, particularly, how much it increased the recently uninsured population referral to primary health care units, and also to study the level of satisfaction with the UHC program. Research was conducted by qualitative and quantitative methods. The target groups' (program beneficiaries, physicians, personnel of the Social Service Agency) opinions were identified by means of face-to-face interviews. Enactment of the UHC programs significantly raised the population refferal to the family physicians, and the specialists. Insignificantly, but also increased the frequency of laboratory and diagnostic services. Despite the serious positive changes caused by UHC program implementation there still remain the problems in the primary healthcare system. Also, it is desirable to raise the financial availability of those medical services, which may cause catastrophic costs. In this respect, such medical services must be involved in the universal healthcare program and been expanded their scale. For the purpose of effective usage of the limited funds allocated for health care services provision, the private health insurance companies should be involved in UHC programs. This, together with the reduction of health care costs will increase a competition in the medical market, and enhance the quality of health service.

Social health status in iran: an empirical study.

PubMed

Amini Rarani, Mostafa; Rafiye, Hassan; Khedmati Morasae, Esmaeil

2013-01-01

As social health is a condition-driven, dynamic and fluid concept, it seems necessary to construct and obtain a national and relevant concept of it for every society. Providing an empirical back up for Iran's concept of social health was the aim of the present study. This study is an ecologic study in which available data for 30 provinces of Iran in 2007 were analyzed. In order to prove construct validity and obtain a social health index, an exploratory factor analysis was conducted on six indicators of population growth, willful murder, poverty, unemployment, insurance coverage and literacy. Following the factor analysis, two factors of Diathesis (made up of high population growth, poverty, low insurance coverage and illiteracy) and Problem (made up of unemployment and willful murder) were extracted. The diathesis and problem explained 48.6 and 19.6% of social health variance respectively. From provinces, Sistan & Baluchistan had the highest rate of poverty and violence and the lowest rate of literacy and insurance coverage. In terms of social health index, Tehran, Semnan, Isfahan, Bushehr and Mazandaran had the highest ranks while Sistan and Baluchistan, Lurestan, Kohkiloyeh and Kermanshah occupied the lowest ones. There are some differences and similarities between Iranian concept of social health and that of other societies. However, a matter that makes our concept special and different is its attention to population. The increase in literacy rate and insurance coverage along with reduction of poverty, violence and unemployment rates can be the main intervention strategies to improve social health status in Iran.

Race/skin color and mental health disorders in Brazil: a systematic review of the literature.

PubMed

Smolen, Jenny Rose; Araújo, Edna Maria de

2017-12-01

Mental health disorders contribute a significant burden to society. This systematic literature review aims to summarize the current state of the literature on race/skin color and mental health disorders in Brazil. PubMed and Lilacs were searched using descriptors for mental health disorders (depression, anxiety, Common Mental Disorders, psychiatric morbidity, etc.) and race to find studies conducted in Brazil. Studies of non-population groups, that did not analyze race/skin color, or for which the mental disorder was not the object of study were excluded. After evaluation of quality, 14 articles were selected for inclusion. There was an overall higher prevalence of mental health disorders in non-Whites. Of the six multivariate analyses that found statistically significant results, five indicated a greater prevalence or odds of mental health disorder in non-Whites compared to Whites (measure of association between 1.18-1.85). This review identified the trend in the literature regarding the association between race and mental health disorders. However, important difficulties complicate the comparability of the studies, principally in function of the differences in the mental health disorders studied, the method of categorizing race/skin color, and the screening tools used in the studies analyzed.

Patient choice, Internet based information sources, and perceptions of health care: Evidence from Sweden using survey data from 2010 and 2013.

PubMed

Wahlstedt, Emma; Ekman, Björn

2016-08-01

Several countries have increased patients' abilities to choose their health care providers, frequently under the assumption that patients are themselves the best agents to make such decisions. In parallel, national and regional health authorities have enhanced access to Internet based information sources (IBIS) to assist patients in making an informed choice. Relatively little, however, is known about the effect that the use of such sources has on key outcomes, including patients' perceptions of care. The aim of this study is to analyze the role of the Internet for patients' confidence in the provider and perceived access to care in the context of choice based reforms in Sweden. The study uses a regional, population health survey from the southern part of Sweden. Non-parametric chi-square tests are used to assess the nature of Internet users, including their gender, age and socioeconomic status. Logistic regression models are specified to analyze the role of IBIS on patient perceptions of care while controlling for other factors. Actual use of Internet based information sources for health care was relatively low in 2010 and only somewhat higher in 2013. The characteristics of IBIS users varied significantly across different population groups, such that they were younger, more educated, female, and also considered themselves to be in better health compared with those who reported not using this source of health care information. Finally, the average IBIS user was less likely to report having a high level of satisfaction with respect to their primary care use; OR 0.69 [95 % CI: 0.54-0,87] and OR 0.52 [95 % CI: 0,41-0,66], for confidence in provider and perceived access to care, respectively, in 2013. Despite health agencies' attempts to make information on health care providers available on the Internet, this source of health care information is not used to any large extent in the current sample. The fact that some people use this source of information more compared with others suggests the need to consider alternative ways of informing the general public about choice options. The use of Internet based sources may also be linked with the experience of actually using health services, which suggests a need to further analyze this complex consumer behavior process.

The politics of health inequalities research in the United States.

PubMed

Navarro, Vicente

2004-01-01

In this article, based on a speech to the European Association of Health Policy, the author discusses the political context in which health inequalities research has historically operated in the United States. The discussion focuses on the limitations of research that uses income, consumption, and status as the primary categories of research practice, and demonstrates these limitations by critically analyzing The Health of Nations (by Kawachi and Kennedy). The author concludes that it is essential to use categories of analysis that focus on class relations as well as race and gender relations and their reproduction through the international and national institutions, to study their impact on the health and well-being of populations.

Relative deprivation and mortality--a longitudinal study in a Swedish population of 4.7 million, 1990-2006.

PubMed

Åberg Yngwe, Monica; Kondo, Naoki; Hägg, Sara; Kawachi, Ichiro

2012-08-16

Relative deprivation has previously been discussed as a possible mechanism underlying the income-health relation. The idea is that income matters to the individual's health, over and above the increased command over resources, as the basis of social comparisons between a person and his or her reference group. The following study aimed to analyze the role of individual-level relative deprivation for all-cause mortality in the Swedish population. The Swedish context, characterized by relatively small income inequalities and promoting values as egalitarianism and equality, together with a large data material provide unique possibilities for analyzing the hypothesized mechanism. The data used are prospective longitudinal data from the Swedish population and based on a linkage of registers. Restricting selection to individuals 25-64 years, alive January 1st 1990, gave 4.7 million individuals, for whom a mortality follow-up was done over a 16-year period. The individual level relative deprivation was measured using the Yitzhaki index, calculating the accumulated shortfall between the individual's income and the income of all other's in the person's reference group. All-cause mortality was used as the outcome measure. Relative deprivation, generated through social comparisons, is one possible mechanism within the income and health relation. The present study analyzed different types of objectively defined reference groups, all based on the idea that people compare themselves to similar others. Results show relative deprivation, when measured by the Yitzhaki index, to be significantly associated with mortality. Also, we found a stronger effect among men than among women. Analyzing the association within different income strata, the effect was shown to be weak among the poorest. Revealing the importance of relative deprivation for premature mortality, over and above the effect of absolute income, these results resemble previous findings. Relative deprivation, based on social comparisons of income, is significantly associated with premature mortality in Sweden, over and above the effect of absolute income. Also, it was found to be more important among men, but weak among the poorest.

[Nutritional health messages transmitted through television advertising. Trends and errors].

PubMed

Ortega, R M; Andrés, P; Jiménez, L M; Ortega, A

1995-01-01

The present study analyzes de publicity messages with a alimentary-nutritional content (n = 448), aired by 2 television channels (one public and one private), during 6 hours a day in the first week of October 1993, examining the most frequent tendencies and errors, and whether or not they are adhering to the nutritional standards intended to improve the health of the population. With this aim, a questionnaire was designed, which was submitted to a control prior to doing the study, and which permitted the same study during the years 1991, 1992, and 1993. The message which was most used to promote the sales of the products, was the taste, followed by quality, novelty, health, nutritional and natural. The messages indicating that the product reduces or minimizes fat, cholesterol, sodium, sugar, alcohol, ... are few or lower than those observed in other populations. In some cases the messages may be useful in re-enforcing the standards of the nutritional educators and health care professionals who try to improve the diet and the health of the public. However, in the majority of cases, the message of the advertisements may mislead or confuse the consumer with irrelevant or incomplete information. They also frequently contribute to the promotion of an extremely thin body image, which guides the food choice of a large percentage of the population. The results of the study may help in the planning of nutritional education of the population, and they emphasize the need for a greater supervision and control of the advertisements.

An approach to assess trends of pharmacist workforce production and density rate in Serbia.

PubMed

Milicevic, Milena Santric; Matejic, Bojana; Terzic-Supic, Zorica; Dedovic, Neveka; Novak, Sonja

2010-01-01

The policy dialog on human resource in health care is one of the central issues of the ongoing health care system reform in the Republic of Serbia. Pharmacists are the third largest health care professional group, after nurses and doctors. This study's objective was to analyze population coverage with pharmacists employed in the public sector of health care system of Serbia during 1961 - 2007, and to project their density by 2017. In this respect, additionally, time-series of annual number of enrolled and graduate pharmacy students were modelled. Time trends of routinely collected national statistical data, concerning the pharmacists, were analyzed by join point regression program, according to grid-search method. During the observed period of time, in Serbia, pharmacist workforce production and deployment trends were generally positive, but with different annual dynamic. Key findings were the slow rise of pharmacist workforce density rates per 100,000 population; the insufficient balance between pharmacists workforce supply side (annual number of enrolled and graduated students) and the public health care sector's ability to absorb annual number of pharmacy graduates. For ten years ahead, density rates of publicly active pharmacist workforce would probably increase for 46%, if no policy interventions were planned to adverse trends of pharmacist workforce production and deployment in public health care sector. The study results may be useful for variety of stakeholders to better understand how and why the supply and deployment of pharmacists were changing; and that the coordination among policy interventions is a crucial successes factor for a health workforce development plan implementation. The repercussions of any changes made to the pharmacy workforce, need to be considered carefully in advance.

Patterns of Internet-based health information seeking in adult survivors of childhood cancer.

PubMed

Claridy, Mechelle D; Hudson, Melissa M; Caplan, Lee; Mitby, Pauline A; Leisenring, Wendy; Smith, Selina A; Robison, Leslie L; Mertens, Ann C

2018-05-01

To assess where, when, and why survivors of childhood cancer seek health information. Data from the Childhood Cancer Survivor Study (CCSS) cohort (n = 1386) and Health Information National Trends Survey (n = 2385) were analyzed to determine the health information seeking strategies of childhood cancer survivors. Descriptive frequencies, χ 2 analyses, t-tests, and multivariable logistic regression models were used. To seek health-related information for themselves, 54% (n = 742) of the childhood survivors reported using the Internet in the past 12 months, compared to 45% of the general population (adjusted OR: 2.76; 95% CI: 2.40-3.19). Childhood cancer survivors who used the Internet for health information were more likely to be female, between the ages of 18-34, have received some college education or be a college graduate, and report being in poor health. Although survivors were less likely than the general population to trust health information from the Internet (P < 0.01), they indicated that they would like a secure website that uses information from their medical records to provide individualized health-related information. The use of the Internet to access health information among the childhood cancer survivors was over 50%. Information on late effects was a high priority for most survivors, as was their interest in websites related to late effects and a website on patient information tailored to personal situations. Identification of factors associated with searching the Internet for cancer information may provide direction for development of effective cancer communication interventions for this at-risk population. © 2018 Wiley Periodicals, Inc.

Generalized Anxiety Symptoms and Identity Processes in Cross-Cultural Samples of Adolescents from the General Population

ERIC Educational Resources Information Center

Crocetti, Elisabetta; Hale, William W., III.; Dimitrova, Radosveta; Abubakar, Amina; Gao, Cheng-Hai; Agaloos Pesigan, Ivan Jacob

2015-01-01

Background: Approximately 20% of adolescents around the world experience mental health problems, most commonly depression or anxiety. High levels of anxiety disorder symptoms can hinder adolescent development, persist into adulthood, and predict negative mental outcomes, such as suicidal ideation and attempts. Objectives: We analyzed generalized…

International Trends and Perspectives: Aging. International Research Document No. 12.

ERIC Educational Resources Information Center

Siegel, Jacob S.; Hoover, Sally L.

This report considers demographic conditions and prospects for the countries of the world with respect to aging. Particular attention is paid to the implications for health care. The information analyzed and presented in this report was obtained from the latest population projections published by the United Nations. The countries are generally…

Primary care provision by volunteer medical brigades in Honduras: a health record review of more than 2,500 patients over three years.

PubMed

Martiniuk, Alexandra L C; Adunuri, Nikesh; Negin, Joel; Tracey, Patti; Fontecha, Claudio; Caldwell, Paul

2012-01-01

The weak health system in Honduras contributes to poor health indicators. To improve population health, a number of volunteer medical brigades from developed countries provide health services in Honduras. To date, there is little information on the brigades' activities and impact. The primary objective of this article is to increase understanding of the type of health care provided by voluntary medical brigades by evaluating and presenting data on patients' presenting symptoms, diagnoses, and care outcomes. The article focuses on an ongoing medical brigade organized by Canadian health professionals in conjunction with Honduras' largest national non-governmental organization. This is a descriptive study of data that are routinely collected by volunteer Canadian health care professionals. Data on all patients presenting to temporary primary health care facilities across Honduras between 2006 and 2009 were analyzed. The data were used to analyze patient demographics, presenting symptoms, diagnoses, and treatments. We found that the brigades provide additional human resources to the relatively weak Honduran health care system. However, while brigades may increase solidarity between Hondurans and Canadians, concerns persist regarding cost-effectiveness and continuity of care for conditions treated by short-term brigade volunteers. Greater scrutiny is needed to increase brigades' effectiveness and ensure they are supportive of domestic health systems.

Social representations of the health care of the Mbyá-Guarani indigenous population by health workers 1

PubMed Central

Falkenberg, Mirian Benites; Shimizu, Helena Eri; Bermudez, Ximena Pamela Díaz

2017-01-01

ABSTRACT Objective: to analyze the social representations of health care of the Mbyá-Guarani ethnic group by multidisciplinary teams from the Special Indigenous Health District in the south coast of Rio Grande do Sul state (Distrito Sanitário Especial Indígena Litoral Sul do Rio Grande do Sul), Brazil. Method: a qualitative method based on the theory of social representations was used. Data were collected via semi-structured interviews with 20 health workers and by participant observation. The interviews were analyzed with ALCESTE software, which conducts a lexical content analysis using quantitative techniques for the treatment of textual data. Results: there were disagreements in the health care concepts and practices between traditional medicine and biomedicine; however, some progress has been achieved in the area of intermedicality. The ethnic boundaries established between health workers and indigenous peoples based on their representations of culture and family, together with the lack of infrastructure and organization of health actions, are perceived as factors that hinder health care in an intercultural context. Conclusion: a new basis for the process of indigenous health care needs to be established by understanding the needs identified and by agreement among individuals, groups, and health professionals via intercultural exchange. PMID:28177056

Strategies for Effectively Documenting Sexual Orientation and Gender Identity in Electronic Health Record.

PubMed

Frangella, Julia; Otero, Carlos; Luna, Daniel

2018-01-01

In this communication we identify strategies for effectively documenting Sexual Orientation and Gender Identity in Electronic Health Records. For this review a multidisciplinary group composed by three physicians, a nurse, an engineer and a lawyer analyzed the evidence in bibliography related to the topic and summarized the results. After analyzing the information, we summarized and classified them into three major topics: To request, to store and to display and access to the information. How to standardize those data and where data specifically will be populated in EHRs have not been answered yet. The target of all of these efforts should be: to be sensitive with the needs of the patient and to ensure high quality of care.

Effects of vitamin D receptor gene polymorphisms on low-resistance training using exercise machines: the 'Power Rehabilitation' program.

PubMed

Murakami, Shin-Ichiro; Otsuki, Takemi; Maeda, Megumi; Miura, Yoshie; Morii, Seiko; Kiyokane, Kenji; Hayakawa, Shin-Ichi; Maeda, Atsushi; Imakawa, Takayo; Harada, Shunpei; Handa, Torataro; Nishimura, Yasumitsu; Murakami, Shuko; Kumagai, Naoko; Hayashi, Hiroaki; Chen, Ying; Suemori, Shin-Ichiro; Fukushima, Yumiko; Nishida, Seikoh; Fukushima, Keisuke

2009-01-01

The enhancement and promotion of health is necessary to maintain the quality of life (QOL) of the aged population in developed nations such as Japan where the number of elderly has been increasing rapidly. For this purpose, low-resistance training using exercise machines ('Power Rehabilitation') has been established as a rehabilitation program. To investigate the individual factors which influence the effects of 'Power Rehabilitation', single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) gene and the ciliary neurotrophic factor (CNTF) gene were analyzed, and the relationship between SNP patterns and the effects of 'Power Rehabilitation' was evaluated. 'Power Rehabilitation' had an effect on the physiological functions involved in the activities of daily life (ADL) rather than muscle strength and size. In addition, certain SNP patterns showed better improvement of parameters associated with the effects of 'Power Rehabilitation' as analyzed by comparison between SNP patterns and factor analysis. Large scale analyses are required to ensure this tendency and to discover individual factors which may help to promote the health and QOL of the aged population.

Applying Theory across Settings, Behaviors and Populations: Translational Challenges and Opportunities

PubMed Central

Mermelstein, Robin J.; Revenson, Tracey A.

2013-01-01

Basic social psychological theories have much to contribute to our understanding of health problems and health-related behaviors and may provide potential avenues for intervention development. However, for these theories to have broader reach and applicability to the field of health psychology, more work needs to be done in integrating contexts into these theories and addressing more specifically their application across settings, behaviors, and populations. We argue that integration of these theories into a broader multi-disciplinary and multi-level ecological framework is needed to enhance their translation into real-world applications. To enhance this translation, we make several recommendations, including breaking down silos between disciplinary perspectives and enhancing bidirectional communication and translation; analyzing boundary conditions of theories; expanding research approaches to move outside the laboratory and maintain a focus on external validity; and conducting efficacy testing of theories with meaningful, relevant endpoints. PMID:23646843

Twenty Years of Public Health Research: Inclusion of Lesbian, Gay, Bisexual, and Transgender Populations

PubMed Central

Boehmer, Ulrike

2002-01-01

Objectives. This study determined to what extent lesbian, gay, bisexual, and transgender (LGBT) populations have been studied over the past 20 years of public health research. Methods. From MEDLINE English-language articles on human subjects published between 1980 and 1999, I identified articles that included LGBT individuals. The abstracts were analyzed with a coding procedure that categorized the content by topic, sexual orientation, and race/ethnicity. Results. LGBT issues were addressed by 3777 articles, or 0.1% of all Medline articles; 61% of the articles were disease-specific, and 85% omitted reference to race/ethnicity. Research unrelated to sexually transmitted diseases addressed lesbians and gay men with similar frequency, whereas bisexual persons were less frequently considered, and the least amount of research focused on transgender individuals. Conclusions. Findings supported that LGBT issues have been neglected by public health research and that research unrelated to sexually transmitted diseases is lacking. PMID:12084696

Applying theory across settings, behaviors, and populations: translational challenges and opportunities.

PubMed

Mermelstein, Robin J; Revenson, Tracey A

2013-05-01

Basic social psychological theories have much to contribute to our understanding of health problems and health-related behaviors and may provide potential avenues for intervention development. However, for these theories to have broader reach and applicability to the field of health psychology, more work needs to be done in integrating contexts into these theories and addressing more specifically their application across settings, behaviors, and populations. We argue that integration of these theories into a broader multidisciplinary and multilevel ecological framework is needed to enhance their translation into real-world applications. To enhance this translation, we make several recommendations, including breaking down silos between disciplinary perspectives and enhancing bidirectional communication and translation; analyzing boundary conditions of theories; expanding research approaches to move outside the laboratory and maintain a focus on external validity; and conducting efficacy testing of theories with meaningful, relevant endpoints. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Insomnia Associated with Valerian and Melatonin Usage in the 2002 National Health Interview Survey

PubMed Central

Bliwise, Donald L.; Ansari, Farzaneh Pour

2007-01-01

Study Objective: Many people use dietary supplements or herbal products to help them sleep. We analyzed the associations between melatonin use and insomnia and between valerian use and insomnia in a representative sample of the United States population. Design and Participants: The data reported upon here were collected in the 2002 Alternative Health/Complementary and Alternative Medicine (CAM) Supplement to the National Health Interview Survey. This was a survey of 31,044 personal interviews that constituted an age-representative and socioeconomically representative sample of the civilian noninstitutionalized population of the United States. Results: Of the survey sample, 5.9% used valerian and 5.2% used melatonin. Of those using valerian, 29.9% endorsed insomnia as 1 reason for CAM use, and, of melatonin users, 27.5% endorsed insomnia as 1 reason for CAM use. Relatively greater use occurred in individuals under age 60 years. The decision to use such substances was made in consultation with a health care provider less than half of the time. Conclusions: Large segments of the United States population used valerian or melatonin for insomnia within the year preceding the survey, and usage typically fell outside the purview of the health care system. Citation: Bliwise DL; Ansari FP. Insomnia associated with valerian and melatonin usage in the 2002 National Health Interview Survey. SLEEP 2007;30(7):881-884. PMID:17682659

2015 Pandemic Influenza Readiness Assessment Among US Public Health Emergency Preparedness Awardees.

PubMed

Fitzgerald, Thomas J; Moulia, Danielle L; Graitcer, Samuel B; Vagi, Sara J; Dopson, Stephanie A

2017-09-01

To assess how US Public Health Emergency Preparedness (PHEP) awardees plan to respond to an influenza pandemic with vaccination. The Centers for Disease Control and Prevention developed the Pandemic Influenza Readiness Assessment, an online survey sent to PHEP directors, to analyze, in part, the readiness of PHEP awardees to vaccinate 80% of the populations of their jurisdictions with 2 doses of pandemic influenza vaccine, separated by 21 days, within 16 weeks of vaccine availability. Thirty-eight of 60 (63.3%) awardees reported being able to vaccinate their populations within 16 weeks; 38 (63.3%) planned to allocate more than 20% of their pandemic vaccine supply to points of dispensing (PODs). Thirty-four of 58 (58.6%) reported staffing as a challenge to vaccinating 80% of their populations; 28 of 60 (46.7%) reported preparedness workforce decreases, and 22 (36.7%) reported immunization workforce decreases between January 2012 and July 2015. Awardees relied on PODs to vaccinate segments of their jurisdictions despite workforce decreases. Planners must ensure readiness for POD sites to vaccinate, but should also leverage complementary sites and providers to augment public health response.

[Messages about physical activity and nutrition offered by Quebec mass media?].

PubMed

Renaud, Lise; Lagaé, Marie Claude; Caron-Bouchard, Monique

2009-01-01

As social elements of our environment, mass media are regarded as determinants of individual and population beliefs, social norms and habits. Since it is recognized that they influence population health, this study aims to obtain a better portrait of Quebec media content regarding physical activity and nutrition messages on a public health level. First, we analyzed the content of fictional television shows (n = 1 3) and advertisements broadcast during those shows (n = 68). Second, we reviewed the content of La Presse newspaper and of French television Société Radio-Canada from 1986 to 2005 with regard to physical activity and nutrition messages. Our results indicate a difference between how men and women are portrayed on French television, with women more often being shown as underweight and men as at or above healthy body weight. The results also show that during the 20-year period of the reviewed content, there were fewer messages about physical activity than about nutrition. To be successful in their goal of improving population health, mass media should address both subjects together in their messages.

[Life expectancy in the Plock area caused by lymphatic and erythrocyte line leukemia].

PubMed

Tyszko, Piotr; Wierzba, Waldemar M

2002-01-01

Among all specific environmental pollution the chemical compounds released in the oil refine process seem to hold the biggest interest. At Medical University of Warsaw we have been studying the influence of the Płock petroleum refinery plant pollution to citizens' health status for over 30 years. The high amount of hydrocarbons--including benzene--were presented in emission. One of the study objectives was to analyze death causes in Płock and Kutno and in the Płock area--according to environmental criteria. The population of the non-petrochemic polluted city Kutno was chosen as the control group. The previous analysis in 1984-1993 showed increased lymphatic or erythrocyte line leukaemia mortality in Płock population vs Kutno population. Similar situation was observed between the area of increased environmental petrochemical pollution and non-polluted area. In this article the Potential Years of Life Lost ratio was used to estimate the life deficiency as the measure of health needs due to mentioned neoplasms. Data indicate that the health needs are bigger than the mortality analysis has shown.

Comparison of the consumption of antidepressants in the immigrant and native populations in a Spanish health region: an observational study

PubMed Central

2010-01-01

Background Health professionals and organizations in developed countries adapt slowly to the increase of ethnically diverse populations attending health care centres. Several studies report that attention to immigrant mental health comes up with barriers in access, diagnosis and therapeutics, threatening equity. This study analyzes differences in exposure to antidepressant drugs between the immigrant and the native population of a Spanish health region. Methods Cross-sectional study of the dispensation of antidepressant drugs to the population aged 15 years or older attending the public primary health centres of a health region, 232,717 autochthonous and 33,361 immigrants, during 2008. Data were obtained from computerized medical records and pharmaceutical records of medications dispensed in pharmacies. Age, sex, country of origin, visits, date of entry in the regional health system, generic drugs and active ingredients were considered. Statistical analysis expressed the percentage of persons exposed to antidepressants stratified by age, gender, and country of origin and prevalence ratios of antidepressant exposition were calculated. Results Antidepressants were dispensed to 11% of native population and 2.6% of immigrants. Depending on age, native women were prescribed antidepressants between 1.9 and 2.7 times more than immigrant women, and native men 2.5 and 3.1 times more than their immigrant counterparts. Among immigrant females, the highest rate was found in the Latin Americans (6.6%) and the lowest in the sub-Saharans (1.4%). Among males, the highest use was also found in the Latin Americans (1.6%) and the lowest in the sub-Saharans (0.7%). The percentage of immigrants prescribed antidepressants increased significantly in relation to the number of years registered with the local health system. Significant differences were found for the new antidepressants, prescribed 8% more in the native population than in immigrants, both in men and in women. Conclusions All the immigrants, regardless of the country of origin, had lower antidepressant consumption than the native population of the same age and sex. Latin American women presented the highest levels of consumption, and the sub-Saharan men the lowest. The prescription profiles also differed, since immigrants consumed more generics and fewer recently commercialized active ingredients. PMID:20478063

Economic impact of a Medicaid population health management program.

PubMed

Rust, George; Strothers, Harry; Miller, William Johnson; McLaren, Susan; Moore, Barbara; Sambamoorthi, Usha

2011-10-01

A population health management program was implemented to assess growth in health care expenditures for the disabled segment of Georgia's Medicaid population before and during the first year of a population health outcomes management program, and to compare those expenditures with projected costs based on various cost inflation trend assumptions. A retrospective, nonexperimental approach was used to analyze claims data from Georgia Medicaid claims files for all program-eligible persons for each relevant time period (intent-to-treat basis). These included all non-Medicare, noninstitutionalized Medicaid aged-blind-disabled adults older than 18 years of age. Comparisons of health care expenditures and utilization were made between base year (2003-2004) and performance year one (2006-2007), and of the difference between actual expenditures incurred in the performance year vs. projected expenditures based on various cost inflation assumptions. Demographic characteristics and clinical complexity of the population (as measured by the Chronic Illness and Disability Payment System risk score) actually increased from baseline to implementation. Actual expenditures were less than projected expenditures using any relevant medical inflation assumption. Actual expenditures were less than projected expenditures by $9.82 million when using a conservative US general medical inflation rate, by $43.6 million using national Medicaid cost trends, and by $106 million using Georgia Medicaid's own cost projections for the non-dually eligible disabled segment of Medicaid enrollees. Quadratic growth curve modeling also demonstrated a lower rate of increase in total expenditures. The rate of increase in expenditures was lower over the first year of program implementation compared with baseline. Weighted utilization rates were also lower in high-cost categories, such as inpatient days, despite increases in the risk profile of the population. Varying levels of cost avoidance could be inferred from differences between actual and projected expenditures using each of the health-related inflation assumptions.

Cardiovascular risk factors and TIA characteristics in 19,872 Swedish TIA patients.

PubMed

Ström, J O; Tavosian, A; Appelros, P

2016-12-01

Transient ischemic attack (TIA) constitutes a major risk factor for stroke, making TIA patients an important group for secondary intervention. The aim of this study was to account for risk factor prevalence in TIA patients and analyze the association between TIA characteristics and risk factors. We included 20,871 TIA events in 19,872 patients who were registered in the Swedish Riksstroke registry during the years 2010 through 2012. Data from other Swedish registers were used for comparison. The following variables were analyzed: age, sex, diabetes mellitus, atrial fibrillation (AF), cigarette smoking, and antihypertensive treatment. Compared to the general population (based on data retrieved from Sweden's national public health survey 'Health on equal terms'), TIA patients more often had diabetes mellitus (prevalence ratio, PR = 2.3), AF without oral anticoagulants (OAC) (PR = 2.8), and AF on OAC (PR = 1.6). Blood pressure medication was less prevalent among TIA patients than in the general population (PR = 0.57). Increasing age was associated with longer attacks. The fact that diabetes mellitus, atrial fibrillation, and smoking are more common in TIA patients than in the general population suggests that these factors are risk factors for TIA, even if causal relations cannot be proven. The relation between increasing age and longer attacks possibly reflects an increased proportion of embolic TIAs, or impaired recovery ability. Our results also suggest a significant proportion of untreated hypertension cases in the population. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effect of increased private share of inpatient psychiatric resources on jail population growth: evidence from the United States.

PubMed

Yoon, Jangho

2011-02-01

There is a strong connection between the mental health and criminal justice systems. This research empirically tested whether the privatization of the inpatient mental health system alters this relationship, contributing to jail population growth. Using state-level panel data on U.S. states and the District of Columbia for the years 1985-1998, this study analyzed the relationship between the size of jail populations and private share of hospital psychiatric beds, first for overall private beds and then separately by private for-profit and nonprofit. Empirical models controlled for changes in mental health financing and resources, variations in criminal justice practice, and demographic and socio-economic factors as well as state and year fixed effects. A method of instrumental variables was employed to make a stronger case for causal inference. Results show that a one-percentage point increase in the private for-profit share of psychiatric beds contributes to the growth of jail inmates by approximately 2.3% annually. A greater private nonprofit share of psychiatric beds does not appear to influence the size of jail populations. These findings suggest that the increased private for-profit share of inpatient psychiatric resources undermines the safety-net and some control function of the mental health system and leads to a greater number of jail inmates. Copyright © 2010 Elsevier Ltd. All rights reserved.

Social Work's Role in Medicaid Reform: A Qualitative Study.

PubMed

Bachman, Sara S; Wachman, Madeline; Manning, Leticia; Cohen, Alexander M; Seifert, Robert W; Jones, David K; Fitzgerald, Therese; Nuzum, Rachel; Riley, Patricia

2017-12-01

To critically analyze social work's role in Medicaid reform. We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods. Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work's practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work's involvement in systems-level practice include lack of visibility, insufficient clarity on social work's role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy. Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level.

The Impact of Audio Book on the Elderly Mental Health.

PubMed

Ameri, Fereshteh; Vazifeshenas, Naser; Haghparast, Abbas

2017-01-01

The growing elderly population calls mental health professionals to take measures concerning the treatment of the elderly mental disorders. Today in developed countries, bibliotherapy is used for the treatment of the most prevalent psychiatric disorders. Therefore, this study aimed to investigate the effects of audio book on the elderly mental health of Retirement Center of Shahid Beheshti University of Medical Sciences. This experimental study was conducted on 60 elderly people participated in 8 audio book presentation sessions, and their mental health aspects were evaluated through mental health questionnaire (SCL-90-R). Data were analyzed using SPSS 24. Data analysis revealed that the mean difference of pretest and posttest of control group is less than 5.0, so no significant difference was observed in their mental health, but this difference was significant in the experimental group (more than 5.0). Therefore, a significant improvement in mental health and its dimensions have observed in elderly people participated in audio book sessions. This therapeutic intervention was effective on mental health dimensions of paranoid ideation, psychosis, phobia, aggression, depression, interpersonal sensitivity, anxiety, obsessive-compulsive and somatic complaints. Considering the fact that our population is moving toward aging, the obtained results could be useful for policy makers and health and social planners to improve the health status of the elderly.

Exploring urban health in Cape Town, South Africa: an interdisciplinary analysis of secondary data

PubMed Central

Mumm, Rebekka; Hänselmann, Eva; Freund, Johanna; Wirsching, Michael; Gärtner, Jan; Gminski, Richard; Vögtlin, Katrin; Körner, Mirjam; Zirn, Lena; Wittwer-Backofen, Ursula; Oni, Tolu

2017-01-01

Background: With modern information technology, an overwhelming amount of data is available on different aspects of societies. Our research investigated the feasibility of using secondary data sources to get an overview of determinants of health and health outcomes in different population strata of Cape Town, a large city of South Africa. Methods: The methodological approach of secondary-data analysis was similar in the different disciplines: Biological Anthropology, Public Health, Environmental Health, Mental Health, Palliative Care, Medical Psychology and Sociology at the University of Freiburg and Public Health at the University of Cape Town. The teams collected information on Cape Town through Internet searches and published articles. The information was extracted, analyzed, condensed, and jointly interpreted. Results: Data show the typical picture of a population in epidemiological and demographic transition exposed to often difficult social, mental, and physical environmental conditions. Comparison between low and higher socioeconomic districts demonstrated that the former had higher air pollution, poorer water quality, and deficient sanitary conditions in addition to sub-optimal mental health services and palliative care. Conclusion: Although important information gaps were identified, the data draw attention to critical public health interventions required in poor health districts, and to motivate for pro-equity policies. PMID:28093045

The Impact of Audio Book on the Elderly Mental Health

PubMed Central

Ameri, Fereshteh; Vazifeshenas, Naser; Haghparast, Abbas

2017-01-01

Introduction: The growing elderly population calls mental health professionals to take measures concerning the treatment of the elderly mental disorders. Today in developed countries, bibliotherapy is used for the treatment of the most prevalent psychiatric disorders. Therefore, this study aimed to investigate the effects of audio book on the elderly mental health of Retirement Center of Shahid Beheshti University of Medical Sciences. Methods: This experimental study was conducted on 60 elderly people participated in 8 audio book presentation sessions, and their mental health aspects were evaluated through mental health questionnaire (SCL-90-R). Data were analyzed using SPSS 24. Results: Data analysis revealed that the mean difference of pretest and posttest of control group is less than 5.0, so no significant difference was observed in their mental health, but this difference was significant in the experimental group (more than 5.0). Therefore, a significant improvement in mental health and its dimensions have observed in elderly people participated in audio book sessions. This therapeutic intervention was effective on mental health dimensions of paranoid ideation, psychosis, phobia, aggression, depression, interpersonal sensitivity, anxiety, obsessive-compulsive and somatic complaints. Conclusion: Considering the fact that our population is moving toward aging, the obtained results could be useful for policy makers and health and social planners to improve the health status of the elderly. PMID:29167723

Effects of Targeted Subsidies Policy on Health Behavior in Iranian Households: A Qualitative Study

PubMed Central

DOSHMANGIR, Leila; DOSHMANGIR, Parinaz; ABOLHASSANI, Nazanin; MOSHIRI, Esmaeil; JAFARI, Mehdi

2015-01-01

Background: This study aimed to explore the effects of national targeted subsidies policy on health behavior of Iranian households. Methods: In this qualitative study, data were collected between January 2012 and December 2013 through face-to-face interviews (23 experts in national and provincial levels of health system and 18 household heads) and through a comprehensive and purposive document analysis. The data was analyzed using a thematic analysis method (inductive-deductive) and assisted by Atlas-ti software. Results: Rising health care costs, removing some food subsidies and the increase in price of most goods and services due to the implementation of economic policy of targeted subsidies have led to significant changes in the demand for health services, changes in the consumption trends of goods and services affecting health as well as changes in the health habits of households. Conclusion: Targeted subsidies and the cash subsidy policy have some negative effects on population health behavior especially among poor people. Hence, maintaining or increasing the cash subsidy is not an efficient allocation of resources toward health care system. So, it is necessary to identify appropriate strategies and policies and apply interventions in order to moderate negative effects and enhance positive effects resulted from implementing this economic reform on population health behavior. PMID:26056676

Experiences of coexisting with chronic illnesses among elderly women in communities.

PubMed

Chang, Yu-Mei; Tsao, Lee-Ing; Huang, Min-His

2014-01-01

Based on the increasing numbers of women in the aging population, the health of women will become critical in the future. Our purpose in this study was to analyze the experiences of elderly women with chronic illness. Twelve elderly Taiwanese women participated in in-depth interviews. "Using my own power out of the disease shackle" was the core category referring to elderly women who coexist with chronic illnesses. Elderly women should be provided with individually targeted plans for disease management and health maintenance to enable them to participate in health care decisions at the onset of chronic diseases.

Comparing the performance of the public, social security and private health subsystems in Argentina by core dimensions of primary health care

PubMed Central

Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie

2016-01-01

Abstract Background Most Latin American health systems are comprised of public (PubS), social security (SSS) and private (PrS) subsystems. These subsystems coexist, causing health care fragmentation and population segmentation. Objective To estimate the extent of subsystem cross-coverage in a geographically bounded population (Rosario city) and to compare the subsystems’ performance on primary health care (PHC) dimensions. Methods Through a cross-sectional, interviewer-administered survey to a representative sample (n = 822) of the Rosario population, we measured the percentage of cross-coverage (people with usual source of care in one subsystem but also covered by another subsystem) and the health services’ performance by core PHC dimensions, as reported by each subsystem’s usual users. We compared the subsystems’ performance using chi-square analysis and one-way analysis of variance testing. We analyzed whether the observed differences were coherent with the predominant institutional and organizational features of each subsystem. Results Overall, 39.3% of the population was affiliated with the PubS, 44.8% with the SSS and 15.9% with the PrS. Cross-coverage was reported by 40.6% of respondents. The performance of the PubS was weak on accessibility but strong on person-and-community-oriented care, the opposite of the PrS. The SSS combined the strengths of the other two subsystems. Conclusion Rosario’s health system has a high percentage of cross-coverage, contributing to issues of fragmentation, segmentation, financial inequity and inefficiency. The overall performance of the SSS was better than that of the PrS and PubS, though each subsystem had a particular performance pattern with areas of strength and weakness that were consistent with their institutional and organizational profiles. PMID:27377651

[The impact of public health system on mortality of malignant neoplasms in Voronezh oblast].

PubMed

Chesnokov, P E; Kuralesina, E N

2013-01-01

The total mortality and population mortality of main classes of diseases and single causes of death are to be considered in operative and strategic planning of development of national economy and industry In the Russian Federation, the decrease of mortality of neoplasms including malignant ones up to 190 per 100 000 of population in 2020 will be one of indicators of effectiveness of implementation of the State program of development of public health in the Russian Federation. The study was organized to determine the possibility to impact the level and dynamics of mortality of malignant neoplasms by means of variation of managed factors on the basis of indicators of activity of public health system. The main indicators of population health and activity of health institutions of Voronezh oblast were analyzed. The methods of mathematical statistics, management theory, system analysis and mathematical modeling were applied. To study the impact of managed factors on mortality of malignant neoplasms on the territory of Voronezh oblast the analysis of correlation interdependency was applied concerning 162 factors characterizing condition and activity of public health system according oblast districts and level of mortality of malignant neoplasms among adult population. The combinations of factors were calculated using the model to determine the level of prospective mortality to come in certain time after implementation of activities changing the given levels of factors. The data concerning qualitative interrelationship of indicators of condition and functioning of network of health institutions with indicators of level and dynamics of mortality of malignant neoplasms can be applied to model and forecast and to evaluate the current and forthcoming situation according indicators of mentioned mortality on the territory of Voronezh oblast in development of comprehensive plan of activities targeted to decreasing of this indicator.

Health care costs in the elderly in Germany: an analysis applying Andersen’s behavioral model of health care utilization

PubMed Central

2014-01-01

Background To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen’s behavioral model of health care utilization, in the German elderly population. Methods Using a cross-sectional design, cost data of 3,124 participants aged 57–84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents’ homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Results Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Conclusions Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs. PMID:24524754

Health care costs in the elderly in Germany: an analysis applying Andersen's behavioral model of health care utilization.

PubMed

Heider, Dirk; Matschinger, Herbert; Müller, Heiko; Saum, Kai-Uwe; Quinzler, Renate; Haefeli, Walter Emil; Wild, Beate; Lehnert, Thomas; Brenner, Hermann; König, Hans-Helmut

2014-02-14

To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen's behavioral model of health care utilization, in the German elderly population. Using a cross-sectional design, cost data of 3,124 participants aged 57-84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents' homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.

Oral health conditions in leprosy cases in hyperendemic area of the Brazilian Amazon

PubMed Central

de Almeida, Zilanda Martins; Ramos, Alberto Novaes; Raposo, Marcos Túlio; Martins-Melo, Francisco Rogerlândio; Vasconcellos, Cidia

2017-01-01

ABSTRACT Leprosy is a hyperendemic chronic condition in the Rondônia State . Despite the significant impact of oral health on the quality of life and clinical evolution of leprosy patients, systematic evaluation of oral health status has been neglected. To analyze the dental-clinical profile, self-perceived oral health and dental health service access of leprosy cases in the municipality of Cacoal in Rondônia State , North Brazil, from 2001 to 2012. A descriptive, cross-sectional study design was performed based on dental evaluation and standardized structured instruments. We investigated clinically assessed and self-perceived oral health status, as well as dental health service access. A total of 303 leprosy cases were included; 41.6% rated their oral health as good, and 42.6% reported being satisfied with their oral health. Self-reported loss of upper teeth was 45.5%. The clinical evaluation revealed that 54.5% had active caries. Most (97.7%) cases reported having been to the dentist at least once in their life and 23.1% used public health services. The poor standard of oral health in this population may increase the risk for leprosy reactions, consequently reducing quality of life. Low access to public health dental services and poor self-perceived oral health reinforce the need to achieve comprehensive health care in this population. PMID:28902294

Job Characteristics Associated With Self-Rated Fair or Poor Health Among U.S. Workers.

PubMed

Luckhaupt, Sara E; Alterman, Toni; Li, Jia; Calvert, Geoffrey M

2017-08-01

Approximately 60% of the U.S. adult population is employed. Many aspects of a person's job may influence health, but it is unclear which job characteristics are most strongly associated with health at a population level. The purpose of this study was to identify important associations between job characteristics and workers' self-rated health in a nationally representative survey of U.S. workers. Data from the 2010 National Health Interview Survey were used to calculate weighted prevalence rates for self-reported fair/poor health for five categories of job characteristics: occupation; pay/benefits (economic); work organization; chemical/environmental hazards; and psychosocial factors. Backward elimination methods were used to build a regression model for self-reported health with the significant job characteristics, adjusting for sociodemographic variables and health behaviors. Data were collected in 2010 and analyzed in 2012-2016. After adjusting for covariates, workers were more likely to have fair/poor health if they were employed in business operations occupations (e.g., buyers, human resources workers, event planners, marketing specialists; adjusted prevalence ratio [APR]=1.85, 95% CI=1.19, 2.88); had no paid sick leave (APR=1.35, 95% CI=1.11, 1.63); worried about becoming unemployed (APR=1.43, 95% CI=1.22, 1.69); had difficulty combining work and family (APR=1.23, 95% CI=1.01, 1.49); or had been bullied/threatened on the job (APR=1.82, 95% CI=1.44, 2.29). Occupation, lack of paid sick leave, and multiple psychosocial factors were associated with fair/poor health among U.S. workers at the population level in 2010. Public health professionals and employers should consider these factors when developing interventions to improve worker health. Published by Elsevier Inc.

Factors Related to Pregnancy Among Female Sex Workers Living with HIV in the Dominican Republic.

PubMed

Cernigliaro, Dana; Barrington, Clare; Perez, Martha; Donastorg, Yeycy; Kerrigan, Deanna

2016-10-01

Female sex workers (FSWs) living with HIV are a vulnerable population for multiple health concerns and have been vastly understudied in public health literature. This study analyzes factors related to pregnancy among 268 FSWs living with HIV in the Dominican Republic. Results indicate that 34 % of participants had been pregnant since HIV diagnosis. Multivariate analysis revealed significant associations between pregnancy after HIV diagnosis and ART interruption (AOR 2.41; 95 % CI 1.19, 4.94), knowledge of mother-to-child transmission (AOR 2.12; 95 % CI 0.99, 4.55), serostatus disclosure to a sex partner (AOR 2.46; 95 % CI 1.31, 4.62), older age (AOR 0.91; 95 % CI 0.87, 0.95) and a more negative perception of their health provider (AOR 0.56; 95 % CI 0.34, 0.93). Results indicate noteworthy associations between having been pregnant and the health provider experience and ART interruption, indicating a significant need for further research on this population to ensure both maternal and child health.

Estimating benefit equity of government health subsidy in healthcare Services in Shandong Province, China: a cross-sectional study.

PubMed

Qin, Wenzhe; Xu, Lingzhong; Li, Jiajia; Sun, Long; Ding, Gan; Shao, Hui; Xu, Ningze

2018-05-18

Government health subsidy (GHS) is an effective tool to improve population health in China. Ensuring an equitable allocation of GHS, particularly among the poorer socio-economic groups, is a major goal of China's healthcare reform. The paper aims to explore how GHS was allocated across different socioeconomic groups, and how well the overall health system was performing in terms of the allocation of subsidy for different types of health services. Data from China's National Health Services Survey (NHSS) in 2013 were used. Benefit incidence analysis (BIA) was applied to examine if GHS was equally distributed across income quintile. Benefit incidence was presented as each quintile's percentage share of total benefits, and the concentration index (CI) and Kakwani index (KI) were calculated. Health benefits from three types of healthcare services (primary health care, outpatient and inpatient services) were analyzed, separated into urban and rural populations. In addition, the distribution of benefits was compared to the distribution of healthcare need (measured by self-reported illness and chronic disease) across income quintiles. In urban populations, the CI value of GHS for primary care was negative. (- 0.14), implying an allocation tendency toward poor region; the CI values of outpatient and inpatient services were both positive (0.174 and 0.194), indicating allocation tendencies toward rich region. Similar allocation pattern was observed in rural population, with pro-poor tendency of primary care service (CI = - 0.082), and pro-rich tendencies of outpatient (CI = 0.153) and inpatient services (CI = 0.203). All the KI values of three health services in urban and rural populations were negative (- 0.4991,-0.1851 and - 0.1651; - 0.482, - 0.247and - 0.197), indicating that government health subsidy was progressive and contributed to the narrowing of economic gap between the poor and rich. The inequitable distribution of GHS in China exited in different healthcare services; however, the GHS benefit is generally progressive. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

Prevalence of selected bacterial infections associated with the use of animal waste in Louisiana.

PubMed

Hill, Dagne D; Owens, William E; Tchounwou, Paul B

2005-04-01

Human health is a major concern when considering the disposal of large quantities of animal waste. Health concerns could arise from exposure to pathogens and excess nitrogen associated with this form of pollution. The objective was to collect and analyze health data related to selected bacterial infections associated with the use of animal waste in Louisiana. An analysis of adverse health effects has been conducted based on the incidence/prevalence rates of campylobacteriosis, E. coli O157:H7 infection, salmonellosis and shigellosis. The number of reported cases increased during the summer months. Analysis of health data showed that reported disease cases of E. coli O157:H7 were highest among Caucasian infants in the 0-4 year old age category and in Caucasian children in the 5-9 year old age category. Fatalities resulting from salmonellosis are low and increases sharply with age. The number of reported cases of shigellosis was found to be higher in African American males and females than in Caucasians. The high rate of identification in the younger population may result from the prompt seeking of medical care, as well as the frequent ordering of stool examination when symptoms become evident among this group of the population. The association with increasing age and fatality due to salmonellosis could be attributed to declining health and weaker immune systems often found in the older population. It is concluded that both animal waste and non-point source pollution may have a significant impact on human health.

Building a diabetes screening population data repository using electronic medical records.

PubMed

Tuan, Wen-Jan; Sheehy, Ann M; Smith, Maureen A

2011-05-01

There has been a rapid advancement of information technology in the area of clinical and population health data management since 2000. However, with the fast growth of electronic medical records (EMRs) and the increasing complexity of information systems, it has become challenging for researchers to effectively access, locate, extract, and analyze information critical to their research. This article introduces an outpatient encounter data framework designed to construct an EMR-based population data repository for diabetes screening research. The outpatient encounter data framework is developed on a hybrid data structure of entity-attribute-value models, dimensional models, and relational models. This design preserves a small number of subject-specific tables essential to key clinical constructs in the data repository. It enables atomic information to be maintained in a transparent and meaningful way to researchers and health care practitioners who need to access data and still achieve the same performance level as conventional data warehouse models. A six-layer information processing strategy is developed to extract and transform EMRs to the research data repository. The data structure also complies with both Health Insurance Portability and Accountability Act regulations and the institutional review board's requirements. Although developed for diabetes screening research, the design of the outpatient encounter data framework is suitable for other types of health service research. It may also provide organizations a tool to improve health care quality and efficiency, consistent with the "meaningful use" objectives of the Health Information Technology for Economic and Clinical Health Act. © 2011 Diabetes Technology Society.

Health care expenditures of children and adults with spina bifida in a privately insured U.S. population.

PubMed

Ouyang, Lijing; Grosse, Scott D; Armour, Brian S; Waitzman, Norman J

2007-07-01

We provide new estimates of medical care utilization and expenditures over the lifespan for persons living with spina bifida in the United States. Updated estimates are essential for calculations of lifetime costs and for economic evaluations of prevention and management strategies for spina bifida. We analyzed data from the 2001-2003 MarketScan database on paid medical and prescription drug claims of persons covered by employer-sponsored health insurance in the United States. Medical care utilization and expenditures during 2003 were analyzed for persons with a diagnosis of spina bifida recorded during 2001-2003 who had 12 months of coverage in a fee-for-service health plan. To calculate expenditures during infancy, a separate analysis was performed for those born during 2002 with claims and expenditures data during the first 12 months of life. We compared medical expenditures for persons with and without spina bifida by age groups. Average incremental medical expenditures comparing patients with spina bifida and those without were $41,460 per year at age 0, $14,070 at ages 1-17, $13,339 at ages 18-44, and $10,134 at ages 45-64. Children ages 1-17 years with spina bifida had average medical expenditures 13 times greater than children without spina bifida. Adults with spina bifida had average medical expenditures three to six times greater than adults without spina bifida in this privately insured population. Although per capita medical care utilization and expenditures are highest among children, adults constitute an important and growing share of the population living with spina bifida. (c) 2007 Wiley-Liss, Inc.

Linking Canadian Population Health Data: Maximizing the Potential of Cohort and Administrative Data

PubMed Central

Doiron, Dany; Raina, Parminder; Fortier, Isabel

2013-01-01

Linkage of data collected by large Canadian cohort studies with provincially managed administrative health databases can offer very interesting avenues for multidisciplinary and cost-effective health research in Canada. Successfully co-analyzing cohort data and administrative health data (AHD) can lead to research results capable of improving the health and well-being of Canadians and enhancing the delivery of health care services. However, such an endeavour will require strong coordination and long-term commitment between all stakeholders involved. The challenges and opportunities of a pan-Canadian cohort-to-AHD data linkage program have been considered by cohort study investigators and data custodians from each Canadian province. Stakeholders acknowledge the important public health benefits of establishing such a program and have established an action plan to move forward. PMID:23823892

Linking Canadian population health data: maximizing the potential of cohort and administrative data.

PubMed

Doiron, Dany; Raina, Parminder; Fortier, Isabel

2013-03-06

Linkage of data collected by large Canadian cohort studies with provincially managed administrative health databases can offer very interesting avenues for multidisciplinary and cost-effective health research in Canada. Successfully co-analyzing cohort data and administrative health data (AHD) can lead to research results capable of improving the health and well-being of Canadians and enhancing the delivery of health care services. However, such an endeavour will require strong coordination and long-term commitment between all stakeholders involved. The challenges and opportunities of a pan-Canadian cohort-to-AHD data linkage program have been considered by cohort study investigators and data custodians from each Canadian province. Stakeholders acknowledge the important public health benefits of establishing such a program and have established an action plan to move forward.

Catholic hospital services for vulnerable populations: are system values sufficient determinants?

PubMed

White, Kenneth R; Chou, Tiang-Hong; Dandi, Roberto

2010-01-01

Catholic hospitals and health systems comprise a substantial segment of nonprofit, mission-driven, health care services, with accountability to institutional pressures of the Roman Catholic Church as well as economic pressures for solvency. Values are the way in which the organization expresses its faith-based institutional identity, which may used to select services that represent those values. The purpose of this study was to identify whether Catholic health systems' explicit values of justice or compassion (and derivatives of those words, known to have similar meaning) were associated with a greater number of system member hospitals' services aimed at vulnerable populations. Using information from Web sites of 41 Catholic health systems in 2007 and data describing their 452 hospitals from the American Hospital Association Annual Survey, the relationship of health system values with hospital services for vulnerable populations was examined while controlling for organizational, market, and demand variables. Although Catholic hospitals as a whole are more likely to provide services to vulnerable populations than to other ownership types, the results show that among Catholic hospitals, values of justice or compassion are not associated with more services (defined in this study) that reflect those values. System hospitals likely to have more services that represent the values of justice and compassion are larger, have a higher Medicaid payer mix, are located in less dense urban areas, and are members of geographically dispersed systems. Hospitals select services that may represent symbolic system values, but community need and financial means are stronger determinants. To bolster community benefit to justify tax exempt status, Catholic hospitals and systems may benefit from further defining, analyzing, and reporting the impact of access to relatively unprofitable services for previously underserved vulnerable populations.

Sexual health behaviors of Deaf American Sign Language (ASL) users.

PubMed

Heiman, Erica; Haynes, Sharon; McKee, Michael

2015-10-01

Little is known about the sexual health behaviors of Deaf American Sign Language (ASL) users. We sought to characterize the self-reported sexual behaviors of Deaf individuals. Responses from 282 Deaf participants aged 18-64 from the greater Rochester, NY area who participated in the 2008 Deaf Health were analyzed. These data were compared with weighted data from a general population comparison group (N = 1890). We looked at four sexual health-related outcomes: abstinence within the past year; number of sexual partners within the last year; condom use at last intercourse; and ever tested for HIV. We performed descriptive analyses, including stratification by gender, age, income, marital status, and educational level. Deaf respondents were more likely than the general population respondents to self-report two or more sexual partners in the past year (30.9% vs 10.1%) but self-reported higher condom use at last intercourse (28.0% vs 19.8%). HIV testing rates were similar between groups (47.5% vs 49.4%) but lower for certain Deaf groups: Deaf women (46.0% vs 58.1%), lower-income Deaf (44.4% vs 69.7%) and among less educated Deaf (31.3% vs 57.7%) than among respondents from corresponding general population groups. Deaf respondents self-reported higher numbers of sexual partners over the past year compared to the general population. Condom use was higher among Deaf participants. HIV was similar between groups, though HIV testing was significantly lower among lower income, less well-educated, and female Deaf respondents. Deaf individuals have a sexual health risk profile that is distinct from that of the general population. Copyright © 2015 Elsevier Inc. All rights reserved.

Sexual Health Behaviors of Deaf American Sign Language (ASL) Users

PubMed Central

Heiman, Erica; Haynes, Sharon; McKee, Michael

2015-01-01

Background Little is known about the sexual health behaviors of Deaf American Sign Language (ASL) users. Objective We sought to characterize the self-reported sexual behaviors of Deaf individuals. Methods Responses from 282 Deaf participants aged 18–64 from the greater Rochester, NY area who participated in the 2008 Deaf Health were analyzed. These data were compared with weighted data from a general population comparison group (N=1890). We looked at four sexual health-related outcomes: abstinence within the past year; number of sexual partners within the last year; condom use at last intercourse; and ever tested for HIV. We performed descriptive analyses, including stratification by gender, age, income, marital status, and educational level. Results Deaf respondents were more likely than the general population respondents to self-report two or more sexual partners in the past year (30.9% vs 10.1%) but self-reported higher condom use at last intercourse (28.0% vs 19.8%). HIV testing rates were similar between groups (47.5% vs 49.4%) but lower for certain Deaf groups: Deaf women (46.0% vs. 58.1%), lower-income Deaf (44.4% vs. 69.7%) and among less educated Deaf (31.3% vs. 57.7%) than among respondents from corresponding general population groups. Conclusion Deaf respondents self-reported higher numbers of sexual partners over the past year compared to the general population. Condom use was higher among Deaf participants. HIV was similar between groups, though HIV testing was significantly lower among lower-income, less well-educated, and female Deaf respondents. Deaf individuals have a sexual health risk profile that is distinct from that of the general population. PMID:26242551

People living on the street from the health point of view.

PubMed

Hino, Paula; Santos, Jaqueline de Oliveira; Rosa, Anderson da Silva

2018-01-01

To know the Brazilian scientific production of the last ten years (2007 to 2016) about people who experience street situations under the health gaze. Integrative literature review using the descriptors: street people, health policy and public health. We analyzed 21 articles available in the Virtual Health Library. Four categories of analysis emerged. There was an increase in the frequency of published work on the subject, showing that the experience of living on the street makes people vulnerable to various diseases and health problems and, in addition, increases the difficulties of access to health services. There was an increase in the discussion of this topic due to the increase in the number of published studies. Despite the existence of public health policies directed to this social group, much still needs to be done to guarantee the health of this population.

Self-employment in joinery: an occupational risk facor?

PubMed

Lesage, Francois-Xavier; Salles, Julie; Deschamps, Frederic

2014-06-01

Only a few studies have analyzed the health of self-employed workers. This cross-sectional study is the first to compare health status among craftsmen joiners and paid joiners. Clinical and paraclinical data for self-employed craftsmen and employees were collected by occupational health doctors according to a standardized protocol and compared. Health data and professional status relationships were analyzed by logistic regression. A total of 171 craftsmen and 196 paid workers were included. Craftsmen had more dermatologic pathologies (odds ratio (OR) = 2.67, p < 0.05), ear/nose/throat symptoms (OR = 3.38, p < 0.001), pulmonary symptoms (OR = 2.46, p < 0.05), musculoskeletal symptoms (OR = 3.09, p < 0.001), and abnormal audiogram (OR = 3.50, p < 0.001). The FEV1 was significantly lower among craftsmen (p < 0.01), independently of tobacco smoke exposure. This survey high-lights a high morbidity rate among self-employed craftsmen, suggesting that among woodworkers, professional status can be a risk factor for health. The preventive medical system for craftsmen has to be rethought to guarantee better safety for this population.

Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil

PubMed Central

Rocha, Juan Stuardo Yazlle; Monteiro, Rosane Aparecida; Moreira, Marizélia Leão

2015-01-01

OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil. METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness. RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients. CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil. PMID:26465661

Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil.

PubMed

Rocha, Juan Stuardo Yazlle; Monteiro, Rosane Aparecida; Moreira, Marizélia Leão

2015-01-01

OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil.METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness.RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients.CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil.

[Between Puebla and Cairo Plus Five].

PubMed

1998-03-01

The National Forum of Women and Population Policies was held in Puebla, Mexico, in January 1998 to assess achievements and lags in carrying out the Program of Action adopted at the International Conference on Population and Development in Cairo. The forum proposed diagnosing the current situation in order to compare existing realities with proposals contained in Mexico¿s National Population Program, the National Reproductive Health and Family Planning Program, and the Mexican program of the UN Population Fund. The lack of disaggregated information and of research, except for a handful of states with particularly grave demographic and reproductive health problems, were barriers to evaluation. It also appeared indispensable to analyze the situations of the nongovernmental organizations involved, and to define priorities among remaining tasks. Two achievements of the forum in Puebla were to reconstitute a coordinating body for follow-up of the Program of Action with a specific work plan, and to reinforce links and communication with state population councils and health institutions in order to facilitate implementation of the Program of Action. Among the 53 organizations represented at the Puebla Forum, 66% were involved in actions to fight poverty and 90% in actions to increase autonomy of women. 74% had ties to government agencies. The themes receiving most attention were sexuality and family planning, pregnancy and delivery, and HIV and other sexually transmitted diseases.

A population-based registry as a source of health indicators for rare diseases: the ten-year experience of the Veneto Region’s rare diseases registry

PubMed Central

2014-01-01

Background Although rare diseases have become a major public health issue, there is a paucity of population-based data on rare diseases. The aim of this epidemiological study was to provide descriptive figures referring to a sizable group of unrelated rare diseases. Methods Data from the rare diseases registry established in the Veneto Region of north-east Italy (population 4,900,000), referring to the years from 2002 to 2012, were analyzed. The registry is based on a web-based system accessed by different users. Cases are enrolled by two different sources: clinicians working at Centers of expertise officially designated to diagnose and care patients with rare diseases and health professionals working in the local health districts. Deaths of patients are monitored by Death Registry. Results So far, 19,547 patients with rare diseases have been registered, and 23% of them are pediatric cases. The overall raw prevalence of the rare diseases monitored in the population under study is 33.09 per 10,000 inhabitants (95% CI 32.56-33.62), whilst the overall incidence is 3.85 per 10,000 inhabitants (95% CI 3.67-4.03). The most commonly-recorded diagnoses belong to the following nosological groups: congenital malformations (Prevalence: 5.45/10,000), hematological diseases (4.83/10,000), ocular disorders (4.47/10,000), diseases of the nervous system (3.51/10,000), and metabolic disorders (2,95/10,000). Most of the deaths in the study population occur among pediatric patients with congenital malformations, and among adult cases with neurological diseases. Rare diseases of the central nervous system carry the highest fatality rate (71.36/1,000). Rare diseases explain 4.2% of general population Years of Life Lost (YLLs), comparing to 1.2% attributable to infectious diseases and 2.6% to diabetes mellitus. Conclusions Our estimates of the burden of rare diseases at population level confirm that these conditions are a relevant public health issue. Our snapshot of their epidemiology is important for public health planning purposes, going to show that population-based registries are useful tools for generating health indicators relating to a considerable number of rare diseases, rather than to specific conditions. PMID:24646171

What does the development of medical tourism in Barbados hold for health equity? an exploratory qualitative case study.

PubMed

Labonté, Ronald; Runnels, Vivien; Crooks, Valorie A; Johnston, Rory; Snyder, Jeremy

2017-01-01

Although the global growth of privatized health care services in the form of medical tourism appears to generate economic benefits, there is debate about medical tourism's impacts on health equity in countries that receive medical tourists. Studies of the processes of economic globalization in relation to social determinants of health suggest that medical tourism's impacts on health equity can be both direct and indirect. Barbados, a small Caribbean nation which has universal public health care, private sector health care and a strong tourism industry, is interested in developing an enhanced medical tourism sector. In order to appreciate Barbadians' understanding of how a medical tourism industry might impact health equity. We conducted 50 individual and small-group interviews in Barbados with stakeholders including government officials, business and health professionals. The interviews were coded and analyzed deductively using the schedule's questions, and inductively for novel findings, and discussed by the authors. The findings suggest that in spite of Barbados' universal health care and strong population health indicators, there is expressed concern for medical tourism's impact on health equity. Informants pointed to the direct ways in which the domestic population might access more health care through medical tourism and how privately-provided medical tourism in Barbados could provide health benefits indirectly to the Barbadian populations. At the same time, they cautioned that these benefits may not materialize. For example, the transfer of public resources - health workers, money, infrastructure and equipment - to the private sector to support medical tourism with little to no return to government revenues could result in health inequity through reductions in access to and availability of health care for residents. In clarifying the direct and indirect pathways by which medical tourism can impact health equity, these findings have implications for health system stakeholders and decision-makers in Barbados and other countries attempting both to build a medical tourism industry and to protect health equity.

Who Seeks Cita Con El Doctor? Twelve Years of Spanish-Language Radio Program Targeting U.S. Latinos.

PubMed

Ramirez, A Susana; Graff, Kaitlin; Nelson, David; Galica, Kasia; Leyva, Bryan; Banegas, Mateo; Huerta, Elmer

2015-10-01

Spanish-dominant Latinos make up 13% of the U.S. population, and this group is poorer and faces multiple threats to health compared with the general population. Additionally, Spanish speakers face challenges accessing health information that is often not available in Spanish. This study provides a descriptive epidemiology of a unique, low-cost health information source: the longest-running U.S.-based Spanish-language call-in radio health education program. From the universe of all calls 1999 to 2011, stratified random sampling yielded 1,237 analyzed calls, which were manually coded for caller sex, age, proxy status, and health concern. Descriptive statistics were used to examine basic demographics of callers and call topics overall and by sex and proxy caller status. Among all calls, the top three call-generating health topics were specific symptoms/conditions, sexual/reproductive health, and gastrointestinal concerns. The top nine topics were consistent among women, men, and proxy callers; however, relative frequency of topics varied across groups. Nearly one quarter of calls were initiated on behalf of someone, generally a child, spouse or sibling, or parent. Sixty percent of callers were women; women made 70% of proxy calls. Understanding the differences in information seeking behaviors, information needs, and source preferences is important for determining where and how to disseminate health information and may help explain disparities in knowledge and health outcomes. The radio talk show format provides a uniquely personal, culturally sensitive channel for meeting health information needs of a vulnerable population while leveraging the cost-effectiveness and wide reach of a mass medium. © 2014 Society for Public Health Education.

[The Clinical Significance of Serum Alpha-fetoprotein in Diagnosing Hepatocellular Carcinoma in a Health Screening Population].

PubMed

Ko, Young Sun; Bae, Joo Hwan; Sinn, Dong Hyun; Gwak, Geum Youn; Kang, Wonseok; Paik, Yong Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon

2017-04-25

Serum alpha-fetoprotein (AFP) measurement is commonly included in a health check-up program in Korea. However, its benefits remain uncertain. We analyzed whether AFP measurement should be included in a general health check-up program to screen for hepatocellular carcinoma (HCC). A total of 36,552 adults aged 18 years or older-who participated in a routine health examination including AFP determination between January 2009 and December 2009 at the Health Promotion Center, Samsung Medical Center, South Korea-were analyzed. High risk of HCC was defined as positivity for hepatitis B surface antigen, anti-hepatitis C virus antibody or having liver cirrhosis. AFP level >10 ng/mL was observed in 27 participants (0.1%) and primary liver cancer was diagnosed in 9 patients (6 HCC and 3 cholangiocarcinoma). Among 1,619 participants with high risk factors of HCC, AFP level >10 ng/mL was observed in 16 participants, of which, 4 diagnoses were made. Sensitivity, specificity, positive predictive value, and negative predictive value of AFP for HCC was 0.66, 0.99, 0.25 and 0.99, respectively, for high risk participants. Among 34,933 participants without risk factors for HCC, 11 patients (<0.1%) showed elevated AFP levels above 10 ng/mL, and no case was diagnosed with primary liver cancer during a median follow-up period of 36 months (range: 0-48 months). AFP elevation was rare in participants without risk factors for HCC, and was unable to screen for HCC in this population. We discourage routine AFP measurements for asymptomatic adults without risk factors of HCC.

The effect of long working hours on 10-year risk of coronary heart disease and stroke in the Korean population: the Korea National Health and Nutrition Examination Survey (KNHANES), 2007 to 2013.

PubMed

Lee, Dong-Wook; Hong, Yun-Chul; Min, Kyoung-Bok; Kim, Tae-Shik; Kim, Min-Seok; Kang, Mo-Yeol

2016-01-01

Recently, the emergence of long working hours and the associated conditions such as coronary heart disease (CHD) and stroke have gained attention. The aim of this study was to investigate the association between long working hours and the 10-year-risk of CHD and stroke, estimated by Jee's health risk-appraisal model for ischemic heart disease. We analyzed data from Koreans who randomly enrolled in Korean National Health and Nutrition Examination Survey 2008-2012 and finally included 13,799 participants. The participants were classified as per their working hours: 0-30 h/week, 31-39 h/week, 40 h/week, 41-50 h/week, 51-60 h/week, 61-70 h/week, 71-80 h/week, and >80 h/week. The risks for CHD and stroke were determined using Jee's health risk-appraisal model. Multiple logistic regression was used to analyze the association between working hours and 10-year risk for CHD. The 10-year risks for CHD and stroke were significantly and positively associated with working hours in both men and women. Furthermore, higher risks for CHD and stroke were associated with longer working hours in women. Long working hours are significantly associated with the risks of CHD and stroke, estimated by Jee's health risk-appraisal model. This study suggests the need for proper management of working hours to reduce CHD risk and stroke risk in the Korean population.

Making the post-MDG global health goals relevant for highly inequitable societies: findings from a consultation with marginalized populations in Guatemala.

PubMed

Ruano, Ana Lorena; Sánchez, Silvia; Jerez, Fernando José; Flores, Walter

2014-10-10

The United Nations presented a set of Millennium Development Goals that aimed to improve social and economic development and eradicate poverty by 2015. Most low and middle-income countries will not meet these goals and today there is a need to set new development agenda, especially when it comes to health. The paper presents the findings from a community consultation process carried out within the Goals and Governance for Global Health (GO4Health) research consortium in Guatemala, which aims to identify community needs and expectations around public policies and health services. Through a participative and open consultation process with experts, civil society organizations and members of the research team, the municipalities of Tectitan and Santa Maria Nebaj were selected. A community consultation process was undertaken with community members and community leaders. Group discussions and in-depth interviews were conducted and later analyzed using thematic analysis, a qualitative method that can be used to analyze data in a way that allows for the identification of recurrent patterns that can be grouped into categories and themes, was used. Following the Go4Health framework's domains for understanding health-related needs, the five themes identified were health, social determinants of health, essential health needs and their provision, roles and responsibilities of relevant stakeholders and community participation in decision-making. Participants reported high levels of discrimination related to ethnicity, to being poor and to living in rural areas. Ethnicity played a major role in how community members feel they are cared for in the health system. Achieving health goals in a context of deep-rooted inequality and marginalization requires going beyond the simple expansion of health services and working with developing trusting relationships between health service providers and community members. Involving community members in decision-making processes that shape policies will contribute to a larger process of community empowerment and democratization. Still, findings from the region show that tackling these issues may prove complicated and require going beyond the health system, as this lack of trust and discrimination has permeated to all public policies that deal with indigenous and rural populations.

Differential Exposure to Hazardous Air Pollution in the United States: A Multilevel Analysis of Urbanization and Neighborhood Socioeconomic Deprivation

PubMed Central

Young, Gary S.; Fox, Mary A.; Trush, Michael; Kanarek, Norma; Glass, Thomas A.; Curriero, Frank C.

2012-01-01

Population exposure to multiple chemicals in air presents significant challenges for environmental public health. Air quality regulations distinguish criteria air pollutants (CAPs) (e.g., ozone, PM2.5) from hazardous air pollutants (HAPs)—187 chemicals which include carcinogens and others that are associated with respiratory, cardiovascular, neurological and numerous other non-cancer health effects. Evidence of the public’s cumulative exposure and the health effects of HAPs are quite limited. A multilevel model is used to assess differential exposure to HAP respiratory, neurological, and cancer hazards (2005) related to the Townsend Index of Socioeconomic Deprivation (TSI), after adjustment for regional population size and economic activity, and local population density. We found significant positive associations between tract TSI and respiratory and cancer HAP exposure hazards, and smaller effects for neurological HAPs. Tracts in the top quintile of TSI have between 38%–60% higher HAP exposure than the bottom quintile; increasing population size from the bottom quintile to the top quintile modifies HAP exposure hazard related to TSI, increasing cancer HAP exposure hazard by 6% to 20% and increasing respiratory HAP exposure hazard by 12% to 27%. This study demonstrates the value of social epidemiological methods for analyzing differential exposure and advancing cumulative risk assessment. PMID:22829799

Differential exposure to hazardous air pollution in the United States: a multilevel analysis of urbanization and neighborhood socioeconomic deprivation.

PubMed

Young, Gary S; Fox, Mary A; Trush, Michael; Kanarek, Norma; Glass, Thomas A; Curriero, Frank C

2012-06-01

Population exposure to multiple chemicals in air presents significant challenges for environmental public health. Air quality regulations distinguish criteria air pollutants (CAPs) (e.g., ozone, PM2.5) from hazardous air pollutants (HAPs)-187 chemicals which include carcinogens and others that are associated with respiratory, cardiovascular, neurological and numerous other non-cancer health effects. Evidence of the public's cumulative exposure and the health effects of HAPs are quite limited. A multilevel model is used to assess differential exposure to HAP respiratory, neurological, and cancer hazards (2005) related to the Townsend Index of Socioeconomic Deprivation (TSI), after adjustment for regional population size and economic activity, and local population density. We found significant positive associations between tract TSI and respiratory and cancer HAP exposure hazards, and smaller effects for neurological HAPs. Tracts in the top quintile of TSI have between 38%-60% higher HAP exposure than the bottom quintile; increasing population size from the bottom quintile to the top quintile modifies HAP exposure hazard related to TSI, increasing cancer HAP exposure hazard by 6% to 20% and increasing respiratory HAP exposure hazard by 12% to 27%. This study demonstrates the value of social epidemiological methods for analyzing differential exposure and advancing cumulative risk assessment.

Medical Expenditures for Children with an Autism Spectrum Disorder in a Privately Insured Population

ERIC Educational Resources Information Center

Shimabukuro, Tom T.; Grosse, Scott D.; Rice, Catherine

2008-01-01

This study provides estimates of medical expenditures for a subset of children and adolescents who receive employer-based health insurance and have a medical diagnosis of an autism spectrum disorder (ASD). Data analyzed were from the 2003 MarketScan[R] research databases. Individuals with an ASD had average medical expenditures that exceeded those…

Prevalence of Nontuberculous Mycobacterial Pulmonary Disease, Germany, 2009–2014

PubMed Central

Wagner, Dirk; de Roux, Andrés; Diel, Roland; Hohmann, David; Hickstein, Lennart; Welte, Tobias; Rademacher, Jessica

2016-01-01

We analyzed routine statutory health insurance claim data to determine prevalence of nontuberculous mycobacterial pulmonary disease in Germany. Documented prevalence rates of this nonnotifiable disease increased from 2.3 to 3.3 cases/100,000 population from 2009 to 2014. Prevalence showed a strong association with advanced age and chronic obstructive pulmonary disease. PMID:27191473

A Boon for Bone Research

NASA Technical Reports Server (NTRS)

1996-01-01

NASA studies for astronaut health in long-term space missions led to the development of the Mechanical Response Tissue Analyzer (MRTA), a research tool for astronaut disuse, osteoporosis and related bone disorders among the general population. Ames Research Center and Stanford University generated a workable device and with Gait Scan, Inc., refined and commercialized it. The MRTA is a portable dsinstrument that measures the bending stiffness of bones using electrically-induced vibration and detects and analyzes the frequencies of the resonating bone. Unlike some other methods, the MRTA uses no radiation and is fast, simple and relatively inexpensive.

Homeless youth: a concept analysis.

PubMed

Washington, Philisie Starling

2011-07-01

INTRODUCTION. A variety of terms have been used to describe the homeless youth population. PURPOSE. The purpose of this article is to analyze the conceptual meanings of the term homeless youths by examining the evolution of the concept and its related terms in the current literature. Method. Online databases from 1990-2010 were analyzed using the Rodgers evolutionary approach. RESULTS. The 6 attributes relating to homeless youth were physical location, age, health, behavior, choice, and survival. CONCLUSION. The analysis provided insight and clarification of homeless youth from a variety of related terms in the literature.

[A lower adherence to Mediterranean diet is associated with a poorer self-rated health in university population].

PubMed

Barrios-Vicedo, Ricardo; Navarrete-Muñoz, Eva Maria; García de la Hera, Manuela; González-Palacios, Sandra; Valera-Gran, Desirée; Checa-Sevilla, José Francisco; Gimenez-Monzo, Daniel; Vioque, Jesús

2014-09-15

A higher adherence to Mediterranean diet is considered as a protective factor against the large number of deaths attributable to the main chronic degenerative diseases in developed countries. Self-rated health is established as a good indicator of population health status and as a predictor of mortality. Studies exploring the relationship between the adherence to Mediterranean diet and self-rated health are scarce, especially, in young adults. Our aim was to explore the factors related, specially the adherence to a priori-defined Mediterranean diet with self-rated health in a cohort of Spanish university students. We analyzed data from 1110 participants of Spanish DiSA-UMH (Dieta, Salud y Antropometría en universitarios de la Universidad Miguel Hernández) study. Diet was assessed using a validated food frequency questionnaire and the adherence to Mediterranean diet was calculated using the relative Mediterranean Diet Score (rMED; score range: 0-18) according to the consumption of 9 dietary components. Self-rated health was gathered from the question: "In general, how do you consider your health to be? (Excellent, good, fair, poor, very poor). Information on sociodemographic and lifestyle characteristics was also collected. Multinomial logistic regression (using relative risk ratio, RRR) was used to analyze the association between the adherence to Mediterranean diet (low rMED: 0-6 points; medium: 7-10 points; high: 11-18 points) and self-rated health (Excellent (reference), good and fair/ poor/very poor). A low, medium or high adherence to Mediterranean diet conformed to 26.8%, 58.7% and 14.4% of participants, which of them reported an excellent (23.1%), good (65.1%) and fair/poor or very poor health, respectively. In multivariate analysis, a lower adherence to Mediterranean diet was significantly (p. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

[Contexts, impasses and challenges for training Public Health workers in Brazil].

PubMed

de Almeida Filho, Naomar Monteiro

2013-06-01

An introductory comment is made on the historical background, institutional impasses and curriculum challenges for training Public Health workers in Brazil. Initially, a thesis is proposed, namely that the Brazilian state has not fulfilled its responsibility to ensure quality public services for the population, with access and equity, shaping "the four perversions of Brazilian education." Secondly, it analyzes the public health system, which is theoretically universal, but being underfunded and with acknowledged shortcomings, contributes to the increase in social exclusion. Lastly, it highlights the need for new models for training people who are technologically competent, suitable for teamwork, creative, autonomous, problem-solving, engaged in health promotion, open to social participation and committed to the humanization of health.

[Efficiency of human resources for health: an approach to its analysis in Mexico].

PubMed

Nigenda, Gustavo; Alcalde-Rabanal, Jaqueline; González-Robledo, Luz María; Serván-Mori, Edson; García-Saiso, Sebastián; Lozano, Rafael

2016-01-01

To analyze efficiency indicators of human resources working at Mexico's Ministry of Health. Three dimensions of efficiency were explored: a) labor wastage, b) distribution of human resources (HR) across levels of care, and c) productivity. Health workers present significant levels of unemployment and underemployment; distribution does not meet international recommendations, and heterogeneous levels of productivity were found among states. Health and educational authorities should develop and implement a HR plan that takes into consideration the needs and demands of the covered population, and includes a clearly defined set of measures to regulate the future production of HR as well as their distribution among and within state health systems, and that allocates incentives to improve performance.

[Use of health services for immigrants and native population: a systematic review].

PubMed

Carmona, Rocío; Alcázar-Alcázar, Raimundo; Sarria-Santamera, Antonio; Regidor, Enrique

2014-01-01

Spain was among the top immigration destinations globally between 1990 and 2005, becoming in 2006 in the European country with the highest net migration. As a result of the migration process and the living conditions in the host countries, immigrants' health may be affected. Limited research has investigated access and use of health services for this population. The aim of this study was to describe the scientific evidence on the use of general and specialist medical services for the immigrant population compared to the native. Systematic review. It has carried out a search of the national and international scientific literature of comparative studies on the use of general and specialist medical services among immigrant and native since 1994-2013. It was used the MEDLINE database as well as a manual search, no language limit or type of study. The methodological quality of the 29 studies included was evaluated. Subject, context, methodological and extrinsic characteristics were collected for comparison of the included studies. We selected 29 studies on the general practitioners' (9 from Spain) and 15 of specialist physician (7 from Spain), they mainly used health surveys as a source of information. Analyze both the attendance and contact with the general practitioner / specialist by nationality or country of birth (among others), mostly by adjusting variables of need and / or socioeconomic. Overall, the immigrant population in Spain have a similar use of general medical services than the native population, and less or similar use of the specialist physician services. These results are in line with studies in other countries.

Cultural conundrums: the ethics of epidemiology and the problems of population in implementing pre-exposure prophylaxis.

PubMed

Fiereck, Kirk

2015-04-01

The impending implementation of pre-exposure prophylaxis (PrEP) has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications (ARVs) to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of the knowledge production practices of epidemiology. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, normatively cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiologic surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of 'who' are inextricably linked to knowledge about sexual personhood. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the multi-disciplinary field of global health. This paper examines how cultural conundrums within the fields of bioethics and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men (MSM) epidemiologic category in the specific national context of South Africa. © 2013 John Wiley & Sons Ltd.

Association between hepatic steatosis and serum liver enzyme levels with atrial fibrillation in the general population: The Study of Health in Pomerania (SHIP).

PubMed

Markus, Marcello Ricardo Paulista; Meffert, Peter J; Baumeister, Sebastian Edgar; Lieb, Wolfgang; Siewert, Ulrike; Schipf, Sabine; Koch, Manja; Kors, Jan A; Felix, Stephan Burkhard; Dörr, Marcus; Targher, Giovanni; Völzke, Henry

2016-02-01

Hepatic steatosis (HS) affects up to 35% of adults in the general population. Atrial fibrillation (AF) is the most prevalent sustained arrhythmia and has a substantial impact on healthcare costs. We analyzed cross-sectional associations of HS and serum liver enzyme levels with prevalent AF in a general population sample. We analyzed data from 3090 women and men, aged 20-81 years, from the population-based Study of Health in Pomerania. HS was determined by ultrasonography. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltranspeptidase (GGT) were measured photometrically. AF was determined by automatic electrocardiographic analysis software. The prevalences of HS and AF were 30.3% and 1.49%, respectively. ALT, AST and GGT showed a positive linear association with the risk of prevalent AF, after multivariable adjustment. The adjusted odds ratios for AF per 1-standard deviation increment in log-transformed serum liver enzyme levels were 1.65 (95% confidence interval [CI]: 1.16 to 2.35; p = 0.006) for ALT, 1.47 (95%CI: 1.07 to 2.02; p = 0.017) for AST and 2.17 (95%CI: 1.64 to 2.87; p < 0.001) for GGT. In contrast, ultrasonographic HS was not associated with AF. Our findings indicate that moderately elevated serum liver enzymes, but not sonographic liver hyperechogenicity, were associated with increased AF prevalence in the general adult population. The hepatic release of increased levels of serum liver enzymes might be accompanied by higher levels of pro-inflammatory, pro-coagulant and pro-fibronogenic mediators that might lead to structural and electrical remodeling of the atrium resulting in the development and persistence of AF. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Greece's high dentist to population ratio: comparisons, causes, and effects.

PubMed

Koletsi-Kounari, Haroula; Papaioannou, William; Stefaniotis, Theodoros

2011-11-01

Reaching the optimal dentist to population ratio is a common health policy challenge around the world, but while many countries have too few dentists for their populations, Greece is facing the opposite problem. This study was designed to describe and analyze trends in the number and distribution of dentists in Greece over the last thirty years and compare the Greek dentist to population ratio with that of the other twenty-six European Union (EU) countries. Demographic data for Greece were obtained from the Hellenic Dental Association and the National Statistical Service of Greece and were analyzed using nonparametric statistical tests. Data for the other EU countries were derived from various authoritative sources. In Greece, the number of dentists per 10,000 inhabitants increased significantly (p<0.05) from 1982 (7.7) to 2007 (13.0), ranking Greece first (in 2008) among the EU countries. The proportional increase in the number of dentists during the decade 1979-88 (30.4 percent) was significant (p<0.05), compared to the decade 1989-98 (22.3 percent) and the nine-year period 1999-2007 (23.6 percent). In 1982 and 1992, the majority of dentists practiced in the Attica Prefecture (Athens) (55.2 percent and 52.6 percent, respectively), but this situation changed significantly in 2007 (p<0.05) (40.1 percent for Attica). The percentage of female dentists remained almost the same from 1982 until 2007, but female dentists' location of practice changed significantly (p<0.05) between 1992 and 2007. After reporting the data, we examine some of the reasons for and effects of the situation and consider the problem that, even with a high dentist to population ratio, Greece has significant oral health access problems.

[Media and public health: example of heat wave during summer 2003].

PubMed

Boyer, L; Robitail, S; Debensason, D; Auquier, P; San Marco, J-L

2005-11-01

The summer of 2003 was the hottest for France in the last 50 years with record day and nighttime temperatures. INSERM statistics estimated that 14,802 heat-related deaths occurred during August 2003 heat wave in France. In the aftermath of this crisis, we thought that it was useful to analyze how the French media dealt with public health during the period from June 1 to August 31, 2003. The objective was to analyze French coverage of public health information during the August 2003 heat wave. Manual and computerized analysis of newspaper and radio reports published from June 1 to August 31, 2003. Articles were obtained by searching the EUROPRESS database. Text analysis was performed using the ALCESTE software package. A total of 1,599 articles were analyzed. Few articles contained warnings about heat exposure and preventive measures. Public health policy was relegated to third place after business and ecology themes. The special problems of the high-risk populations were not mentioned until after the rising death toll was known and emphasis was placed on the implications of the crisis in the political process. The findings of this study show the poor performance of public health policy in France and that media must be given guidance to fulfil its role in providing public health information. This crisis discloses the absence of public health culture in France and involves the "social exclusion" related to a breakdown of social cohesion. More cooperation is needed between the media and public health professionals to avoid future heat-wave and other public health crises. France must develop a public health culture to promote involvement of both the community and individuals in public health issues.

[Status and actualization of tasks to improve the scientific-methodological and regulatory frameworks in the field of human ecology and environmental health].

PubMed

Rakhmanin, Iu A; Sinitsyna, O O

2013-01-01

Contemporary factors that affect the health of the population have been analyzed. There was shown the growing activity of chemical pollution of the environment. Therefore, in order to prevent the growth of negative health and environment consequences caused by increased levels of exposure to chemicals preventive potential for solutions of this complex problem and all strenuous efforts to assist possibly of the sound management of the chemicals should be enhanced. Problematic issues of harmonization of the Russian normative and guidance documents have been actualized. Perspective directions of science development in the field of human ecology and environmental health are suggested.

Promoting Health Equity Research: Insights from a Canadian Initiative.

PubMed

Stewart, Miriam J; Kushner, Kaysi Eastlick

2014-03-01

In 2002 the Canadian Institutes of Health Research launched a national initiative to promote health equity research reflecting the World Health Organization imperative of investment in health equity research. Funded researchers and teams have investigated health disparities faced by vulnerable populations, analyzed interactions of health determinants, and tested innovative interventions. Strategies for building research capacity have supported students, postdoctoral fellows, new investigators, and interdisciplinary research teams. Partnerships have been created with 10 national and 7 international organizations. Strategies used to secure and sustain this research initiative could be adapted to other contexts. Nurse scholars led the launch and have sustained the legacy of this national research initiative. Moreover, nurse researchers and research trainees, supported by the initiative, have contributed to the expansion and translation of the health equity knowledge base. Copyright© by Ingram School of Nursing, McGill University.

Social Health Status in Iran: An Empirical Study

PubMed Central

AMINI RARANI, Mostafa; RAFIYE, Hassan; KHEDMATI MORASAE, Esmaeil

2013-01-01

Background: As social health is a condition-driven, dynamic and fluid concept, it seems necessary to construct and obtain a national and relevant concept of it for every society. Providing an empirical back up for Iran’s concept of social health was the aim of the present study. Methods: This study is an ecologic study in which available data for 30 provinces of Iran in 2007 were analyzed. In order to prove construct validity and obtain a social health index, an exploratory factor analysis was conducted on six indicators of population growth, willful murder, poverty, unemployment, insurance coverage and literacy. Results: Following the factor analysis, two factors of Diathesis (made up of high population growth, poverty, low insurance coverage and illiteracy) and Problem (made up of unemployment and willful murder) were extracted. The diathesis and problem explained 48.6 and 19.6% of social health variance respectively. From provinces, Sistan & Baluchistan had the highest rate of poverty and violence and the lowest rate of literacy and insurance coverage. In terms of social health index, Tehran, Semnan, Isfahan, Bushehr and Mazandaran had the highest ranks while Sistan and Baluchistan, Lurestan, Kohkiloyeh and Kermanshah occupied the lowest ones. Conclusion: There are some differences and similarities between Iranian concept of social health and that of other societies. However, a matter that makes our concept special and different is its attention to population. The increase in literacy rate and insurance coverage along with reduction of poverty, violence and unemployment rates can be the main intervention strategies to improve social health status in Iran. PMID:23515572

Public health and precision medicine share a goal.

PubMed

Vaithinathan, Asokan G; Asokan, Vanitha

2017-05-01

The advances made in genomics and molecular tools aid public health programs in the investigation of outbreaks and control of diseases by taking advantage of the precision medicine. Precision medicine means "segregating the individuals into subpopulations who vary in their disease susceptibility and response to a precise treatment" and not merely designing of drugs or creation of medical devices. By 2017, the United Kingdom 100,000 Genomes Project is expected to sequence 100,000 genomes from 70,000 patients. Similarly, the Precision Medicine Initiative of the United States plans to increase population-based genome sequencing and link it with clinical data. A national cohort of around 1 million people is to be established in the long term, to investigate the genetic and environmental determinants of health and disease, and further integrated to their electronic health records that are optional. Precision public health can be seen as administering the right intervention to the needy population at an appropriate time. Precision medicine originates from a wet-lab while evidence-based medicine is nurtured in a clinic. Linking the quintessential basic science research and clinical practice is necessary. In addition, new technologies to employ and analyze data in an integrated and dynamic way are essential for public health and precision medicine. The transition from evidence-based approach in public health to genomic approach to individuals with a paradigm shift of a "reactive" medicine to a more "proactive" and personalized health care may sound exceptional. However, a population perspective is needed for the precision medicine to succeed. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

Smoking habits and health-related quality of life in a rural Japanese population.

PubMed

Funahashi, Koichi; Takahashi, Ippei; Danjo, Kazuma; Matsuzaka, Masashi; Umeda, Takashi; Nakaji, Shigeyuki

2011-03-01

To investigate the association between smoking and health-related quality of life (HRQOL) in a rural Japanese population. A cross-sectional study of data from 823 subjects in Iwaki area of Hirosaki City, Japan. SF-36 scores between non-smokers and smokers were compared. To test the sensitivity of SF-36 scores in detecting health deterioration, effects of having diseases and having deviations from normal thresholds in health check-up were analyzed by adding them into covariates in ANCOVA. There was no significant difference in SF-36 scores between non-smokers and smokers. Presence of diseases significantly decreased the physical components of SF-36 scores while the results of health check-up had no significant influence on SF-36 scores. The results suggested the possibility that in Japan, where smoking prevalence is still relatively high, smokers may be less sensitive to sub-clinical deterioration in their own health status than smokers in Western countries that already have experienced the major decline in their smoking rate. The importance of having the smoker become more sensitive to the sub-clinical adverse effects of cigarette smoking should be stressed for the success of smoking control programs.

[The Construction of a Mental Health Component for the National Survey: NMHS 2015, Colombia].

PubMed

de Santacruz, Cecilia; Torres, Nubia; Gómez-Restrepo, Carlos; Matallana, Diana; Borda, Juan Pablo

2016-12-01

Usually, mental health has been defined as the absence of mental disorders. In order to approach this concept in a plain sanitas way, it was considered necessary to crosslink a component for the National Mental Health Survey 2015 (NMHS; ENSM for its acronym in Spanish), that would respond to the specific orientation and particularities of the country. To describe the structure and contents of the mental health component of the NMHS 2015 for the Colombian population over 7 years of age. Review, documentary analysis and discussion regarding the concepts and tools with the team in charge of the NMHS and other groups. 353 documents were reviewed, and 180 were analyzed and discussed. The component model is presented, considering the ethic dimension of relationship care as a main element; it merges two inquiry dimensions or categories: subjective-relational, and social-collective. The structured mental health component provides information regarding the entire population. It also allows understanding and approaching the concept of mental health as a personal and collective "good life". Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

The Use of Deer Vehicle Accidents as a Proxy for Measuring the Degree of Interaction Between Human and Deer Populations and Its Correlation With the Incidence Rate of Lyme Disease

PubMed Central

Wiznia, Daniel H.; Christos, Paul J.; LaBonte, Andrew M.

2014-01-01

The study described in this article examined the relationship between the incidence rate of deer vehicle accidents (DVAs), a proxy for measuring the interaction between populations of humans and deer, and human Lyme disease incidence rate. The authors also examined the relationship between deer population density and human Lyme incidence rate. They analyzed data from Connecticut’s Department of Environmental Protection and the Department of Public Health from 1999 through 2008 by deer management zone (DMZ) and town. For DVA incidence rate versus Lyme incidence rate for both DMZs and towns, most of the correlation coefficients computed yearly were moderate to strong and all of the p-values were significant. A weak correlation was observed between deer population density and Lyme disease incidence rate by DMZ. The authors propose DVAs as a proxy for measuring the interaction between coexisting populations of humans and deer. The authors’ study suggests that additional investigations of DVAs and their relationship to Lyme disease to further assess the utility of public health interventions are warranted. PMID:23621054

Prevalence of common hemoglobin variants in an afro-descendent Ecuadorian population

PubMed Central

2013-01-01

Background Hemoglobinopathies are among the most studied and frequent pathologies. These genetic disorders are considered a very important health care threat in many tropical countries. Ecuador is a tropical Latin-American country with an important presence of afro-descendants (7.2%). Afro-descendants are among the ethnic groups with higher frequency of hemoglobinopathies reported. Ambuqui is a region within the Imbabura province with an important presence of afro-descendants (>50%). The present study analyzed the frequency of the most common hemoglobin variants in an asymptomatic afro-descendent population using capillary electrophoresis. Findings From 114 individuals, 25 (22%) reported a hemoglobin variant. All individuals that presented hemoglobin variants were heterozygotes (asymptomatic). Hemoglobin S (sickle cell trait) was the most frequent variant found (14%), followed by hemoglobin E (4.4%), Fetal (2.6%) and C (1%). Conclusion Prevalence of hemoglobin S was consistent with populations from other countries, but it was lower than other Ecuadorian afro-descendent populations. Frequency of hemoglobin C was lower than other afro-descendent populations. This data suggests the possibility of gene flow from Native American individuals to the Ambuqui population there by lowering the frequency of their hemoglobin variants compared with other afro-descendant populations. Evaluating the frequency of hemoglobinopathies in Ecuadorian populations is essential. Despite the high frequency of these disorders, very few health care facilities implement hemoglobinopathies tests as a routine practice. PMID:23557107

Health Care Utilization and Expenditures of Patients with Diabetes Comorbid with Depression Disorder: A National Population-Based Cohort Study.

PubMed

Huang, Chun-Jen; Hsieh, Hui-Min; Chiu, Herng-Chia; Wang, Peng-Wei; Lee, Mei-Hsuan; Li, Chih-Yi; Lin, Ching-Hua

2017-11-01

The study investigated to compare health care utilization and expenditures between diabetic patients with and without depression in Taiwan. Health care utilization and expenditure among diabetic patients with and without depression disorder during 2000 and 2004 were examined using Taiwan's population-based National Health Insurance claims database. Health care utilization included outpatient visits and the use of inpatient services, and health expenditures were outpatient, inpatient, and total medical expenditures. Moreover, general estimation equation models were used for analyzing the factors associated with outpatient visits and expenditures. Multiple logistic regression analysis was applied for identifying the factors associated with hospitalization. The average annual outpatient visits and annual total medical expenditures in the study period were 44.23-52.20; NT$87,496-133,077 and 30.75-32.92; NT$64,411-80,955 for diabetic patients with and without depression. After adjustment for covariates, our results revealed that gender and complication were associated with out-patient visits. Moreover, the time factor was associated with the total medical expenditure, and residential urbanization and complication factors were associated with hospitalization. Health care utilization and expenditures for diabetic patients with depression were significantly higher than those without depression. Sex, complications, time, and urbanization are the factors associated with health care utilization and expenditures.

Forecasting the need for physicians in the United States: the Health Resources and Services Administration's physician requirements model.

PubMed Central

Greenberg, L; Cultice, J M

1997-01-01

OBJECTIVE: The Health Resources and Services Administration's Bureau of Health Professions developed a demographic utilization-based model of physician specialty requirements to explore the consequences of a broad range of scenarios pertaining to the nation's health care delivery system on need for physicians. DATA SOURCE/STUDY SETTING: The model uses selected data primarily from the National Center for Health Statistics, the American Medical Association, and the U.S. Bureau of Census. Forecasts are national estimates. STUDY DESIGN: Current (1989) utilization rates for ambulatory and inpatient medical specialty services were obtained for the population according to age, gender, race/ethnicity, and insurance status. These rates are used to estimate specialty-specific total service utilization expressed in patient care minutes for future populations and converted to physician requirements by applying per-physician productivity estimates. DATA COLLECTION/EXTRACTION METHODS: Secondary data were analyzed and put into matrixes for use in the mainframe computer-based model. Several missing data points, e.g., for HMO-enrolled populations, were extrapolated from available data by the project's contractor. PRINCIPAL FINDINGS: The authors contend that the Bureau's demographic utilization model represents improvements over other data-driven methodologies that rely on staffing ratios and similar supply-determined bases for estimating requirements. The model's distinct utility rests in offering national-level physician specialty requirements forecasts. Images Figure 1 PMID:9018213

Combining environment and health information systems for the assessment of atmospheric pollution on human health.

PubMed

Skouloudis, Andreas N; Kassomenos, Pavlos

2014-08-01

The use of emerging technologies for environmental monitoring with satellite and in-situ sensors have become essential instruments for assessing the impact of environmental pollution on human health, especially in areas that require high spatial and temporal resolution. This was until recently a rather difficult problem. Regrettably, with classical approaches the spatial resolution is frequently inadequate in reporting environmental causes and health effects in the same time scale. This work examines with new tools different levels of air-quality with sensor monitoring with the aim to associate those with severe health effects. The process established here facilitates the precise representation of human exposure with the population attributed in a fine spatial grid and taking into account environmental stressors of human exposure. These stressors can be monitored with innovative sensor units with a temporal resolution that accurately describes chronic and acute environmental burdens. The current understanding of the situation in densely populated areas can be properly analyzed, before commitments are made for reductions in total emissions as well as for assessing the effects of reduced trans-boundary fluxes. In addition, the data processed here with in-situ sensors can assist in establishing more effective regulatory policies for the protection of vulnerable population groups and the satellite monitoring instruments permit abatement strategies that are close to real-time over large geographical areas. Copyright © 2014 Elsevier B.V. All rights reserved.

Health disparities and direct-to-consumer prescription drug advertising: a content analysis of targeted magazine genres, 1992-2002.

PubMed

Mastin, Teresa; Andsager, Julie L; Choi, Jounghwa; Lee, Kyungjin

2007-01-01

Health disparities exist in the United States based on race, gender, and socioeconomic status. One way to alleviate some of the disparities regarding certain diseases or conditions is to increase awareness among populations most affected. Physicians have suggested that direct-to-consumer advertising (DTCA) of prescription drugs could play a role in awareness. Social identity theory suggests that individuals are likely to attend messages if they can identify, often based on race or gender, with people portrayed in the messages. This study analyzed DTCA in 11 years of Black, women's, news, and entertainment magazines to determine whether models in the ads targeted specific populations. Black magazines were more likely to contain ads featuring Black models only than were other genres, which had more DTCA picturing White models only. Health conditions the drugs were intended for varied by genre and over time, with STD drugs appearing primarily in Black magazines, and DTCA for heart disease not published in Black magazines, despite cardiovascular diseases being the No. 1 cause of death for Blacks (and Whites). Women's magazines featured DTCA for a wide variety of drugs, reinforcing their roles as caretakers, with proportionally few ads for women's health. Implications for targeted use of magazine genres as a means of providing health information to specific populations are discussed.

Reflective practice and competencies in global health training: lesson for serving diverse patient populations.

PubMed

Castillo, Jonathan; Goldenhar, Linda M; Baker, Raymond C; Kahn, Robert S; Dewitt, Thomas G

2010-09-01

Resident interest in global health care training is growing and has been shown to have a positive effect on participants' clinical skills and cultural competency. In addition, it is associated with career choices in primary care, public health, and in the service of underserved populations. The purpose of this study was to explore, through reflective practice, how participation in a formal global health training program influences pediatric residents' perspectives when caring for diverse patient populations. Thirteen pediatric and combined-program residents enrolled in a year-long Global Health Scholars Program at Cincinnati Children's Hospital Medical Center during the 2007-2008 academic year. Educational interventions included a written curriculum, a lecture series, one-on-one mentoring sessions, an experience abroad, and reflective journaling assignments. The American Society for Tropical Medicine and Hygiene global health competencies were used as an a priori coding framework to qualitatively analyze the reflective journal entries of the residents. Four themes emerged from the coded journal passages from all 13 residents: (1) the burden of global disease, as a heightened awareness of the diseases that affect humans worldwide; (2) immigrant/underserved health, reflected in a desire to apply lessons learned abroad at home to provide more culturally effective care to immigrant patients in the United States; (3) parenting, or observed parental, longing to assure that their children receive health care; and (4) humanitarianism, expressed as the desire to volunteer in future humanitarian health efforts in the United States and abroad. Our findings suggest that participating in a global health training program helped residents begin to acquire competence in the American Society for Tropical Medicine and Hygiene competency domains. Such training also may strengthen residents' acquisition of professional skills, including the Accreditation Council for Graduate Medical Education competencies.

Hepatic steatosis is associated with aortic valve sclerosis in the general population: the Study of Health in Pomerania (SHIP).

PubMed

Markus, Marcello Ricardo Paulista; Baumeister, Sebastian Edgar; Stritzke, Jan; Dörr, Marcus; Wallaschofski, Henri; Völzke, Henry; Lieb, Wolfgang

2013-07-01

We aimed to analyze the association between hepatic steatosis and aortic valve sclerosis in the general population. Cross-sectional data of 2212 men and women, aged 45 to 81 years, from the baseline examination of the population-based Study of Health in Pomerania (SHIP-0) were analyzed. Hepatic steatosis was primarily defined as the presence of a hyperechogenic ultrasound pattern of the liver. Aortic valve sclerosis was determined by echocardiography. In our sample, hepatic steatosis was present in 877 (39.7%) individuals. Among participants with hepatic steatosis, aortic valve sclerosis was more common (n=323; 36.8%) compared with participants without hepatic steatosis (n=379; 28.4%; P<0.001). After adjustment for potential confounders, individuals with hepatic steatosis had 33% higher odds of aortic valve sclerosis compared with those without hepatic steatosis (95% confidence interval, 6%-66%; P=0.014). Additional adjustment for high-sensitive C-reactive protein, serum ferritin levels, and white blood cells slightly reduced the association to 32% (95% confidence interval, 4%-66%; P=0.021). Our findings add evidence that hepatic steatosis and aortic valve sclerosis are interrelated after adjustment for major confounders. The release of proatherogenic substances by the steatotic liver or its contribution to insulin resistance and dyslipidemia may contribute to the development of calcification and sclerosis of the aortic valve.

[Pilot-experience in home care: bedridden aged patients of a basic health unit, Porto Alegre, Brazil].

PubMed

Marques, Giselda Quintana; Freitas, Ivani Bueno de Almeida

2009-12-01

The objectives of this study were to describe the development of a pilot-project in home care to bedridden aged patients at a Basic Health Unit, and identify demographic, social and health aspects of these patients, as well as relevant aspects reported by the health team that implemented the home care. The study had descriptive and evaluative characteristics. The patients' enrollment forms and health records and the project's records were analyzed. The pilot-experience permitted to develop the team's skills, in addition to being enriching and of great responsibility for the professionals and caregivers involved. The results indicated the need for continuous home care and adjustments in its organization with the purpose of increasing the areas for health care and improving the population's quality of life.

The implementation of public health interventions in Africa: a neglected strategic theme.

PubMed

Ridde, V; Olivier de Sardan, J-P

2017-02-01

Organizing effective public health interventions is required to improve population health and reduce social inequalities in health. However, measuring their effectiveness is not enough; we must also understand how these interventions are implemented and what role is played by the context and the social actors. Today, it seems that the importance of studying intervention implementation by public health actors (stakeholders, policy makers, donors, and researchers) has not yet been sufficiently considered. In this Tribune, we wish to draw the attention of the public health community, including that interested in interventions in Africa, to the need to analyze their implementation in depth. We must produce empirical and theoretical knowledge about implementation but also train students and young researchers more effectively in this scientific approach, which, although indispensable, has been ignored too long.

Online Health-Information Seeking Among Older Populations: Family Influences and the Role of the Medical Professional.

PubMed

Magsamen-Conrad, Kate; Dillon, Jeanette M; Billotte Verhoff, China; Faulkner, Sandra L

2018-02-23

There are myriad technological devices, computer programs, and online information sources available for people to manage their health and the health of others. However, people must be technologically and health literate and capable of accessing, analyzing, and sharing the information they encounter. The authors interviewed middle-aged and older adults about their online health information seeking behavior and discovered that technology and health literacy are influenced by a collective ability to manage the health and technological needs of a family. We used information management theory to frame participants' experiences of their self-efficacy using technology to manage the health of loved ones. Findings suggest that health can be co-managed if at least one person in a family unit is technologically "savvy" and able to effectively share health information. However, individuals' confidence in their own literacy often depends on others, usually family members who tend to "do" instead of "teach."

Utilization of Antenatal HealthCare Services among Fishermen Population in Kanchipuram District, Tamil Nadu: A Cross-sectional Study.

PubMed

Danasekaran, Raja; Raja, Pavithra; Ranganathan, Karnaboopathy

2017-01-01

Considering the global and national level commitments in improving the maternal health as well as reducing the maternal mortality, assessment of factors influencing the delivery of antenatal healthcare services becomes essential. The aim is to assess the utilization of antenatal health services and to identify the factors influencing their utilization among women of fishermen population in Kanchipuram district, Tamil Nadu. The cross-sectional study was carried out among the mothers in Kovalam area of Kanchipuram district. Details were collected using a pretested questionnaire and analyzed using statistical software. The study included 284 mothers, of which 35% were illiterates. Nearly 60.21% have got registered with the Government sector, 59.51% of the mothers had three or more antenatal visits, 64.08% have received two doses of tetanus toxoid, and 73.24% have taken iron and folic acid tablets. Factors which were identified to have statistically significant association with better utilization of antenatal health services were age >30 years, higher educational status, skilled workers, those having their first child, and higher socioeconomic class. This study has reported the fact that antenatal healthcare services were not utilized fully by the community and the fishermen population being a special group has to be given the needed attention from the healthcare delivery system.

[Risk behavior for the health of students at the State University of North Paraná, Brazil--proposal for online intervention].

PubMed

Mello, Marcus Vinícius de Oliveira; Bernardelli Junior, Rinaldo; Menossi, Berlis Ribeiro dos Santos; Vieira, Fabio da Silva Ferreira

2014-01-01

Getting to know the lifestyles of university students provides important input for possible decision-making for the implementation of intervention programs within the university environment. The objective of this study was to analyze the prevalence of risk behaviors to health in a representative sample of UENP students and, in accordance with the information obtained, indicate specific actions using means that can assist in reducing such behaviors. The survey of the main risk factors for the health of the population in question was performed by database analysis. The orientation was conducted through social networks, with online control over access to and interactions with members of the networks using information made available by the research. More than 200 messages were posted, trying to put this population on the path towards factors related to healthy habits. A viewing average of 471.2 ± 128.16 people accessed the page and an average of 12,915.07 ± 6,517.45 people saw the posts per week. Given the above, we suggest actions in UENP to encourage healthy habits, and the social networks proved to be a viable tool for this though other media may be offered, seeking to encourage this population to adopt a more active and health lifestyle.

Psychiatric emergencies of minors with and without migration background.

PubMed

Akkaya-Kalayci, Türkan; Popow, Christian; Waldhör, Thomas; Winkler, Dietmar; Özlü-Erkilic, Zeliha

2017-03-01

The conditions of children and adolescents with migration background receiving emergency psychiatric care in Europe are not well known. Migrants usually attend regular psychiatric care less frequently than the autochthonous population. We therefore speculated that, being undertreated, they would be overrepresented among psychiatric emergency care patients. We retrospectively analyzed the records of 1093 minors aged 4‑18 years treated during a period of three years at the psychiatric emergency outpatient clinic of the Department of Child and Adolescent Psychiatry at the Medical University of Vienna. More minors with migration background than natives consulted our emergency clinic. Most frequent reasons for referral were suicide attempts by Turkish patients, acute stress disorder in Serbian/Croatian/Bosnian and in Austrian patients. Psychiatric diagnoses like eating and personality disorders were mostly diagnosed in natives. We found gender specific differences between the groups. The reasons for these differences possibly relate to deficits of adequate mental health-care in Austria, to intercultural and intrafamiliar conflicts related to acculturation distress in the migrant population. Prospective longitudinal studies focusing on the utilization of mental health care by the migrant children and the impact of the migration background on their mental health are needed for improving adequate culture-sensitive mental-health care for this population.

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

PubMed Central

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

2014-01-01

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

Characteristics of the distribution of doctors in the Mais Médicos (More Doctors) Program in the states of Brazil's Northeast.

PubMed

Nogueira, Priscila Tamar Alves; Bezerra, Adriana Falangola Benjamin; Leite, Antonio Flaudiano Bem; Carvalho, Islândia Maria de Sousa; Gonçalves, Rogério Fabiano; Brito-Silva, Keila Silene de

2016-09-01

Inequalities in access to health, reflecting shortages and inadequate geographical distribution of health professionals, have been indicated as a challenge for Brazil. This paper analyzes the geographical distribution of professionals of the Mais Médicos Program allocated in the Northeastern Region of Brazil, through a descriptive cross-sectional study. Secondary data provided by the Health Ministry were used, and thematic maps of distribution of doctors in the Region were prepared. Data on 4,716 doctors who became members of health teams in 1,294 municipalities in six Indigenous Health Districts in the years 2013 and 2014 were analyzed. The greater part of the municipalities of the Region received between one and five doctors. The municipalities most benefited had, at least, 20% of their population in extreme poverty. 99.9% of the doctors were allocated in a Health Center or Primary Healthcare Unit. The majority were women (57%), predominantly of the 45-49 age group (24%). In spite of the advances achieved by the Program - such as distribution of the doctors in locations with greater vulnerability - some States continue to have significant shortages of healthcare.

Inorganic arsenic in Chinese food and its cancer risk.

PubMed

Li, Gang; Sun, Guo-Xin; Williams, Paul N; Nunes, Luis; Zhu, Yong-Guan

2011-10-01

Even moderate arsenic exposure may lead to health problems, and thus quantifying inorganic arsenic (iAs) exposure from food for different population groups in China is essential. By analyzing the data from the China National Nutrition and Health Survey (CNNHS) and collecting reported values of iAs in major food groups, we developed a framework of calculating average iAs daily intake for different regions of China. Based on this framework, cancer risks from iAs in food was deterministically and probabilistically quantified. The article presents estimates for health risk due to the ingestion of food products contaminated with arsenic. Both per individual and for total population estimates were obtained. For the total population, daily iAs intake is around 42 μg day(-1), and rice is the largest contributor of total iAs intake accounting for about 60%. Incremental lifetime cancer risk from food iAs intake is 106 per 100,000 for adult individuals and the median population cancer risk is 177 per 100,000 varying between regions. Population in the Southern region has a higher cancer risk than that in the Northern region and the total population. Sensitive analysis indicated that cancer slope factor, ingestion rates of rice, aquatic products and iAs concentration in rice were the most relevant variables in the model, as indicated by their higher contribution to variance of the incremental lifetime cancer risk. We conclude that rice may be the largest contributor of iAs through food route for the Chinese people. The population from the South has greater cancer risk than that from the North and the whole population. Copyright © 2011 Elsevier Ltd. All rights reserved.

Disparities in Infectious Disease Hospitalizations for American Indian/Alaska Native People

PubMed Central

Holman, Robert C.; Folkema, Arianne M.; Singleton, Rosalyn J.; Redd, John T.; Christensen, Krista Y.; Steiner, Claudia A.; Schonberger, Lawrence B.; Hennessy, Thomas W.; Cheek, James E.

2011-01-01

Objectives We described disparities in infectious disease (ID) hospitalizations for American Indian/Alaska Native (AI/AN) people. Methods We analyzed hospitalizations with an ID listed as the first discharge diagnosis in 1998–2006 for AI/AN people from the Indian Health Service National Patient Information Reporting System and compared them with records for the general U.S. population from the Nationwide Inpatient Survey. Results The ID hospitalization rate for AI/AN people declined during the study period. The 2004–2006 mean annual age-adjusted ID hospitalization rate for AI/AN people (1,708 per 100,000 populiation) was slightly higher than that for the U.S. population (1,610 per 100,000 population). The rate for AI/AN people was highest in the Southwest (2,314 per 100,000 population), Alaska (2,063 per 100,000 population), and Northern Plains West (1,957 per 100,000 population) regions, and among infants (9,315 per 100,000 population). ID hospitalizations accounted for approximately 22% of all AI/AN hospitalizations. Lower-respiratory--tract infections accounted for the largest proportion of ID hospitalizations among AI/AN people (35%) followed by skin and soft tissue infections (19%), and infections of the kidney, urinary tract, and bladder (11%). Conclusions Although the ID hospitalization rate for AI/AN people has declined, it remains higher than that for the U.S. general population, and is highest in the Southwest, Northern Plains West, and Alaska regions. Lower-respiratory-tract infections; skin and soft tissue infections; and kidney, urinary tract, and bladder infections contributed most to these health disparities. Future prevention strategies should focus on high-risk regions and age groups, along with illnesses contributing to health disparities. PMID:21800745

Story Immersion in a Health Videogame for Childhood Obesity Prevention.

PubMed

Lu, Amy Shirong; Thompson, Debbe; Baranowski, Janice; Buday, Richard; Baranowski, Tom

2012-02-15

Stories can serve as powerful tools for health interventions. Story immersion refers to the experience of being absorbed in a story. This is among the first studies to analyze story immersion's role in health videogames among children by addressing two main questions: Will children be more immersed when the main characters are similar to them? Do increased levels of immersion relate to more positive health outcomes? Eighty-seven 10-12-year-old African-American, Caucasian, and Hispanic children from Houston, TX, played a health videogame, "Escape from Diab" (Archimage, Houston, TX), featuring a protagonist with both African-American and Hispanic phenotypic features. Children's demographic information, immersion, and health outcomes (i.e., preference, motivation, and self-efficacy) were recorded and then correlated and analyzed. African-American and Hispanic participants reported higher immersion scores than Caucasian participants ( P = 0.01). Story immersion correlated positively ( P values < 0.03) with an increase in Fruit and Vegetable Preference ( r = 0.27), Intrinsic Motivation for Water ( r = 0.29), Vegetable Self-Efficacy ( r = 0.24), and Physical Activity Self-Efficacy ( r = 0.32). Ethnic similarity between videogame characters and players enhanced immersion and several health outcomes. Effectively embedding characters with similar phenotypic features to the target population in interactive health videogame narratives may be important when motivating children to adopt obesity prevention behaviors.

Vegan lifestyle behaviors: an exploration of congruence with health-related beliefs and assessed health indices.

PubMed

Dyett, Patricia A; Sabaté, Joan; Haddad, Ella; Rajaram, Sujatha; Shavlik, David

2013-08-01

This study aimed to investigate health belief as a major motive for diet and lifestyle behaviors of 100 vegans in the United States; and to determine congruence with selected health and nutrition outcomes. Response data from an administered questionnaire was analyzed. Statistical analyses determined the most common factors influencing diet choice; the number of vegans practicing particular lifestyle behaviors; body mass index; and prevalence of self-reported chronic disease diagnoses. Nutrient intakes were analyzed and assessed against Dietary Reference Intakes. Health was the most reported reason for diet choice (47%). In the health belief, animal welfare, and religious/other motive categories, low percentages of chronic disease diagnoses were reported: 27%, 11%, and 15%, respectively. There were no significant differences in health behaviors and indices among vegan motive categories, except for product fat content choices. Within the entire study population, health-related vegan motive coincided with regular exercise; 71% normal BMI (mean=22.6); minimal alcohol and smoking practices; frequently consumed vegetables, nuts, and grains; healthy choices in meal types, cooking methods, and low-fat product consumption; and adequate intakes for most protective nutrients when compared to reference values. But incongruence was found with 0% intake adequacy for vitamin D; and observation of excessive sodium use. Copyright © 2013 Elsevier Ltd. All rights reserved.

Advancing Strategies for Agenda Setting by Health Policy Coalitions: A Network Analysis of the Canadian Chronic Disease Prevention Survey.

PubMed

McGetrick, Jennifer Ann; Raine, Kim D; Wild, T Cameron; Nykiforuk, Candace I J

2018-06-11

Health in all policies can address chronic disease morbidity and mortality by increasing population-level physical activity and healthy eating, and reducing tobacco and alcohol use. Both governmental and nongovernmental policy influencers are instrumental for health policy that modifies political, economic, and social environments. Policy influencers are informed and persuaded by coalitions that support or oppose changing the status quo. Empirical research examining policy influencers' contact with coalitions, as a social psychological exposure with health policy outcomes, can benefit from application of health communication theories. Accordingly, we analyzed responses to the 2014 Chronic Disease Prevention Survey for 184 Canadian policy influencers employed in provincial governments, municipalities, large workplaces, school boards, and the media. In addition to contact levels with coalitions, respondents' jurisdiction, organization, and ideology were analyzed as potential moderators. Calculating authority score centrality using network analysis, we determined health policy supporters to be more central in policy influencer networks, and theorized their potential to impact health policy public agenda setting via priming and framing processes. We discuss the implications of our results as presenting opportunities to more effectively promote health policy through priming and framing by coordinating coalitions across risk behaviors to advance a societal imperative for chronic disease prevention.

Identification of population substructure among Jews using STR markers and dependence on reference populations included.

PubMed

Listman, Jennifer B; Hasin, Deborah; Kranzler, Henry R; Malison, Robert T; Mutirangura, Apiwat; Sughondhabirom, Atapol; Aharonovich, Efrat; Spivak, Baruch; Gelernter, Joel

2010-06-14

Detecting population substructure is a critical issue for association studies of health behaviors and other traits. Whether inherent in the population or an artifact of marker choice, determining aspects of a population's genetic history as potential sources of substructure can aid in design of future genetic studies. Jewish populations, among which association studies are often conducted, have a known history of migrations. As a necessary step in understanding population structure to conduct valid association studies of health behaviors among Israeli Jews, we investigated genetic signatures of this history and quantified substructure to facilitate future investigations of these phenotypes in this population. Using 32 autosomal STR markers and the program STRUCTURE, we differentiated between Ashkenazi (AJ, N = 135) and non-Ashkenazi (NAJ, N = 226) Jewish populations in the form of Northern and Southern geographic genetic components (AJ north 73%, south 23%, NAJ north 33%, south 60%). The ability to detect substructure within these closely related populations using a small STR panel was contingent on including additional samples representing major continental populations in the analyses. Although clustering programs such as STRUCTURE are designed to assign proportions of ancestry to individuals without reference population information, when Jewish samples were analyzed in the absence of proxy parental populations, substructure within Jews was not detected. Generally, for samples with a given grandparental country of birth, STRUCTURE assignment values to Northern, Southern, African and Asian clusters agreed with mitochondrial DNA and Y-chromosomal data from previous studies as well as historical records of migration and intermarriage.

Identification of population substructure among Jews using STR markers and dependence on reference populations included

PubMed Central

2010-01-01

Background Detecting population substructure is a critical issue for association studies of health behaviors and other traits. Whether inherent in the population or an artifact of marker choice, determining aspects of a population's genetic history as potential sources of substructure can aid in design of future genetic studies. Jewish populations, among which association studies are often conducted, have a known history of migrations. As a necessary step in understanding population structure to conduct valid association studies of health behaviors among Israeli Jews, we investigated genetic signatures of this history and quantified substructure to facilitate future investigations of these phenotypes in this population. Results Using 32 autosomal STR markers and the program STRUCTURE, we differentiated between Ashkenazi (AJ, N = 135) and non-Ashkenazi (NAJ, N = 226) Jewish populations in the form of Northern and Southern geographic genetic components (AJ north 73%, south 23%, NAJ north 33%, south 60%). The ability to detect substructure within these closely related populations using a small STR panel was contingent on including additional samples representing major continental populations in the analyses. Conclusions Although clustering programs such as STRUCTURE are designed to assign proportions of ancestry to individuals without reference population information, when Jewish samples were analyzed in the absence of proxy parental populations, substructure within Jews was not detected. Generally, for samples with a given grandparental country of birth, STRUCTURE assignment values to Northern, Southern, African and Asian clusters agreed with mitochondrial DNA and Y-chromosomal data from previous studies as well as historical records of migration and intermarriage. PMID:20546593

Prevalence and comorbidity of diabetes mellitus among non-institutionalized older adults in Germany - results of the national telephone health interview survey ‘German Health Update (GEDA)’ 2009

PubMed Central

2013-01-01

Background Despite the major public health impact of diabetes, recent population-based data regarding its prevalence and comorbidity are sparse. Methods The prevalence and comorbidity of diabetes mellitus were analyzed in a nationally representative sample (N = 9133) of the non-institutionalized German adult population aged 50 years and older. Information on physician-diagnosed diabetes and 20 other chronic health conditions was collected as part of the national telephone health interview survey ‘German Health Update (GEDA)’ 2009. Overall, 51.2% of contacted persons participated. Among persons with diabetes, diabetes severity was defined according to the type and number of diabetes-concordant conditions: no diabetes-concordant condition (grade 1); hypertension and/or hyperlipidemia only (grade 2); one comorbidity likely to represent diabetes-related micro- or macrovascular end-organ damage (grade 3); several such comorbidities (grade 4). Determinants of diabetes severity were analyzed by multivariable ordinal regression. Results The 12-month prevalence of diabetes was 13.6% with no significant difference between men and women. Persons with diabetes had a significantly higher prevalence and average number of diabetes-concordant as well as diabetes-discordant comorbidities than persons without diabetes. Among persons with diabetes, 10.2%, 46.8%, 35.6% and 7.4% were classified as having severity grade 1–4, respectively. Determinants of diabetes severity included age (cumulative odds ratio 1.05, 95% confidence interval 1.03-1.07, per year) and number of discordant comorbidities (1.40, 1.25-1.55). With respect to specific discordant comorbidities, diabetes severity was correlated to depression (2.15, 1.29-3.56), respiratory disease (2.75, 1.72-4.41), musculoskeletal disease (1.53, 1.06-2.21), and severe hearing impairment (3.00, 1.21-7.41). Conclusions Diabetes is highly prevalent in the non-institutionalized German adult population 50 years and older. Diabetes comorbidities including diabetes-concordant and diabetes-discordant conditions need to be considered in epidemiological studies, in order to monitor disease burden and quality of diabetes care. Definitional standards of diabetes severity need to be refined and consented. PMID:23433228

Engaging academia to advance the science and practice of environmental public health tracking.

PubMed

Strosnider, Heather; Zhou, Ying; Balluz, Lina; Qualters, Judith

2014-10-01

Public health agencies at the federal, state, and local level are responsible for implementing actions and policies that address health problems related to environmental hazards. These actions and policies can be informed by integrating or linking data on health, exposure, hazards, and population. The mission of the Centers for Disease Control and Prevention׳s National Environmental Public Health Tracking Program (Tracking Program) is to provide information from a nationwide network of integrated health, environmental hazard, and exposure data that drives actions to improve the health of communities. The Tracking Program and federal, state, and local partners collect, integrate, analyze, and disseminate data and information to inform environmental public health actions. However, many challenges exist regarding the availability and quality of data, the application of appropriate methods and tools to link data, and the state of the science needed to link and analyze health and environmental data. The Tracking Program has collaborated with academia to address key challenges in these areas. The collaboration has improved our understanding of the uses and limitations of available data and methods, expanded the use of existing data and methods, and increased our knowledge about the connections between health and environment. Valuable working relationships have been forged in this process, and together we have identified opportunities and improvements for future collaborations to further advance the science and practice of environmental public health tracking. Published by Elsevier Inc.

Standardizing flow cytometric assays in long-term population-based studies

NASA Astrophysics Data System (ADS)

Melzer, Susanne; Bocsi, Jozsef; Tárnok, Attila

2015-03-01

Quantification of leukocyte subpopulations and characterization of antigen-expression pattern on the cellular surface can play an important role in diagnostics. The state of cellular immunology on the single-cell level was analyzed by polychromatic flow cytometry in a recent comparative study within the average Leipzig population (LIFE - Leipzig Research Centre for Civilization Diseases). Data of 1699 subjects were recorded over a long-time period of three years (in a total of 1126 days). To ensure compatibility of such huge data sets, quality-controls on many levels (stability of instrumentation, low intra-laboratory variance and reader independent data analysis) are essential. The LIFE study aims to analyze various cytometric pattern to reveal the relationship between the life-style, the environmental effects and the individual health. We therefore present here a multi-step quality control procedure for long-term comparative studies.

Spatial and temporal trends in the mortality burden of air pollution in China: 2004–2012

PubMed Central

Liu, Miaomiao; Huang, Yining; Ma, Zongwei; Jin, Zhou; Liu, Xingyu; Wang, Haikun; Liu, Yang; Wang, Jinnan; Jantunen, Matti; BiDr, Jun; KinneyDr, Patrick L.

2017-01-01

While recent assessments have quantified the burden of air pollution at the national scale in China, air quality managers would benefit from assessments that disaggregate health impacts over regions and over time. We took advantage of a new 10 × 10 km satellite-based PM2.5 dataset to analyze spatial and temporal trends of air pollution health impacts in China, from 2004 to 2012. Results showed that national PM2.5 related deaths from stroke, ischemic heart disease and lung cancer increased from approximately 800,000 cases in 2004 to over 1.2 million cases in 2012. The health burden exhibited strong spatial variations, with high attributable deaths concentrated in regions including the Beijing–Tianjin Metropolitan Region, Yangtze River Delta, Pearl River Delta, Sichuan Basin, Shandong, Wuhan Metropolitan Region, Changsha–Zhuzhou–Xiangtan, Henan, and Anhui, which have heavy air pollution, high population density, or both. Increasing trends were found in most provinces, but with varied growth rates. While there was some evidence for improving air quality in recent years, this was offset somewhat by the countervailing influences of in–migration together with population growth. We recommend that priority areas for future national air pollution control policies be adjusted to better reflect the spatial hotspots of health burdens. Satellite-based exposure and health impact assessments can be a useful tool for tracking progress on both air quality and population health burden reductions. PMID:27745948

Spatial and temporal trends in the mortality burden of air pollution in China: 2004-2012.

PubMed

Liu, Miaomiao; Huang, Yining; Ma, Zongwei; Jin, Zhou; Liu, Xingyu; Wang, Haikun; Liu, Yang; Wang, Jinnan; Jantunen, Matti; Bi, Jun; Kinney, Patrick L

2017-01-01

While recent assessments have quantified the burden of air pollution at the national scale in China, air quality managers would benefit from assessments that disaggregate health impacts over regions and over time. We took advantage of a new 10×10km satellite-based PM 2.5 dataset to analyze spatial and temporal trends of air pollution health impacts in China, from 2004 to 2012. Results showed that national PM 2.5 related deaths from stroke, ischemic heart disease and lung cancer increased from approximately 800,000 cases in 2004 to over 1.2 million cases in 2012. The health burden exhibited strong spatial variations, with high attributable deaths concentrated in regions including the Beijing-Tianjin Metropolitan Region, Yangtze River Delta, Pearl River Delta, Sichuan Basin, Shandong, Wuhan Metropolitan Region, Changsha-Zhuzhou-Xiangtan, Henan, and Anhui, which have heavy air pollution, high population density, or both. Increasing trends were found in most provinces, but with varied growth rates. While there was some evidence for improving air quality in recent years, this was offset somewhat by the countervailing influences of in-migration together with population growth. We recommend that priority areas for future national air pollution control policies be adjusted to better reflect the spatial hotspots of health burdens. Satellite-based exposure and health impact assessments can be a useful tool for tracking progress on both air quality and population health burden reductions. Copyright © 2016. Published by Elsevier Ltd.

Discrimination, Mental Health, and Substance Use Disorders Among Sexual Minority Populations.

PubMed

Lee, Ji Hyun; Gamarel, Kristi E; Bryant, Kendall J; Zaller, Nickolas D; Operario, Don

2016-08-01

Sexual minority (lesbian, gay, bisexual) populations have a higher prevalence of mental health and substance use disorders compared to their heterosexual counterparts. Such disparities have been attributed, in part, to minority stressors, including distal stressors such as discrimination. However, few studies have examined associations between discrimination, mental health, and substance use disorders by gender among sexual minority populations. We analyzed data from 577 adult men and women who self-identified as lesbian, gay, or bisexual and participated in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Six questions assessed discrimination due to sexual orientation. Weighted multivariable logistic regression examined associations between experiences of sexual orientation discrimination and both mental health and substance use disorders. Analyses were conducted separately for sexual minority men and women, adjusting for sociodemographic covariates. Sexual minority men who ever experienced discrimination (57.4%) reported higher odds of any lifetime drug use disorder and cannabis use disorder compared to sexual minority men who never experienced discrimination. Sexual minority women who ever experienced discrimination (42.9%) reported higher odds of any lifetime mood disorder and any lifetime anxiety disorder compared to sexual minority women who never experienced discrimination. The findings suggest that discrimination is differentially associated with internalizing (mental health) and externalizing (substance use) disorders for sexual minority men and women. These findings indicate a need to consider how homophobia and heteronormative discrimination may contribute to distinct health outcomes for lesbian and bisexual women compared with gay and bisexual men.

HMOs and the barriers to access for the pediatric population requiring emergency medical services.

PubMed

Uva, J L

1996-06-01

The main objectives of this study are to analyze the Massachusetts Health Maintenance Organizations (HMOs) in order to determine their standard definition of an emergency, the HMOs instructions for seeking emergency care, and distribution of such instructions for the pediatric population. A 15-question survey concerning pediatric emergency care policies and procedures was asked of each of the 20 HMOs contacted. Quarterly statements of each of the 20 HMOs were obtained from the Division of Insurance as well as the HMO's written materials distributed to the enrollees as member handbooks. Ninety percent of the HMOs had a definition of emergency care for the adult population, whereas 0% had a definition of emergency care specifically for the pediatric population. One hundred percent of the HMOs had instructions for emergency care, but 0% had specific provisions for pediatric emergency care. All 20 HMOs inform their enrollees about emergency policies through a member handbook. The results of this study reveal the lack of a standard definition of an emergency for HMOs. The current definitions of "urgent," "emergency," and "life-threatening emergency" care do not reflect the pediatric population, rather, these definitions are based on the adult population. The lack of specific pediatric guidelines could compromise the health of the children in HMOs.

Geographic variation in health IT and health care outcomes: A snapshot before the meaningful use incentive program began.

PubMed

McLaughlin, Catherine G; Lammers, Eric

2015-03-01

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which includes the Meaningful Use (MU) incentive program, was designed to increase the adoption of health information technology (IT) by physicians and hospitals. Policymakers hope that increased use of health IT to exchange health information will in turn enhance the quality and efficiency of health care delivery. In this study, we analyze the extent to which key outcomes vary based on the levels of health ITness among physicians and hospitals before the HITECH and MU programs led to increases in adoption and changes in use. Our findings provide an important baseline for a future evaluation of the impact of these programs on population-level outcomes. We constructed measures of the degree of hospital and physician adoption and use ("health ITness") at the level of the hospital referral region (HRR). We used data from the 2010 IT Supplement of the American Hospital Association (AHA) Annual Survey of Hospitals to capture hospital health ITness and data from the 2010 survey of ambulatory health care sites produced by SK&A Information Services for the physician measure. We conducted cross-sectional analyses of the relationship between market-level Medicare costs and use and three measures: (1) physician health ITness, (2) hospital health ITness, and (3) an overall measure of health ITness. In general, greater levels of physician health ITness are associated with decreasing costs and use. Many of these relationships lose statistical significance, however, when we control for population and market characteristics such as the average age and health status of Medicare beneficiaries, mean household income, and the HMO penetration rate. Several of the relationships also change according to the level of hospital health ITness. Our findings suggest that greater levels of physician health ITness are associated with decreasing costs and use for a number of services, including inpatient costs and stays, imaging services, and lab tests, in 2010. Our health ITness and outcomes measures are aggregated at the HRR level; as such, these results do not suggest that the adoption and use of health IT by individual physicians or hospitals leads to decreases in costs or use for their individual patients. Nevertheless, these baseline findings provide important information to be considered in future research analyzing the impact of HITECH and the MU incentives. Copyright © 2014. Published by Elsevier Inc.

High incidence of diseases endemic to the Amazon region of Brazil, 2001-2006.

PubMed

Penna, Gerson; Pinto, Luiz Felipe; Soranz, Daniel; Glatt, Ruth

2009-04-01

In Brazil, reportable diseases are the responsibility of the Secretariat of Health Surveillance of the Brazilian Federal Ministry of Health. During 2001-2006, to determine incidence and hospitalization rates, we analyzed 5 diseases (malaria, leishmaniasis [cutaneous and visceral], dengue fever, leprosy, and tuberculosis) that are endemic to the Amazon region of Brazil. Data were obtained from 773 municipalities in 3 regions. Although incidence rates of malaria, leishmaniasis, tuberculosis, and leprosy are decreasing, persons in lower socioeconomic classes with insufficient formal education are affected more by these diseases and other health inequalities than are other population groups in the region.

High Incidence of Diseases Endemic to the Amazon Region of Brazil, 2001–2006

PubMed Central

Pinto, Luiz Felipe; Soranz, Daniel; Glatt, Ruth

2009-01-01

In Brazil, reportable diseases are the responsibility of the Secretariat of Health Surveillance of the Brazilian Federal Ministry of Health. During 2001–2006, to determine incidence and hospitalization rates, we analyzed 5 diseases (malaria, leishmaniasis [cutaneous and visceral], dengue fever, leprosy, and tuberculosis) that are endemic to the Amazon region of Brazil. Data were obtained from 773 municipalities in 3 regions. Although incidence rates of malaria, leishmaniasis, tuberculosis, and leprosy are decreasing, persons in lower socioeconomic classes with insufficient formal education are affected more by these diseases and other health inequalities than are other population groups in the region. PMID:19331758

Epidemiology of Postherpetic Neuralgia in Korea: An Electronic Population Health Insurance System Based Study.

PubMed

Hong, Myong-Joo; Kim, Yeon-Dong; Cheong, Yong-Kwan; Park, Seon-Jeong; Choi, Seung-Won; Hong, Hyon-Joo

2016-04-01

Postherpetic neuralgia (PHN) is a disease entity defined as persistent pain after the acute pain of herpes zoster gradually resolves. It is associated with impaired daily activities, resulting in reduced quality of life. General epidemiological data on PHN is necessary for the effective management. However, data on the epidemiology of PHN in Korea is lacking. The aim of this study was to evaluate the epidemiological features of PHN in the general population.We used population-based medical data for 51,448,491 subscribers to the Health Insurance Service in the year of 2013 to analyze of PHN epidemiology in Korea, such as the incidence, regional distribution, seasonal variation, and healthcare resource utilization. Total number of patients and medical cost on PHN were analyzed from 2009 to 2013.Findings indicate that the incidence of PHN in Korea was 2.5 per 1000 person-years, which was strongly correlated with age and sex. There were no differences in seasonal variation or regional distribution. The medical cost increased steadily over the study period. When admitted to general hospitals, patients with PHN were mainly managed in the dermatology and anesthesiology departments.The incidence and prevalence rates of PHN in Koreans appear to be considerably higher compared to those in western populations, while the sex and age predisposition was similar. Considering that the pain associated with PHN can have a marked impact on a patient's quality of life resulting in a medicosocial economic burden, anesthesiology physicians have an important role in primary care in Korea. Future research on the cost-effectiveness of the management of PHN is needed.

Mental Health and Related Factors of Hospital Nurses.

PubMed

Nukui, Hiroshi; Murakami, Michio; Midorikawa, Sanae; Suenaga, Minako; Rokkaku, Yuichi; Yabe, Hirooki; Ohtsuru, Akira

2017-03-01

The mental health of hospital nurses is a key health issue in public health promotion during the recovery phase following the Fukushima disaster. In this study, conducted 4 years after the disaster, we analyzed the overall mental health, knowledge, risk perception of radiation, and work and daily life burdens of nurses working at medical institutions in the Fukushima Prefecture (collection rate = 89.6%; response number = 730). Overall mental health status was estimated using the 12-item version of the General Health Questionnaire, and 333 respondents (45.6%) scored above the 12-item General Health Questionnaire threshold point (≥4), indicating probable emotional distress compared with the general population under normal circumstances. Multivariate logistic analysis suggested that the ability to cope with daily life and work-related stressors were more important than risk perception and acquisition of knowledge regarding radiation and its control methods for supporting the mental health of nurses following the Fukushima disaster.

Exploring Local Public Health Workflow in the Context of Automated Translation Technologies

PubMed Central

Mandel, Hannah; Turner, Anne M.

2013-01-01

Despite the growing limited English proficiency (LEP) population in the US, and federal regulations requiring multilingual health information be available for LEP individuals, there is a lack of available high quality multilingual health promotion materials. The costs and personnel time associated with creating high quality translations serve as barriers to their creation, especially in resource limited public health settings. To explore the potential adoption of novel machine translation and document dissemination technologies for improving the creation and sharing of translated public health materials, we interviewed key health department personnel in Washington State. We analyzed translation workflow, elucidated key themes regarding public health translation work, and assessed attitudes towards electronic document exchange and machine translation. Public health personnel expressed the need for human quality assurance and oversight, but appreciated the potential of novel information technologies to assist in the production and dissemination of translated materials for public health practice. PMID:24551385

[Opinion of administrative personnel about smoke-free regulations].

PubMed

Wojtysiak, Piotr; Polańska, Kinga; Bak-Romaniszyn, Leokadia; Czarnecka, Karolina; Kaleta, Dorota

2010-01-01

The aim of the study was to analyze the opinion of administrative personnel in school on smoke-free regulations. The study population consisted of 320 subjects. Among the study population questionnaire was conducted including socio-demographic characteristic, smoking and SHS profile. Detail information was collected about opinion on smoke-free public places such as offices, other workplaces, health and educational buildings, restaurants and bars. About 22% of study population declared current tobacco smoking. More current everyday smoking was observed among men comparing to women (17.8% vs. 9.1%; p < 0.05). The study indicated that high percentage support total ban of smoking in public offices (84%), health care buildings (89%), and educational buildings (86%). 60% of the study subject were in favor of smoke-fee restaurants and 38% sypport smoke-free burs, pubs and clubs. The strong approval for ban on tobacco product advertising was indicated by 41% of respondents and 38% of them expect pictorial warnings on tobacco packs.

Race/Ethnicity and Primary Language: Health Beliefs about Colorectal Cancer Screening in a Diverse, Low-Income Population.

PubMed

Brenner, Alison Tytell; Ko, Linda K; Janz, Nancy; Gupta, Shivani; Inadomi, John

2015-08-01

Colorectal cancer (CRC) is an important cause of cancer death in adults in the U.S.; screening is effective but underutilized, particularly among minorities. The purpose of this paper was to explore whether health belief model (HBM) constructs pertaining to CRC screening differ by race/ethnicity and primary language. Data were from the baseline surveys of 933 participants (93.5%) in a randomized trial promoting CRC screening in San Francisco. Composite scores for each construct were created from multiple items, dichotomized for analysis, and analyzed using multivariate logistic regression. Most participants were Asian (29.7%) or Hispanic (34.3%), and many were non-English speakers. Non-English speaking Hispanics (p<.001) and English-speaking Asians (p=.002) reported lower perceived susceptibility than non-Hispanic Whites (NHW). Non-English speaking Hispanics reported more and non-English speaking Asians fewer perceived barriers (psychological and structural) than NHW. Understanding how different populations think about CRC screening may be critical in promoting screening in diverse populations.

Pyogenic Liver Abscess as Endemic Disease, Taiwan

PubMed Central

Tsai, Feng-Chiao; Huang, Yu-Tsung; Chang, Luan-Yin

2008-01-01

Pyogenic liver abscess has become a health problem in Taiwanese society. However, the extent of this problem has remained unclear because of the lack of a population-based study. We therefore performed a nationwide analysis of pyogenic liver abscess in Taiwan from 1996 through 2004. We analyzed 29,703 cases from the Taiwan National Health Insurance database and 506 cases from National Taiwan University Hospital. Our analysis showed that the annual incidence of pyogenic liver abscess increased steadily from 11.15/100,000 population in 1996 to 17.59/100,000 in 2004. Diabetes, malignancy, renal disease, and pneumonia were associated with a higher risk for the disease. By contrast, death due to pyogenic liver abscess decreased over time, although population-based abscess-related death increased slightly. Renal disease, malignancy, pneumonia, and heart disease correlated with higher death rates; Klebsiella pneumoniae infection and therapeutic procedures were related to lower death rates. Diabetes did not significantly change death rates for the 506 patients from the hospital. PMID:18826824

Mexican registry of pediatric cardiac surgery. First report.

PubMed

Cervantes-Salazar, Jorge; Calderón-Colmenero, Juan; Ramírez-Marroquín, Samuel; Palacios-Macedo, Alexis; Bolio Cerdán, Alejandro; Vizcaíno Alarcón, Alfredo; Curi-Curi, Pedro; de la Llata, Manuel; Erdmenger Orellana, Julio; González, Julieta; García Soriano, Federico; Calderón, Alejandro; Casillas, Luis; Villanueva, Filiberto; Sánchez Ramírez, Roberto; Osnaya, Héctor; Necoechea, Juan Carlos; Alva Espinoza, Carlos; Prado Villegas, Guillermo

Currently, there is a spreading worldwide tendency to characterize health issues and to propose alternative solutions via the creation of computerized databases. The aim of this study was to present the results in a computerized database of pediatric cardiac surgeries developed under the auspices of the Mexican Association of Specialists in Congenital Heart Diseases (Asociación Mexicana de Especialistas en Cardiopatías Congénitas A.C) and coordinated by the collegiate group of Pediatric Cardiology and Surgery as petitioned by the National Institutes of Health and High Specialty Hospitals Coordinating Commission. We analyzed all cases registered in the database during a 1-year observation period (August 1, 2011 to July 31, 2012) by all major Health Ministry-dependent institutes and hospitals offering surgical services related to pediatric cardiopathies to the non-insured population. Seven institutions participated voluntarily in completing the database. During the analyzed period, 943 surgeries in 880 patients with 7% reoperations (n=63) were registered. Thirty-eight percent of the surgeries were performed in children <1 year of age. The five most common cardiopathies were patent ductus arteriosus (n=96), ventricular septal defect (n=86), tetralogy of Fallot (n=72), atrial septal defect (n=68), and aortic coarctation (n=54). Ninety percent of surgeries were elective and extracorporeal circulation was used in 62% of surgeries. Global mortality rate was 7.5% with the following distribution in the RACHS-1 score categories: 1 (n=4, 2%), 2 (n=19, 6%), 3 (n=22, 8%), 4 (n=12, 19%), 5 (n=1, 25%), 6 (n=6, 44%), and non-classifiable (n=2, 9%). This analysis provides a representative view of the surgical practices in cardiovascular diseases in the pediatric population at the national non-insured population level. However, incorporating other health institutions to the national registry database will render a more accurate panorama of the national reality in surgical practices in the population <18 years of age. Copyright © 2014 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

Exploring relationships among social integration, social isolation, self-rated health, and demographics among Latino day laborers.

PubMed

Steel, Kenneth C; Fernandez-Esquer, Maria Eugenia; Atkinson, John S; Taylor, Wendell C

2018-05-01

Research indicates social integration and social isolation are related to health, and Latino day laborers (LDLs) tend to be socially isolated and, thus, at high risk for adverse health consequences. relationships among social isolation, social integration, self-rated health (SRH), and demographics were examined in a sample of LDLs to contribute to the literature on social networks and health in this and other migrant populations. We analyzed data from 324 LDLs who participated in Proyecto SHILOS (Salud del Hombre Inmigrante Latino), a Houston-based survey of Latino immigrant men's health. Based on the literature, we hypothesized SRH would be (1) positively associated with social integration and (2) negatively associated with social isolation. All proposed measures were first entered into a correlation matrix to identify significant bivariate relationships (p ≤ .05, two-tailed). Associations between variables that were directly correlated with SRH and variables that were, in turn, proximally associated with these variables were then used to develop a structural equation path model of SRH. Individual paths in the model were measured for significance, and goodness of fit was assessed by the model chi-square, the Comparative Fit Index, and the Root Mean Square Error of Approximation. Inconsistent with the first hypothesis, SRH was negatively associated with social integration, as measured by the number of trusted friends. Consistent with the second hypothesis, SRH was negatively associated with social isolation, as measured by needing someone to talk to. More frequent contact with family was also negatively associated with social isolation. Our findings suggest social integration may not always protect and promote health. Therefore, assessing the quality of LDLs' different relationships, not just the quantity, is vital. Future studies should further analyze the effects that social resources have on perceptions of social isolation and health in LDLs and other migrant populations.

Burnout: Interpreting the Perception of Iranian Primary Rural Health Care Providers from Working and Organizational Conditions

PubMed Central

Keshvari, Mahrokh; Mohammadi, Eesa; Boroujeni, Ali Zargham; Farajzadegan, Ziba

2012-01-01

Objectives: Health care providers in the rural centers offer the primary health services in the form of proficiencies and professions to the most required target population in the health system. These services are provided in certain condition and population with a verity of limitations. This study aimed to describe and interpret the experiences of the employees from their own working condition in the rural health centers. Methods: The present study conducted in a qualitative research approach and content analysis method through individual and group interviews with 26 employed primary health care providers (including 7 family physicians, 7 midwives, and 12 health workers) in the rural health centers in Isfahan in 2009. Sampling was done using purposive sampling method. The data were analyzed using qualitative content analysis as constant comparative basis. Results: During the content analysis process, six themes were obtained; “instability and frequent changes”, “involved in laws and regulations”, “pressure and stress due to unbalanced workload and manpower”, “helplessness in performing the tasks and duties”, “sense of identity threat and low self-concept”, and “deprivation of professional development”. The mentioned themes indicate a main and more important theme called “burnout”. Conclusions: Health services providers in the rural health centers are working in stressful and challenging work conditions and are suffered from deprivation of something for which are responsible to the community. PMID:22826774

Systematic literature review of Internet interventions across health behaviors

PubMed Central

Hou, Su-I; Charlery, Su-Anne Robyn; Roberson, Kiersten

2014-01-01

Purpose: This review examines Internet interventions aiming to change health behaviors in the general population. Methods: Internet health interventions in the USA published between January 2005 and December 2013 were identified through Medline and CINAHL. Keywords used were (Internet or e-health or social media or web) paired with (intervention or program*). A total of 38 articles met all criteria and were reviewed. Results: Studies were analyzed by targeted health behavior interventions: tobacco (5), alcohol (4), weight loss (7), physical activity (PA) (7), nutrition (2), PA and nutrition combined (5), HIV or sexual health (4), and chronic diseases (4). Interventions ranged from one session to 24  weeks (average 6–12 weeks). Common strategies used, including web-based information, tailored feedback, weekly e-mails, goal setting, and self-assessment. Social cognitive theory and the transtheoretical models were the most commonly used frameworks. Recruitment strategies were typically media based varied by settings and populations. Except for the tobacco interventions, the majority studies yielded significant outcomes. Conclusion: This review provides updates and synthesized knowledge on the design and consistent effectiveness of Internet interventions across health behaviors. Results have implications for public health and healthcare professionals, as they play a key role in developing and delivering health promotion interventions as well as in assisting the communities and clients serviced obtaining evidence-based health information. PMID:25750795

Supporting a Culture of Evidence-Based Policy: Federal Funding for Public Health Law Evaluation Research, 1985-2014.

PubMed

Ibrahim, Jennifer K; Sorensen, Aaron A; Grunwald, Heidi; Burris, Scott

Law powerfully influences health and can be a critical tool for promoting population well-being. Evaluation research is needed to measure the health effects of law and guide policy making and implementation. The purpose of this study was to assess trends in National Institutes of Health (NIH) funding for scientific public health law research (PHLR). Using data from the UberResearch NIH grant repository, we collected and coded all grants with a focus on health law between FY'85 and FY'14 and then analyzed the grants by funding agency and topic areas. Between FY'85 and FY'14, NIH funded 510 research grants on health policy making, the health effects of laws or enforcement practices. On average, 4 PHLR grants were funded annually with a median total funding of $545 956 (range: $2535-$44 052 300) and a median annual funding of $205 223 (range: $2535-$7 019 517). National Institutes of Health has supported important PHLR but not nearly to the extent necessary to ensure that public health laws affecting the population are evaluated in a rigorous and timely manner. In addition to greater funding evaluation research, NIH can increase its support for creating legal datasets, fund training in PHLR, and work with the National Library of Medicine to create Medical Subject Headings (MeSH) terms related to PHLR.

Analysis of changes in the association of income and the utilization of curative health services in Mexico between 2000 and 2006

PubMed Central

2011-01-01

Background A common characteristic of health systems in most developing countries is unequal access to health services. As a result, members of the poorest population groups often do not receive formal attention for health services, because they cannot afford it. In 2001 in Mexico, to address income-related differences in the use of health services, the government launched a major healthcare reform, which includes a health insurance program called Seguro Popular, aimed at improving healthcare access among poor, uninsured residents. This paper analyzes the before and after changes in the demand for curative ambulatory health services focusing on the association of income-related characteristics and the utilization of formal healthcare providers vs. no healthcare service utilization. Methods By using two nationally representative health surveys (ENSA-2000 and ENSANUT-2006), we modeled an individual's decision when experiencing an illness to use services provided by the (1) Ministry of Health (MoH), (2) social security, (3) private entities, or (4) to not use formal services (no healthcare service utilization). Results Poorer individuals were more likely in 2006 than in 2000 to respond to an illness by using formal healthcare providers. Trends in provider selection differed, however. The probability of using public services from the MoH increased among the poorest population, while the findings indicated an increase in utilization of private health services among members of low- and middle-income groups. No significant change was seen among formal workers -covered by social security services-, regardless of socioeconomic status. Conclusions Overall, for 2006 the Mexican population appears less differentiated in using healthcare across economic groups than in 2000. This may be related, in part, to the implementation of Seguro Popular, which seems to be stimulating healthcare demand among the poorest and previously uninsured segment of the population. Still, public health authorities need to address the remaining income-related healthcare utilization differences, the differences in quality between public and private health services, and the general perception that MoH facilities offer inferior services. PMID:21978183

Analysis of changes in the association of income and the utilization of curative health services in Mexico between 2000 and 2006.

PubMed

Danese-Dlsantos, Laura G; Sosa-Rubí, Sandra G; Valencia-Mendoza, Atanacio

2011-10-07

A common characteristic of health systems in most developing countries is unequal access to health services. As a result, members of the poorest population groups often do not receive formal attention for health services, because they cannot afford it. In 2001 in Mexico, to address income-related differences in the use of health services, the government launched a major healthcare reform, which includes a health insurance program called Seguro Popular, aimed at improving healthcare access among poor, uninsured residents. This paper analyzes the before and after changes in the demand for curative ambulatory health services focusing on the association of income-related characteristics and the utilization of formal healthcare providers vs. no healthcare service utilization. By using two nationally representative health surveys (ENSA-2000 and ENSANUT-2006), we modeled an individual's decision when experiencing an illness to use services provided by the (1) Ministry of Health (MoH), (2) social security, (3) private entities, or (4) to not use formal services (no healthcare service utilization). Poorer individuals were more likely in 2006 than in 2000 to respond to an illness by using formal healthcare providers. Trends in provider selection differed, however. The probability of using public services from the MoH increased among the poorest population, while the findings indicated an increase in utilization of private health services among members of low- and middle-income groups. No significant change was seen among formal workers -covered by social security services-, regardless of socioeconomic status. Overall, for 2006 the Mexican population appears less differentiated in using healthcare across economic groups than in 2000. This may be related, in part, to the implementation of Seguro Popular, which seems to be stimulating healthcare demand among the poorest and previously uninsured segment of the population. Still, public health authorities need to address the remaining income-related healthcare utilization differences, the differences in quality between public and private health services, and the general perception that MoH facilities offer inferior services.

Health status among black African-born women in Kansas City: a preliminary assessment.

PubMed

Ndikum-Moffor, Florence M; Faseru, Babalola; Filippi, Melissa K; Wei, Hou; Engelman, Kimberly K

2015-10-05

Health information and statistics for Black foreign-born women in the United States are under-reported or not available. Black foreign-born women typically are classified under the general category of African American, ignoring the heterogeneity that exists in the United States Black population. It is important to identify health issues and behaviors of African-born women to effectively address health disparities. Black African-born women (N = 29), 20 years or older completed a survey about general and women's health, health history, acculturation, lifestyle, social and health challenges, beliefs about breast cancer. Data were analyzed using SPSS 14.0 software. Categorical variables were summarized with frequencies and percentages and continuous variables were summarized with means and standard variation. A Likert scale (strongly agree, agree, disagree, and strongly disagree) was used to assess beliefs about breast cancer. Most (71.4%) participants had a high school education or more, 70% were employed, and 50% had health insurance. Two-thirds received health care from primary care doctors, 20.7% from health departments, and 39.3% got annual checkups. Lack of jobs, healthcare cost, language barrier, discrimination, and child care were the top social issues faced by participants. High blood pressure, obesity, oral health, HIV/AIDS, and diabetes were indicated as the most common health problems. The percent of participants (60%) that had not had a mammogram within the previous 2 years was more than the state average (24%) for women 40 years and older reported by the Kansas Department of Health and Environment. The percent of participants (40%) that had a mammogram within the previous 2 years was lower than the national average (73.2%) for African American women. Study provides a snapshot of social concerns and health issues in an African population residing in Midwestern United States. Understanding the socio-cultural characteristics of this population is necessary to address health disparities.

[The status and risk factors of self-health management among community residents in Shenzhen].

PubMed

Zhuang, Runsen; Xiang, Yueying; Han, Tieguang; Zhang, Yuan

2014-07-01

To analyze the risk factors of the self-health management among Shenzhen's community residents by surveying the status of the self-health management. Multi-stage cluster random sampling was used in this study. The estimated sample size was 6 400 of the study, and the actual number of the subjects was 6 413, who were from 32 communities in Shenzhen. All the subjects were investigated by using a self-devised questionnaire on July 2012. The contents of the questionnaire included sociodemographic characteristics of genders, age, household register, marriage suatus, degrees of education, income, investment of health, family population, the status of self-health management, self-health assessment, illness and injury in the last two weeks, chronic diseases and in hospital last year. Through binary logistic regression, factors influencing the self-health status were analyzed. The proportion of self-health management among the residents was 29.47% (1 890/6 413), and the proportion was 37.26% (392/1 052) among the first ten chronic disease patients. The proportions of diabetes mellitus, anemia, cardiovascular disease, chronic bronchitis and hypertension patients were higher, which were 46.67% (35/75) , 41.94% (26/62), 38.96% (30/77) , 38.95% (37/95) and 38.93% (102/262) respectively. The binary regression analysis results showed that the effect factors of the self-health management were high age (OR = 1.22, 95% CI: 1.15-1.30) , females (OR = 1.20, 95% CI: 1.07-1.34) , high culture (OR = 1.24, 95% CI: 1.15-1.34) , high monthly income (OR = 1.07, 95% CI: 1.00- 1.13) , large family population (OR = 1.23, 95%CI: 1.10-1.38) , household register in Shenzhen (OR = 1.13, 95% CI: 1.00-1.29) , chronic diseases (OR = 1.22, 95% CI: 1.05-1.42). The proportion of self-health management among the community residents in Shenzhen was not high. We should put more effort on construction of health management system, and take action on intervention of the risk factor of health management status.

Map of biomedical research in Cameroon; a documentary review of approved protocols from 1997 to 2012.

PubMed

Walter, Ebile Akoh; Jerome, Ateudjieu; Marceline, Djuidje Ngounoue; Yakum, Martin Ndinakie; Pierre, Watcho

2017-11-21

Over the last decade, there has been a rapid increase in biomedical research in Cameroon. However, the question of whether these research projects target major health priorities, vulnerable populations and geographic locations at risk remains to be answered. The aim of this paper is to describe the state of biomedical research in Cameroon which is a key determinant that would guide future health care policies and promote equitable access to healthcare. A documentary review of all approved protocols (proposals) of biomedical research projects, from 1997 through 2012, at the Cameroon National Ethics Committee. Protocols were reviewed systematically by independent reviewers and data were extracted on a grid. Data were analyzed by calculating proportions at 95% confidence interval, chi-square test (chi2) and p-values. Two thousand one hundred seventy two protocols were reviewed for data extraction. One thousand three hundred ninety-five (64.7%) were student projects, 369 (17.0%) projects had international sponsors, and 1528 (72.4%) were hospital-based studies. The most targeted domain was the fight against diseases 1323 (61.3%); mostly HIV 342 (25.8%) and Malaria 136 (10.3%). Over half of the studies were concentrated in the Centre region 1242 (57.2%), with the least projects conducted in the Northern region 15 (0.7%). There was strong evidence that international and local sponsors would influence the research site (p-value = 0.01) and population targets (p-value = 0.00). Although biomedical research targets some important diseases that pose a great burden to Cameroonians, the most vulnerable populations are excluded from research. Biomedical research scarcely addresses other components of the health system and emerging diseases of vital public health importance. We recommend that the government should play a central role, between researchers from academic institutions, sponsors, NGOs and research institutions, to ensure that biomedical research addresses the health priorities of Cameroonians. It should include vulnerable populations, and address other components of the health system for a balance. These recommendations are critical to ensuring that future research informed health policies reflect the health needs of the populations and promote equity in healthcare access.

Health state of adolescents in the Republic Sakha (Yakutia).

PubMed

Egorova, Vera B; Savvina, Nadezhda V; Munkhalova, Yana A; Dmitrieva, Tatyana G; Markova, Sardana V; Artamonova, Sargylana U

2016-01-01

According to the state policy in the field of health care, one of the priority directions is the improving of medical care for children's population [1]. It should be noted, that the state of health of the population and the development of society as a whole is largely determined by the level of adolescents health who have a significant impact on the health of the nation as a whole, and form the cultural, intellectual, industrial and reproductive potential [2, 3]. This article analyzes the health status indicators of adolescent population of the Republic Sakha (Yakutia), including the dynamics of the disease, including socially conditioned diseases, disability and mortality among the teenage population. To study of health status of adolescents, social condition of life and there dynamic we use statistic materials of Yakut Republican Medical informative-analytic center, carry out medical prophylactic examination and survey research of 748 adolescents in 7 districts of republic, using questionnaires Global epidemic surveillance system health status of schoolchildren with support from WHO / UNAIDS / UNICEF / UNESCOCO. Established negative trend of deceasing of adolescent population, the increase in performance of both primary and general morbidity. Out of the total incidence of first place ranking among teenagers occupied by respiratory diseases, diseases of the eye and diseases of the digestive system. The most intensive increased prevalence of neurological diseases, cardiovascular system diseases, injuries and poisoning, and others external causes. Over the years remain unstable indicators of socio-caused diseases (alcoholism, drug addiction, tuberculosis, sexually transmitted infections). Despite the positive dynamics of some socially constructed and socially significant diseases, the relevance of this problem persists. Analysis of the dynamics of disability among children and adolescents showed a reduction in performance. In the structure of disability dominate diseases of the nervous system and sensory organs, congenital malformations and mental illness. Among the main causes of deaths in adolescence are external causes, there is no downward trend. There were significant gender differences, the increase in mortality associated with substance use among children died prevail children Yakut nationality. These results let us to plan and conduct the prophylactic work to decrease the pathology level among adolescents, and also to detect the need in medical staff and other resources.

Achievement of national clinical practice recommendations among those in the Puerto Rican population with diabetes mellitus.

PubMed

Rodríguez-Vigil, Efraín; Rodríguez-Chacón, Migdalia; Trabanco, Cesar; Irizarry-Ramos, Jessica

2014-12-01

To analyze glycemic control among patients with diabetes mellitus (DM) in Puerto Rico (PR) using the 2011 American Diabetes Association (ADA) recommendations and glycemic goals as standards. We also explored other factors that are related to glycemic control. Glycemic data were obtained from 600 adults with DM from 5 different regions in PR. The patient's health insurance coverage, type of health care provider, type of diabetes treatment, gender, age, physical activity, weight, degree of hypertension and degree and type of dyslipidemia comorbidities (when one or both were applicable), and disease duration were variables of interest. Univariate and bivariate analyses were conducted to describe the population and determine the statistical differences in the glycemic control of the subjects. Fewer than half of the participants achieved the ADA-recommended levels for HbA1c (37.3%) and blood pressure (34%). However, relatively more participants met the goals for high-density lipoprotein cholesterol (51.7%), low-density lipoprotein cholesterol (59.9%), and triglycerides (61.5%). The percentage of participants reaching the HbA1c, blood pressure, and low-density lipoprotein cholesterol goals at the same time was 9.9%. Patients with private health insurance achieved better glycemic control than did patients in the public-managed healthcare system. Half of the population presented simultaneous hypertension, dyslipidemia, and DM comorbidities. Only 50% of the participants were physically active. In the sample population, glycemic control levels and blood pressure levels in adults with DM were far from the ADA-recommended standards. Physical activity levels, type of medical insurance, and type of DM medical treatment were the main modifiable factors associated with the goal of attaining glycemic control. Barriers that limit the achievement of this goal should be analyzed in more detail to improve the medical care for people with DM.

[Health services utilization by the immigrant and native-born populations in the autonomous region of Murcia (Spain)].

PubMed

López Nicolás, Angel; Ramos Parreño, José María

2009-12-01

To analyze the patterns of utilisation for three types of public health services (outpatient specialist visits, emergency visits and hospitalisations) in the Comunidad Autónoma de la Región de Murcia. We examine the differences between the average rates of utilization of these services among natives and non-Spanish immigrants, and whether these differences are due to differences in demographic structure, or to different behaviour between these groups. We use econometric models for utilisation to exploit administrative records on health care utilisation and the well established Oaxaca decomposition method. This splits average rates of utilisation and/or average health expenditure into two components: the first one stands for the part of the difference that can be attributed to differential patterns of behaviour among the two groups; the second one represents the part of the difference in average expenditure that can be attributed to the fact that average demographic characteristics among both groups differ. The rates of use of outpatient specialist visits, emergencies and hospital nights by the native population are greater than the corresponding rates for the immigrant population. For individuals aged between 20 to 40 years old, the utilisation rates of African and Latin-American females are higher than those for native females. The average health expenditure of native males is greater than that of immigrants. The difference is mainly due to different demographic features among the native and immigrant populations, except for the group, whose individuals show a different behaviour. In fact, among the 20 to 40 age group, the average health expenditure of native females equals that of Latin-American women, which is in turn below that of African females. In this paper we show that the remarkable differences in the age-gender balance among different (in terms of nationality) groups of insured residents in Murcia has a considerable effect on consumption of health services and therefore on the average health care expenditure attributable to these groups.

Dietary habits of a school population and implications for oral health.

PubMed

Llena Puy, C; Forner, L

2010-04-01

The study analyzes the consumption of cariogenic foods in a population of children between 6 and 10 years old. Transversal descriptive study on a sample of 369 children who first attended to the Department 9 Dentistry dental office of the Valencia Region Health Agency (Spain). A self-administered food consumption frequency questionnaire was used to evaluate how often the food on the list were consumed by the children. Sticky sugar-rich foods, sugared milk and dairy products, food containing starch and sugar, sugary liquids and food with semihydrolyzed starch were consumed by over 50% of the sample at main meals and between meals. The mean intake of all these food groups, was over five times a week. The older children ate more fruit and foods rich in semihydrolyzed starch at main meals. Sweetened medication significantly reduced with age. Sugar-free sweets were consumed by almost 60% of the sample. The study shows a high intake of food with cariogenic potential, in particular processed food with added sugar and food with semihydrolyzed starch consumed between meals. This situation indicates the need to include health education programs in our population focused to improve the dietary habits of children and teenagers.

Prevalence of Selected Bacterial Infections Associated with the Use of Animal Waste in Louisiana

PubMed Central

Hill, Dagne D.; Owens, William E.; Tchounwou, Paul B.

2005-01-01

Human health is a major concern when considering the disposal of large quantities of animal waste. Health concerns could arise from exposure to pathogens and excess nitrogen associated with this form of pollution. The objective was to collect and analyze health data related to selected bacterial infections associated with the use of animal waste in Louisiana. An analysis of adverse health effects has been conducted based on the incidence/prevalence rates of campylobacteriosis, E. coli O157:H7 infection, salmonellosis and shigellosis. The number of reported cases increased during the summer months. Analysis of health data showed that reported disease cases of E. coli O157:H7 were highest among Caucasian infants in the 0–4 year old age category and in Caucasian children in the 5–9 year old age category. Fatalities resulting from salmonellosis are low and increases sharply with age. The number of reported cases of shigellosis was found to be higher in African American males and females than in Caucasians. The high rate of identification in the younger population may result from the prompt seeking of medical care, as well as the frequent ordering of stool examination when symptoms become evident among this group of the population. The association with increasing age and fatality due to salmonellosis could be attributed to declining health and weaker immune systems often found in the older population. It is concluded that both animal waste and non-point source pollution may have a significant impact on human health. PMID:16705805

Partnerships in Health Systems: Social Organization as limits and possibilities in the Family Health Strategy Management.

PubMed

Silva, Vanessa Costa E; Barbosa, Pedro Ribeiro; Hortale, Virgínia Alonso

2016-05-01

This is a case study in the municipality of Rio de Janeiro about management in the Family Health Strategy based on the Social Organizations model. The aims were to characterize and analyze aspects of the governance system adopted by the Rio de Janeiro Municipal Health Department and identify limits and possibilities of this model as a management option in Brazil's Unified Health System. A qualitative study was performed based on a literature review, document analysisand interviews with key informants. This management model facilitated the expansion of access to primary healthcare through the Family Health Strategy in Rio - where the population covered increased from 7.2% of the population in 2008 to 45.5% in 2015. The results showthat some practices in the contractual logic need to be improved, including negotiation and accountability with autonomywith the service suppliers. Evaluation and control has focus on processes, not results, and there has not been an increase in transparency and social control. The system of performance incentives has been reported as inducing improvements in the work process of the health teams. It is concluded that the regulatory capacity of the municipal management would need to be improved. On the other hand, there is an important and significant process of learning in progress.

[Changes in perceived health in war-displaced population, Ayacucho, Peru: 1980-2004].

PubMed

Medina, José Moya; López-Moreno, Sergio

2011-03-01

The current study aims to show the individual and familiar changes in health patterns suffered by indigenous communities which were displaced from their Andean communities to Ayacucho city, Peru, for war-related political reasons, during the period of 1980 and 2004. Information about health self-perception was collected from displaced farmers living in Ayacucho city, and analyzed by using ethnographic research tools in: origin communities; during the displaced process to town, and during the integration process once the war was over in 1993. It was found out that these poor Andean communities had traditionally lived under severe social exclusion conditions, and were characterized by low access to health services and high childhood and maternal mortality rates. Vulnerability to disease, malnutrition and death reached a higher impact during the early years after the displacement, followed by a reconstructive process in order to set up a new social network. It gets consolidated once the war is over. At that time, life conditions start becoming more favorable, identification documents were regularized, and an improvement in access to health programs and services is detected. These changes also reflected the improvement on health self-perception. Nevertheless, mental health will remain causing distress in every age group of the population.

Human papillomavirus vaccine initiation in Asian Indians and Asian subpopulations: a case for examining disaggregated data in public health research.

PubMed

Budhwani, H; De, P

2017-12-01

Vaccine disparities research often focuses on differences between the five main racial and ethnic classifications, ignoring heterogeneity of subpopulations. Considering this knowledge gap, we examined human papillomavirus (HPV) vaccine initiation in Asian Indians and Asian subpopulations. National Health Interview Survey data (2008-2013), collected by the National Center for Health Statistics, were analyzed. Multiple logistic regression analysis was conducted on adults aged 18-26 years (n = 20,040). Asian Indians had high income, education, and health insurance coverage, all positive predictors of preventative health engagement and vaccine uptake. However, we find that Asian Indians had comparatively lower rates of HPV vaccine initiation (odds ratio = 0.41; 95% confidence interval = 0.207-0.832), and foreign-born Asian Indians had the lowest rate HPV vaccination of all subpopulations (2.3%). Findings substantiate the need for research on disaggregated data rather than evaluating vaccination behaviors solely across standard racial and ethnic categories. We identified two populations that were initiating HPV vaccine at abysmal levels: foreign-born persons and Asian Indians. Development of culturally appropriate messaging has the potential to improve these initiation rates and improve population health. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Fundamental frequency perturbation indicates perceived health and age in male and female speakers

NASA Astrophysics Data System (ADS)

Feinberg, David R.

2004-05-01

There is strong support for the idea that healthy vocal chords are able to produce fundamental frequencies (F0) with minimal perturbation. Measures of F0 perturbation have been shown to discriminate pathological versus healthy populations. In addition to measuring vocal chord health, F0 perturbation is a correlate of real and perceived age. Here, the role of jitter (periodic variation in F0) and shimmer (periodic variation in amplitude of F0) in perceived health and age in a young adult (males aged 18-33, females aged 18-26), nondysphonic population was investigated. Voices were assessed for health and age by peer aged, opposite-sex raters. Jitter and shimmer were measured with Praat software (www.praat.org) using various algorithms (jitter: DDP, local, local absolute, PPQ5, and RAP; shimmer: DDA, local, local absolute, APQ3, APQ5, APQ11) to reduce measurement error, and to ascertain the robustness of the findings. Male and female voices were analyzed separately. In both sexes, ratings of health and age were significantly correlated. Measures of jitter and shimmer correlated negatively with perceived health, and positively with perceived age. Further analysis revealed that these effects were independent in male voices. Implications of this finding are that attributions of vocal health and age may reflect actual underlying condition.

Losing Count: The Federal Statistical System. Population Trends and Public Policy Occasional Paper Number 16.

ERIC Educational Resources Information Center

Wallman, Katherine K.

The main responsibility of the U.S. Bureau of the Census, Bureau of Labor Statistics, and the National Centers for Health and Education Statistics is to collect, process, analyze, and disseminate statistical data on the economic, physical, and social characteristics of the United States. Under the Paperwork Reduction Act of 1980, the federal…

Rates of Femicide in Women of Different Races, Ethnicities, and Places of Birth: Massachusetts, 1993-2007

ERIC Educational Resources Information Center

Azziz-Baumgartner, Eduardo; McKeown, Loreta; Melvin, Patrice; Dang, Quynh; Reed, Joan

2011-01-01

To describe the epidemiology of intimate partner violence (IPV) homicide in Massachusetts, an IPV mortality data set developed by the Massachusetts Department of Public Health was analyzed. The rates of death were estimated by dividing the number of decedents over the aged-matched population and Poisson regression was used to estimate the…

Is There Any Relation between Alexithymia in Parents and Children? Effects on Children's Quality of Life

ERIC Educational Resources Information Center

Castañeda López, Esther; Peñacoba Puente, Cecilia; Benito Moreno, Silvia

2018-01-01

Introduction: The study of alexithymia in children (especially in healthy children), contrary to adult populations, has not been studied extensively, despite its relevant relation to health and quality of life. The purpose of this study was to analyze, in healthy children, the relation between children's alexithymia and their parents' alexithymia,…

Growing concerns and controversies to Taiwan's National Health Insurance-what are the lessons from mainland China, South Korea and Singapore?

PubMed

Lee, Yen-Han; Ang, Ting Fang Alvin; Chiang, Timothy C; Kaplan, Warren A

2018-01-01

It has been over 20 years since Taiwan's implementation of its National Health Insurance (NHI) program. Under this program, the health insurance coverage rate has reached approximately 99% of the population. Despite guaranteeing the residents of Taiwan equal access regardless of socioeconomic status and background, critical problems and controversies persist, and they continue to challenge the NHI. We analyze the primary issues facing the NHI program with emphasis on financial and consumer behavioral aspects. Furthermore, we apply models from mainland China, South Korea and Singapore to discuss what Taiwan could learn from the systems employed by these countries to modify the NHI. Targeting the needs of the NHI, we have three policy recommendations: separating the NHI scheme into different target populations, strengthening the NHI referral system and regulating the access of overseas citizens to health services while in Taiwan. After two decades in existence, problems persist and there is a continuing need to improve Taiwan's NHI. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Associations between informal care, disease, and risk factors: A Spanish country-wide population-based study.

PubMed

González-de Paz, Luís; Real, Jordi; Borrás-Santos, Alicia; Martínez-Sánchez, José M; Rodrigo-Baños, Virginia; Dolores Navarro-Rubio, María

2016-05-01

This population-based study using 2011-2012 Spanish National Health Survey data aimed to measure the impact of disease, health-related habits, and risk factors associated with informal caregiving. We included and matched self-reported informal caregivers [ICs] with controls (1:4) from the same survey. For each outcome, we analyzed associations between ICs and controls using linear regression or logistic regression models. ICs had 3.4 per cent more depression (OR: 1.33, 95 per cent confidence intervals [CI]:1.06, 1.68). ICs had lower social support (95 per cent CI: 1.64, 3.28), they did more housework alone (OR:3.6, 95 per cent CI:2.65, 4.89), and had greater stress (95 per cent CI:0.13, 0.83). Women ICs caring alone had more anxiety than other groups. We found no statistical association between caregivers and worse health-related habits or increased risk factors (less physical activity, smoking, drinking, and cholesterol). Our results provide evidence that health-care professionals and organizations should recognize the importance of caring for those who care.

Mental health research in the Arab world.

PubMed

Jaalouk, Doris; Okasha, Ahmed; Salamoun, Mariana M; Karam, Elie G

2012-11-01

To assess the progression of mental health research over four decades in the Arab world. Publications on mental health in 21 Arab countries from 1966 to 2006 were screened using PubMed and Psychinfo. Data were collected and analyzed for Arab authors and affiliations, publication year, topic and type of journal. In 40 years (1966-2005), the Arab world published 2,213 articles on a vast variety of topics, most common being mood, anxiety and substance use disorders, and mostly in international journals. By the last decade, the total yearly publications increased about eightfold since the first two decades, and nearly doubled from the third one. The disparity of output was high across countries. The highest yearly output was from Egypt, Saudi Arabia, Kuwait and Lebanon. Per million population, the top four producing countries were Kuwait, Bahrain, Lebanon and United Arab Emirates. Over a decade, the Arab world produced approximately 17% of the global output of mental health publications/million population and was comparative to Latin American and Caribbean countries. There is a wide gap in comparison with the industrialized world, with a fertile ground for cross-cultural and genetic studies.

NIH funding trajectories and their correlations with US health dynamics from 1950 to 2004.

PubMed

Manton, Kenneth G; Gu, Xi-Liang; Lowrimore, Gene; Ullian, Arthur; Tolley, H Dennis

2009-07-07

To determine optimal future National Institutes of Health (NIH) funding levels, the longitudinal correlation of the level of investment in NIH research with population changes in the risk of specific diseases should be analyzed. This is because NIH research is the primary source of new therapies and treatments for major chronic diseases, many of which were viewed as relatively untreatable in the 1950s. NIH research is also important in developing preventative and screening strategies to support public health interventions. These correlations are examined 1938 to 2004 for 4 major chronic diseases [cardiovascular disease (CVD), stroke, cancer, and diabetes] and the NIH institutes responsible for research for those diseases. This analysis shows consistent non-linear temporal correlations of funding to mortality rates across diseases. The economic implications of this are discussed assuming that improved health at later ages will allow projected declines in the rate of growth of the US labor force to be partly offset by a higher rate of labor force participation in the US elderly population due to reduced chronic disease risks and functional impairment.

The Future of Public Health Informatics: Alternative Scenarios and Recommended Strategies

PubMed Central

Edmunds, Margo; Thorpe, Lorna; Sepulveda, Martin; Bezold, Clem; Ross, David A.

2014-01-01

Background: In October 2013, the Public Health Informatics Institute (PHII) and Institute for Alternative Futures (IAF) convened a multidisciplinary group of experts to evaluate forces shaping public health informatics (PHI) in the United States, with the aim of identifying upcoming challenges and opportunities. The PHI workshop was funded by the Robert Wood Johnson Foundation as part of its larger strategic planning process for public health and primary care. Workshop Context: During the two-day workshop, nine experts from the public and private sectors analyzed and discussed the implications of four scenarios regarding the United States economy, health care system, information technology (IT) sector, and their potential impacts on public health in the next 10 years, by 2023. Workshop participants considered the potential role of the public health sector in addressing population health challenges in each scenario, and then identified specific informatics goals and strategies needed for the sector to succeed in this role. Recommendations and Conclusion: Participants developed recommendations for the public health informatics field and for public health overall in the coming decade. These included the need to rely more heavily on intersectoral collaborations across public and private sectors, to improve data infrastructure and workforce capacity at all levels of the public health enterprise, to expand the evidence base regarding effectiveness of informatics-based public health initiatives, and to communicate strategically with elected officials and other key stakeholders regarding the potential for informatics-based solutions to have an impact on population health. PMID:25848630

What causes childhood stunting among children of San Vicente, Guatemala: Employing complimentary, system-analysis approaches.

PubMed

Voth-Gaeddert, Lee E; Stoker, Matthew; Cornell, Devin; Oerther, Daniel B

2018-04-01

Guatemala has the sixth worst stunting rate with 48% of children under five years of age classified as stunted according to World Health Organization standards. This study utilizes two different yet complimentary system-analysis approaches to analyze correlations among environmental and demographic variables, environmental enteric dysfunction (EED), and child height-for-age (stunting metric) in Guatemala. Two descriptive models constructed around applicable environmental and demographic factors on child height-for-age and EED were analyzed using Network Analysis (NA) and Structural Equation Modeling (SEM). Data from two populations of children between the age of three months and five years were used. The first population (n = 2103) was drawn from the Food for Peace Baseline Survey conducted by the US Agency for International Development (USAID) in 2012, and the second population (n = 372) was drawn from an independent survey conducted by the San Vicente Health Center in 2016. The results from the NA of the height-for-age model confirmed pathogen exposure, nutrition, and prenatal health as important, and the results from the NA of the EED model confirmed water source, water treatment, and type of sanitation as important. The results from the SEM of the height-for-age model confirmed a statistically significant correlation among child height-for-age and child-mother interaction (-0.092, p = 0.076) while the SEM of the EED model confirmed the statistically significant correlation among EED and type of water treatment (-0.115, p = 0.013). Our approach supports important efforts to understand the complex set of factors associated with child stunting among communities sharing similarities with San Vicente. Copyright © 2018 Elsevier GmbH. All rights reserved.

Self-reported health in mothers: the impact of age, and socioeconomic conditions.

PubMed

Floderus, Birgitta; Hagman, Maud; Aronsson, Gunnar; Marklund, Staffan; Wikman, Anders

2008-01-01

The aim of the present analysis was to study health and well-being in mothers compared to women without children, and to analyze potential interactions with age and socioeconomic conditions. The study comprised 5,368 Swedish women born in 1960-1979 who were interviewed in any of the population-based Surveys of Living Conditions during the period 1996-2003. Having children at home was related to self-reported health symptoms and long-standing illness in multiple logistic regression models. The impact of age, cohabitation status, full-time or part-time work, and income level were analyzed. While mothers were less burdened by long-standing illness, partly due to selection mechanisms (a "healthy mother effect"), they experienced worse self-rated health and more fatigue than women without children, and the odds of poor self-rated health and fatigue increased by number of children. Conditions that strengthened the association between motherhood and impaired health were young maternal age, full-time employment, high income, and being alone. The study indicates a need for improved negotiations between parents regarding a fair share of work and family duties and extended support for lone mothers to prevent adverse health effects in women combining children and work. The results may be useful to policy-makers and employers in developing new policies.

Body mass index and the impact of a health promotion intervention on health services use and expenditures.

PubMed

Meng, Hongdao; Liebel, Dianne; Wamsley, Brenda R

2011-06-01

To examine the effect of body mass index (BMI) on the impact of a health promotion intervention on health services use and expenditures among Medicare beneficiaries with disabilities. We analyzed data from 452 Medicare beneficiaries who participated in a Medicare demonstration. The intervention included the following components: patient education, health promotion coaching, medication management, and physician care management. We performed the analysis by using generalized linear models (GLM) to examine the impact of BMI and the intervention on total health care expenditures. The intervention was cost neutral over the 2-year study period. Participants in the intervention group used less home health aide services (p = .03) and had fewer nursing home days (p = .05). The intervention appeared to have smaller effects on expenditures as BMI level increased. The findings suggest that a health promotion intervention may achieve better beneficiary outcomes without an increase in resource use in this Medicare population.

Locomotor problems among rural elderly population in a District of Aligarh, North India.

PubMed

Maroof, Mohd; Ahmad, Anees; Khalique, Najam; Ansari, M Athar

2017-01-01

Locomotor functions decline with the age along with other physiological changes. This results in deterioration of the quality of life with decreased social and economic role in the society, as well as increased dependency, for the health care and other basic services. The demographic transition resulting in increased proportion of elderly may pose a burden to the health system. To find the prevalence of locomotor problems among the elderly population, and related sociodemographic factors. The study was a community-based cross-sectional study done at field practice area of Rural Health Training Centre, JN Medical College, AMU, Aligarh, Uttar Pradesh, India. A sample of 225 was drawn from 1018 elderly population aged 60 years and above using systematic random sampling with probability proportionate to size. Sociodemographic characteristics were obtained using pretested and predesigned questionnaire. Locomotor problems were assessed using the criteria used by National Sample Survey Organization. Data were analyzed using SPSS version 20. Chi-square test was used to test relationship of locomotor problems with sociodemographic factors. P <0.05 was considered statistically significant. The prevalence of locomotor problems among the elderly population was 25.8%. Locomotor problems were significantly associated with age, gender, and working status whereas no significant association with literacy status and marital status was observed. The study concluded that approximately one-fourth of the elderly population suffered from locomotor problems. The sociodemographic factors related to locomotor problems needs to be addressed properly to help them lead an independent and economically productive life.

Influence knowledge and behavior of TB medical personnels’ concordance principle based communications skill at primary healthcare, Medan, Indonesia

NASA Astrophysics Data System (ADS)

Wahyuni, A. S.; Soeroso, N. N.; Alona, I.; Yunanda, Y.; Siregar, I.

2018-03-01

Concordance behavior of TB management is a form of collaboration among doctors, personnel, and patients in treating TB. Approvalamong them could be achieved if credibility and policy occur. This study is aimed to analyze the influence of TB medical personnel’s concordance behaviour principle to patient obedience at primary health care in Medan.The design of this study was quasi experimental, focusing on interventional primary health care, which is those who applied concordance behaviour principle to non-interventionalprimary health care. The population is TB patients, starting from 18 years old, TB category I with positive Acid Fast Bacilli Smear Test (AFBST), and taking TB regimens at Medan. Seventy- four patients were selected to be samples. They had undergone interview based on validated concordance principle, knowledge, behavior, and treatment. Data were analyzed using chi- square. The percentage of knowledge, behavior of TB patient to the treatment is higher on interventional primary health care than noninterventional ones. Treatment awareness based on concordance principle is expected to planish DOTS-based TB programs.

Social Work’s Role in Medicaid Reform: A Qualitative Study

PubMed Central

Wachman, Madeline; Manning, Leticia; Cohen, Alexander M.; Seifert, Robert W.; Jones, David K.; Fitzgerald, Therese; Nuzum, Rachel; Riley, Patricia

2017-01-01

Objectives. To critically analyze social work’s role in Medicaid reform. Methods. We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods. Results. Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work’s practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work’s involvement in systems-level practice include lack of visibility, insufficient clarity on social work’s role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy. Conclusions. Social workers have unique skills that are valuable to building health systems that promote population health and reduce health inequities. Although there is considerable opportunity for social work to increase its role in Medicaid reform, there is little social work involvement at the systems level. PMID:29236537

H-index of Collective Health professors in Brazil.

PubMed

Pereira, Julio Cesar Rodrigues; Bronhara, Bruna

2011-06-01

To estimate reference values and the hierarchy function of professors engaged in Collective Health in Brazil by analyzing the distribution of the h-index. From the Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Portal of Coordination for the Improvement of Higher Education Personnel ), 934 authors were identified in 2008, of whom 819 were analyzed. The h-index of each professor was obtained through the Web of Science using search algorithms controlling for namesakes and alternative spellings of their names. For each Brazilian region and for the country as a whole, we adjusted an exponential probability density function to provide the population parameters and rate of decline by region. Ranking measures were identified using the complement of the cumulative probability function and the hierarchy function among authors according to the h-index by region. Among the professors analyzed, 29.8% had no citation record in Web of Science (h=0). The mean h for the country was 3.1, and the region with greatest mean was the southern region (h=4.7). The median h for the country was 3.1, and the greatest median was for the southern region (3.2). Standardizing populations to one hundred, the first rank in the country was h=16, but stratification by region shows that, within the northeastern, southeastern and southern regions, a greater value is necessary for achieving the first rank. In the southern region, the index needed to achieve the first rank was h=24. Most of the Brazilian Collective Health authors, if assessed on the basis of the Web of Science h-index, did not exceed h=5. Regional differences exist, with the southeastern and northeastern regions being similar and the southern region being outstanding.

Dental health in antique population of Vinkovci - Cibalae in Croatia (3rd-5th century).

PubMed

Peko, Dunja; Vodanović, Marin

2016-08-01

Roman city Cibalae (Vinkovci) - the birthplace of Roman emperors Valentinian I and Valens was a very well developed urban ares in the late antique what was evidenced by numerous archaeological findings. The aim of this paper is to get insight in dental health of antique population of Cibalae. One hundred individuals with 2041 teeth dated to 3rd - 5th century AD have been analyzed for caries, antemortem tooth loss, periapical diseases and tooth wear. Prevalence of antemortem tooth loss was 4.3% in males, 5.2% in females. Prevalence of caries per tooth was 8.4% in males, 7.0% in females. Compared to other Croatian antique sites, ancient inhabitants of Roman Cibalae had rather good dental health with low caries prevalence and no gender differences. Statistically significant difference was found between males in females in the prevalence of periapical lesions and degree of tooth wear. Periapical lesions were found only in males.

Health care expenditures of overweight and obese U.S. adults with intellectual and developmental disabilities.

PubMed

Li, Henan; Fujiura, Glenn; Magaña, Sandra; Parish, Susan

2018-04-01

U.S. adults with intellectual and developmental disabilities (IDD) have poorer health status and greater risks for being overweight and obese, which are major drivers of health care expenditures in the general population. Health care expenditures and IDD have not been studied using nationally representative samples, and the impact of overweight and obesity have not been examined. Using nationally representative data, we aimed to compare the health care expenditures of not-overweight, overweight and obese U.S. adults with IDD, and calculate model-adjusted expenditures. Pooled data from the 2002-2011 Medical Expenditure Panel Survey linked to National Health Interview Survey (n = 1224) were analyzed. Two-part model regressions were conducted, with covariates being year of survey, age, sex, race/ethnicity, household income status, geographical region, urban/rural, marital status, insurance coverage, perceived health status, and perceived mental health status. Overall, obese adults with intellectual and developmental disabilities had higher expenditures than their non-obese peers. Being obese was associated with an estimated additional $2516 in mean expenditures and $1200 in median expenditures compared with the reference group, who were neither overweight nor obese. Obesity is an important predictor of higher health care costs among community-living adults with IDD Finding effective strategies and interventions to address obesity in this population has great financial and policy significance. Copyright © 2018 Elsevier Ltd. All rights reserved.

Mental disability and discriminatory practices: effects of social representations of the Mexican population.

PubMed

Mariana, Espinola-Nadurille; Guadalupe, Delgado

2009-05-01

The prevalence of mental disorders in Mexico is 26.1%. This shows that an important percentage of the population suffers from mental disability. Despite this the country's healthcare system does not provide the least acceptable standard of care for the mentally disabled. The aim of this study was to describe the general population's social representations of the disabled and analyze their relationship with the discriminatory practices from the state towards the mentally ill with respect to their right to health. This study was a secondary analysis of the First National Survey on Discrimination in Mexico. In the survey 1,437 effective interviews that comprised a representative sample, were obtained from people aged 18 to 60 living in rural and urban settings. The response rate was 76.5%. The assessment tool was a self-administered questionnaire that yielded perceptions, attitudes, values and social representations about discrimination towards groups of people that supposedly were targets of discrimination by the general population. In the survey the mentally ill were included under disability. As a secondary analysis of the survey for the purpose of this study, we selected a subset of questions that provided important information about social representations of the general Mexican population towards persons with disabilities. The general population's social representations of the disabled were analyzed. The disabled are the second group after the elderly perceived as the most discriminated and neglected and bearing more suffering. A whole set of negative representations concerning the disabled, such as lack of acceptance and respect, low self-confidence, mistreatment, incomprehension, isolation, intolerance, indifference and bad attitudes from others, were elicited. Social representations are social correspondents of the discriminatory practices that the state exerts toward the mentally ill with respect to their right to health. These representations serve to maintain, naturalize and legitimize these practices. All sectors of society should make an effort to change the negative social representations towards this vulnerable section of society.

[The relationships between population and economy, and between population and education].

PubMed

Yu, W

1981-01-01

The relationship between population and economy is regarded seriously by China and other countries. This problem can be analyzed and studied under 2 aspects: 1) the influence of economic development on changes in population, and 2) the influence of population increases on economic development. Under the 1st aspect, improved living conditions, hygiene, and health care generally result in lowered mortality rates. Improved economic conditions in China also increased the birthrate and at the same time increased birth control among the people; the increased birthrate was due to more marriages after liberation. In economically advanced countries, due to high expenses in raising children, people tend to limit family sizes to 2 children/family. Under the 2nd aspect, population increases place strains on the food supply and nutritional requirements, especially when increases are too rapid. They also demand more educational resources and influence quality of education. As there are currently 210 million students in China, the quality of education suffers, particularly at the college level, since most of Chinese manpower, physical and financial resources are spent on primary and secondary education. In terms of housing, transportation, health care, and natural resources, they are all intimately related to and influenced by increases in population. Consequently, the living standard would be difficult to raise if population increases are too rapid. Since 1971, population increases have been incorporated into 5-yearly and later yearly national economic plans in China. The large Chinese population is a major obstacle in raising the Chinese economic level, hence a well-planned population control program is essential.

Health consequences of postsocialist transition: dietary and lifestyle determinants of plasma lipids in Yakutia.

PubMed

Sorensen, M V; Snodgrass, J J; Leonard, W R; Tarskaia, A; Ivanov, K I; Krivoshapkin, V G; Spitsyn, V A

2005-01-01

The rapid social and cultural changes introduced by the collapse of the Soviet Union have resulted in important differences in cardiovascular health for indigenous Siberians. This study investigated diet and lifestyle determinants of plasma lipids in the Yakut, an indigenous Siberian herding population. The study used a cross-sectional design with data on 201 subjects in three urbanized towns and three rural communities in northeastern Siberia. Data on sociodemographic characteristics, dietary intake, and material lifestyle were collected, and lipids were analyzed from venous whole blood. Diet was analyzed using patterns of dietary intake based on principal components analysis of a dietary intake (food frequency) questionnaire. We identified three diet patterns: a traditional subsistence diet, a market foods diet, and a mixed diet. The effect of lifestyle on cardiovascular risk factors was measured using an ethnographically defined lifestyle index, with two orthogonal dimensions: subsistence lifestyle and modern lifestyle. Total cholesterol (TC) and low-density lipoprotein (LDL) were significantly higher among those consuming a traditional subsistence diet of meat and dairy products. A modern lifestyle was associated with lower TC and LDL but higher adiposity and higher risk of obesity. LDL and TC were higher in rural communities and lower in urbanized towns. The significantly higher lipid levels associated with a subsistence diet and indirectly with a subsistence lifestyle indicate the emergence of a significant health problem associated with the social and cultural changes occurring in Yakutia today. These findings underscore the need for dietary modification and promotion of physical activity among those most at risk for cardiovascular disease (CVD). Moreover, these results differ from those commonly seen in "modernizing" populations, in that elements of subsistence lifestyle are associated with an elevated rather than reduced risk of CVD. Such variable responses to lifestyle change emphasize the need to better understand the distinct social and historical events that may influence health changes among populations in transition. Copyright 2005 Wiley-Liss, Inc

Trends and outcome predictors after traumatic brain injury surgery: a nationwide population-based study in Taiwan.

PubMed

Shi, Hon-Yi; Hwang, Shiuh-Lin; Lee, I-Chen; Chen, I-Te; Lee, King-Teh; Lin, Chih-Lung

2014-12-01

The authors sought to analyze trends in hospital resource utilization and mortality rates in a population of patients who had received traumatic brain injury (TBI) surgery. This nationwide population-based cohort study retrospectively analyzed 18,286 patients who had received surgical treatment for TBI between 1998 and 2010. The multiple linear regression model and Cox proportional hazards model were used for multivariate assessment of outcome predictors. The prevalence rate of surgical treatment for patients with TBI gradually but significantly (p < 0.001) increased by 47.6% from 5.0 per 100,000 persons in 1998 to 7.4 per 100,000 persons in 2010. Age, sex, Deyo-Charlson comorbidity index score, hospital volume, and surgeon volume were significantly associated with TBI surgery outcomes (p < 0.05). Over the 12-year period analyzed, the estimated mean hospital treatment cost increased 19.06%, whereas the in-hospital mortality rate decreased 10.9%. The estimated mean time of overall survival after TBI surgery (± SD) was 83.0 ± 4.2 months, and the overall in-hospital and 1-, 3-, and 5-year survival rates were 74.5%, 67.3%, 61.1%, and 57.8%, respectively. These data reveal an increased prevalence of TBI, especially in older patients, and an increased hospital treatment cost but a decreased in-hospital mortality rate. Health care providers and patients should recognize that attributes of the patient and of the hospital may affect hospital resource utilization and the mortality rate. These results are relevant not only to other countries with similar population sizes but also to countries with larger populations.

Police on the front line of community geriatric health care: challenges and opportunities.

PubMed

Brown, Rebecca T; Ahalt, Cyrus; Steinman, Michael A; Kruger, Kelly; Williams, Brie A

2014-11-01

As the population ages, police increasingly serve as first responders to incidents involving older adults in which aging-related health plays a critical role. The goals of this study were to assess police officers' knowledge of aging-related health, to identify challenges police experience in their encounters with older adults, and to describe their recommendations for how to address those challenges. This was a mixed-methods study of 141 San Francisco police officers recruited from mandatory police trainings between 2011 and 2013. Descriptive statistics were used to analyze 141 self-administered questionnaires, and principles of grounded theory were used to analyze open-ended questionnaire responses and 11 additional qualitative interviews. Eighty-nine percent of officers reported interacting with older adults at least monthly. Although 84% of police reported prior training in working with older adults, only 32% rated themselves as knowledgeable about aging-related health. Participants described themselves as first responders to medical and social emergencies involving older adults and identified several challenges, including identifying and responding to aging-related conditions and ensuring appropriate medical and social service handoffs. To address these challenges, officers recommended developing trainings focused on recognizing and responding to aging-related conditions and improving police knowledge of community resources for older adults. They also called for enhanced communication and collaboration between police and clinicians. These findings suggest that, because they assume a front-line role in responding to older adults with complex medical and social needs, many police may benefit from additional knowledge about aging-related health and community resources. Collaboration between police and healthcare providers presents an important opportunity to develop geriatrics training and interprofessional systems of care to support police work with a rapidly aging population. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Health-Related Disaster Communication and Social Media: Mixed-Method Systematic Review.

PubMed

Eckert, Stine; Sopory, Pradeep; Day, Ashleigh; Wilkins, Lee; Padgett, Donyale; Novak, Julie; Noyes, Jane; Allen, Tomas; Alexander, Nyka; Vanderford, Marsha; Gamhewage, Gaya

2017-08-21

This mixed-method evidence synthesis drew on Cochrane methods and principles to systematically review literature published between 2003 and 2016 on the best social media practices to promote health protection and dispel misinformation during disasters. Seventy-nine studies employing quantitative, qualitative, and mixed methods on risk communication during disasters in all UN-languages were reviewed, finding that agencies need to contextualize the use of social media for particular populations and crises. Social media are tools that still have not become routine practices in many governmental agencies regarding public health in the countries studied. Social media, especially Twitter and Facebook (and equivalents in countries such as China), need to be incorporated into daily operations of governmental agencies and implementing partners to build familiarity with them before health-related crises happen. This was especially observed in U.S. agencies, local government, and first responders but also for city governments and school administrations in Europe. For those that do use social media during health-related risk communication, studies find that public relations officers, governmental agencies, and the general public have used social media successfully to spread truthful information and to verify information to dispel rumors during disasters. Few studies focused on the recovery and preparation phases and on countries in the Southern hemisphere, except for Australia. The vast majority of studies did not analyze the demographics of social media users beyond their geographic location, their status of being inside/outside the disaster zone; and their frequency and content of posting. Socioeconomic demographics were not collected and/or analyzed to drill deeper into the implications of using social media to reach vulnerable populations. Who exactly is reached via social media campaigns and who needs to be reached with other means has remained an understudied area.

Did the Family Health Strategy have an impact on indicators of hospitalizations for stroke and heart failure? Longitudinal study in Brazil: 1998-2013.

PubMed

Cavalcante, Denise de Fátima Barros; Brizon, Valéria Silva Cândido; Probst, Livia Fernandes; Meneghim, Marcelo de Castro; Pereira, Antonio Carlos; Ambrosano, Gláucia Maria Bovi

2018-01-01

The objective was to analyze whether socioeconomic factors related to the context and those related to the model of care-specifically the coverage of primary care by the Family Health Strategy (ESF)-had an impact on hospitalizations due to heart failure (HF) and stroke, in the State of São Paulo/Brazil between 1998 and 2013. A longitudinal ecological study involving 645 municipalities was conducted in the state of São Paulo/Brazil from 1998 to 2013, using the Hospital Information System (SIH-DataSUS database). The hospitalizations for primary care sensitive conditions: Stroke and heart failure (HF) that correspond to the International Classification of Diseases (ICD 10): I50, I63 to I67; I69, G45 to G46 were analyzed longitudinally during the period indicated regarding the percentage of people covered by the Family Health Program (PSF) adjusted for confounders (population size, gross domestic product -GDP and human development index- HDI). There was a significant decrease in the number of hospitalizations for heart failure and stroke per 10000 (inhabitants) in the period (p <0.0001), with a significant relationship with increased proportion of ESF (p <0.0001), and this remained significant even when possible confounders (population size, GDP and HDI) were included in the model (p <0.0001). GDP per capita was close to or higher than that if many European countries, which shows the relevance of the study. The health care model based on the Family Health Strategy positively impacted hospitalization indicators for heart failure and stroke, indicating that this model is effective in the prevention of primary care sensitive conditions.

A nonparametric method to generate synthetic populations to adjust for complex sampling design features.

PubMed

Dong, Qi; Elliott, Michael R; Raghunathan, Trivellore E

2014-06-01

Outside of the survey sampling literature, samples are often assumed to be generated by a simple random sampling process that produces independent and identically distributed (IID) samples. Many statistical methods are developed largely in this IID world. Application of these methods to data from complex sample surveys without making allowance for the survey design features can lead to erroneous inferences. Hence, much time and effort have been devoted to develop the statistical methods to analyze complex survey data and account for the sample design. This issue is particularly important when generating synthetic populations using finite population Bayesian inference, as is often done in missing data or disclosure risk settings, or when combining data from multiple surveys. By extending previous work in finite population Bayesian bootstrap literature, we propose a method to generate synthetic populations from a posterior predictive distribution in a fashion inverts the complex sampling design features and generates simple random samples from a superpopulation point of view, making adjustment on the complex data so that they can be analyzed as simple random samples. We consider a simulation study with a stratified, clustered unequal-probability of selection sample design, and use the proposed nonparametric method to generate synthetic populations for the 2006 National Health Interview Survey (NHIS), and the Medical Expenditure Panel Survey (MEPS), which are stratified, clustered unequal-probability of selection sample designs.

A nonparametric method to generate synthetic populations to adjust for complex sampling design features

PubMed Central

Dong, Qi; Elliott, Michael R.; Raghunathan, Trivellore E.

2017-01-01

Outside of the survey sampling literature, samples are often assumed to be generated by a simple random sampling process that produces independent and identically distributed (IID) samples. Many statistical methods are developed largely in this IID world. Application of these methods to data from complex sample surveys without making allowance for the survey design features can lead to erroneous inferences. Hence, much time and effort have been devoted to develop the statistical methods to analyze complex survey data and account for the sample design. This issue is particularly important when generating synthetic populations using finite population Bayesian inference, as is often done in missing data or disclosure risk settings, or when combining data from multiple surveys. By extending previous work in finite population Bayesian bootstrap literature, we propose a method to generate synthetic populations from a posterior predictive distribution in a fashion inverts the complex sampling design features and generates simple random samples from a superpopulation point of view, making adjustment on the complex data so that they can be analyzed as simple random samples. We consider a simulation study with a stratified, clustered unequal-probability of selection sample design, and use the proposed nonparametric method to generate synthetic populations for the 2006 National Health Interview Survey (NHIS), and the Medical Expenditure Panel Survey (MEPS), which are stratified, clustered unequal-probability of selection sample designs. PMID:29200608

[Scientific bases of the organization of psychiatric care: the solution of practical problems in the framework of priority research].

PubMed

Yastrebov, V S; Mitikhin, V G; Solokhina, T A; Mitikhina, I A

ОBJECTIVE: a system analysis and modeling for important areas of research of the organization of psychiatric services in Russia in the study mental health of the population, identification of factors affecting the formation of the contingent of persons with mental disorders, organizational and functional structure of mental health services and mental health care. The authors analyzed scientific publications on the problems of psychiatric care organization as well as the results of own research over the last 25 years using system analysis. The approach that allows a creation of a range of population models to monitor the status of mental health based on medical, demographic and social factors (more than 60 factors) of life was suggested. The basic models and approaches for the evaluation of activity of divisions of mental health services at the macro and micro-social levels, taking into account expert information and individual characteristics of patients and relatives, were demonstrated. To improve treatment quality, the models of identification of the factors, which positively or negatively influenced the commitment to psychopharmacotherapy of patients with schizophrenia and their families, were developed.

Organochlorines in urban soils from Central India: probabilistic health hazard and risk implications to human population.

PubMed

Kumar, Bhupander; Mishra, Meenu; Verma, V K; Rai, Premanjali; Kumar, Sanjay

2018-04-21

This study presents distribution of organochlorines (OCs) including HCH, DDT and PCBs in urban soils, and their environmental and human health risk. Forty-eight soil samples were extracted using ultrasonication, cleaned with modified silica gel chromatography and analyzed by GC-ECD. The observed concentrations of ∑HCH, ∑DDT and ∑PCBs in soils ranged between < 0.01-2.54, 1.30-27.41 and < 0.01-62.8 µg kg -1 , respectively, which were lower than the recommended soil quality guidelines. Human health risk was estimated following recommended guidelines. Lifetime average daily dose (LADD), non-cancer risk or hazard quotient (HQ) and incremental lifetime cancer risk (ILCR) for humans due to individual and total OCs were estimated and presented. Estimated LADD were lower than acceptable daily intake and reference dose. Human health risk estimates were lower than safe limit of non-cancer risk (HQ < 1.0) and the acceptable distribution range of ILCR (10 -6 -10 -4 ). Therefore, this study concluded that present levels of OCs (HCH, DDT and PCBs) in studied soils were low, and subsequently posed low health risk to human population in the study area.

[Morbidity profile and hospital expenses with elderly patients in Paraná State, Brazil, 2008-2012].

PubMed

Kernkamp, Clarice da Luz; Costa, Cassia Kely Favoretto; Massuda, Ely Mitie; Silva, Eraldo Schunk; Yamaguchi, Mirian Ueda; Bernuci, Marcelo Picinin

2016-07-21

Growth in the elderly population has increased both the demand for health services and healthcare expenses, with relevant consequences for economic stability. The current study aimed to analyze the morbidity profile and hospital expenses with elderly patients in relation to socioeconomic and demographic conditions in Paraná State, Brazil, from 2008 to 2012, applying principal components analysis and groupings. Regions with higher and lower economic and human development showed high prevalence of hospitalizations and costs pertaining to the circulatory and respiratory systems and cardiac diseases for males and females. In regions with intermediary development, diseases of the nervous system in men and of the circulatory system in women had the highest morbidity and hospital expenses. Thus, measures for prevention and health promotion in this elderly population should be targeted to regional investigations.

[The Spanish Red Cross, the repatriation of soldiers during the colonial wars and the development of medical science in Spain, 1896-1950].

PubMed

Gallo, María Isabel Porras; Heras-Salord, Jaime de Las

2016-01-01

This article examines the role played by the Spanish Red Cross (founded in 1864) in the introduction and spread of humanitarian technologies and the development of medical science in Spain, using the case study of medical care for sick and wounded soldiers repatriated during the wars in Cuba, the Philippines and Morocco, and analyzing the impact these measures had on health care and public health among the civilian population. The article shows how this organization set up health care for Spanish soldiers, establishing a network of specialized medical centers that were later also used to provide medical care for civilians and to address new public health problems.

[Changes necessary for continuing health reform: I. The "external" change].

PubMed

Martín Martín, J; de Manuel Keenoy, E; Carmona López, G; Martínez Olmos, J

1990-01-01

The article analyzes the need to obtain support from all actors if the reform of the health system is to be finalized. The relevant groups are the government, professional groups, workers, the population, civil servants, managers and firms with interests in the health field. It is necessary to develop a social marketing strategy that reinforces and broadens the current supports to change. Basic elements would be: Develop new service to satisfy users' needs; orient the services to defined "market" segments; position new services or "re-position" the existing ones in order to communicate their advantages; develop a plan of marketing based on promotion, prize and place focused on the role of health professionals as the main service sellers.

Stakeholders' perceptions of transferability criteria for health promotion interventions: a case study.

PubMed

Trompette, Justine; Kivits, Joëlle; Minary, Laetitia; Cambon, Linda; Alla, François

2014-11-04

The effects of health promotion interventions are the result not only of the interventions themselves, but also of the contexts in which they unfold. The objective of this study was to analyze, through stakeholders' discourse, the characteristics of an intervention that can influence its outcomes. This case study was based on semi-structured interviews with health promotion stakeholders involved in a regional program (PRALIMAP). General hypotheses on transferability and on how the intervention is presumed to produce its effects were used to construct an interview guide. Interviews were analyzed using thematic coding. Twenty-three stakeholders were interviewed. Results showed stakeholders made few references to population and environment characteristics. Three themes emerged as significant for the stakeholders: implementation modalities and methodology, modalities used to mobilize actors; and transferability-promoting factors and barriers. Our work contributes to a better understanding not only of transferability factors, but also of stakeholders' perceptions of them, which are just as important, because those perceptions themselves are a factor in mobilization of actors, implementation, and transferability.

Analyzing the politico-moral foundations of the Iran’s health system based on theories of justice

PubMed Central

Akrami, Forouzan; Abbasi, Mahmoud; Karimi, Abbas; Shahrivari, Akbar; Majdzadeh, Reza; Zali, Alireza

2017-01-01

Public health ethics is a field that covers both factual and ethical issues in health policy and science, and has positive obligations to improve the well-being of populations and reduce social inequalities. It is obvious that various philosophies and moral theories can differently shape the framework of public health ethics. For this reason, the present study reviewed theories of justice in order to analyze and criticize Iran’s general health policies document, served in 14 Articles in 2014. Furthermore, it explored egalitarianism as the dominant theory in the political philosophy of the country’s health care system. According to recent theories of justice, however, health policies must address well-being and its basic dimensions such as health, reasoning, autonomy, and the role of the involved agencies and social institutions in order to achieve social justice beyond distributive justice. Moreover, policy-making in the field of health and biomedical sciences based on Islamic culture necessitates a theory of social justice in the light of theological ethics. Educating people about their rights and duties, increasing their knowledge on individual agency, autonomy, and the role of the government, and empowering them will help achieve social justice. It is recommended to design and implement a strategic plan following each of these policies, based on the above-mentioned values and in collaboration with other sectors, to clarify the procedures in every case. PMID:29291037

Analyzing the politico-moral foundations of the Iran's health system based on theories of justice.

PubMed

Akrami, Forouzan; Abbasi, Mahmoud; Karimi, Abbas; Shahrivari, Akbar; Majdzadeh, Reza; Zali, Alireza

2017-01-01

Public health ethics is a field that covers both factual and ethical issues in health policy and science, and has positive obligations to improve the well-being of populations and reduce social inequalities. It is obvious that various philosophies and moral theories can differently shape the framework of public health ethics. For this reason, the present study reviewed theories of justice in order to analyze and criticize Iran's general health policies document, served in 14 Articles in 2014. Furthermore, it explored egalitarianism as the dominant theory in the political philosophy of the country's health care system. According to recent theories of justice, however, health policies must address well-being and its basic dimensions such as health, reasoning, autonomy, and the role of the involved agencies and social institutions in order to achieve social justice beyond distributive justice. Moreover, policy-making in the field of health and biomedical sciences based on Islamic culture necessitates a theory of social justice in the light of theological ethics. Educating people about their rights and duties, increasing their knowledge on individual agency, autonomy, and the role of the government, and empowering them will help achieve social justice. It is recommended to design and implement a strategic plan following each of these policies, based on the above-mentioned values and in collaboration with other sectors, to clarify the procedures in every case.

Burden and correlates of mental health diagnoses among sex workers in an urban setting.

PubMed

Puri, Nitasha; Shannon, Kate; Nguyen, Paul; Goldenberg, Shira M

2017-12-19

Women involved in both street-level and off-street sex work face disproportionate health and social inequities compared to the general population. While much research has focused on HIV and sexually transmitted infections (STIs) among sex workers, there remains a gap in evidence regarding the broader health issues faced by this population, including mental health. Given limited evidence describing the mental health of women in sex work, our objective was to evaluate the burden and correlates of mental health diagnoses among this population in Vancouver, Canada. An Evaluation of Sex Workers Health Access (AESHA) is a prospective, community-based cohort of on- and off-street women in sex work in Vancouver, Canada. Participants complete interviewer-administered questionnaires semi-annually. We analyzed the lifetime burden and correlates of self-reported mental health diagnoses using bivariate and multivariable logistic regression. Among 692 sex workers enrolled between January 2010 and February 2013, 338 (48.8%) reported ever being diagnosed with a mental health issue, with the most common diagnoses being depression (35.1%) and anxiety (19.9%). In multivariable analysis, women with mental health diagnoses were more likely to identify as a sexual/gender minority (LGBTQ) [AOR=2.56, 95% CI: 1.72-3.81], to use non-injection drugs [AOR=1.85, 95% CI: 1.12-3.08], to have experienced childhood physical/sexual trauma [AOR=2.90, 95% CI: 1.89-4.45], and work in informal indoor [AOR=1.94, 95% CI: 1.12 - 3.40] or street/public spaces [AOR=1.76, 95% CI: 1.03-2.99]. This analysis highlights the disproportionate mental health burden experienced by women in sex work, particularly among those identifying as a sexual/gender minority, those who use drugs, and those who work in informal indoor venues and street/public spaces. Evidence-informed interventions tailored to sex workers that address intersections between trauma and mental health should be further explored, alongside policies to foster access to safer workspaces and health services.

Public Health's Approach to Systemic Racism: a Systematic Literature Review.

PubMed

Castle, Billie; Wendel, Monica; Kerr, Jelani; Brooms, Derrick; Rollins, Aaron

2018-05-04

Recently, public health has acknowledged racism as a social determinant of health. Much evidence exists on the impact of individual-level racism and discrimination, with little to no examination of racism from the standpoint of systems and structures. The purpose of this systematic literature review is to analyze the extent to which public health currently addresses systemic racism in the published literature. Utilizing the PRISMA guidelines, this review examines three widely used databases to examine published literature covering the topic as well as implications for future research and practice. A total of 85 articles were included in the review analysis after meeting study criteria. Across numerous articles, the terms racism and systemic racism are largely absent. A critical need exists for an examination of the historical impact of systemic racism on the social determinants of health and health of marginalized populations.

Social participation within a context of political violence: implications for the promotion and exercise of the right to health in Guatemala.

PubMed

Flores, Walter; Ruano, Ana Lorena; Funchal, Denise Phe

2009-01-01

Social participation has been understood in many different ways, and there are even typologies classifying participation by the degree of a population's control in decision making. Participation can vary from a symbolic act, which does not involve decision making, to processes in which it constitutes the principal tool for redistributing power within a population. This article argues that analyzing social participation from a perspective of power relations requires knowledge of the historical, social, and economic processes that have characterized the social relations in a specific context. Applying such an analysis to Guatemala reveals asymmetrical power relations characterized by a long history of repression and political violence. The armed conflict during the second half of the 20th century had devastating consequences for a large portion of the population as well as the country's social leadership. The ongoing violence resulted in negative psychosocial effects among the population, including mistrust toward institutions and low levels of social and political participation. Although Guatemala made progress in creating spaces for social participation in public policy after signing the Peace Accords in 1996, the country still faces after-effects of the conflict. One important task for the organizations that work in the field of health and the right to health is to help regenerate the social fabric and to rebuild trust between the state and its citizens. Such regeneration involves helping the population gain the skills, knowledge, and information needed in order to participate in and affect formal political processes that are decided and promoted by various public entities, such as the legislative and executive branches, municipal governments, and political parties. This process also applies to other groups that build citizenship through participation, such as neighborhood organizations and school and health committees.

Fall risk and prevention needs assessment in an older adult Latino population: a model community global health partnership.

PubMed

Hanlin, Erin R; Delgado-Rendón, Angélica; Lerner, E Brooke; Hargarten, Stephen; Farías, René

2013-01-01

The impact of falls in older adults presents a significant public health burden. Fall risk is not well-described in Latino populations nor have fall prevention programs considered the needs of this population. The objectives of this study were to develop a needs assessment of falls in older adult Latinos at a community center (CC), determine fall prevention barriers and strengths in this population, determine the level of interest in various fall prevention methods, and provide medical students an opportunity for participation in a culturally diverse community project. A cross-sectional survey was conducted with a convenience sample of older adult program participants. The survey was developed in collaboration with both partners. CC participants were approached by the interviewer and asked to participate. They were read the survey in their preferred language and their answers were recorded. Data were analyzed using descriptive statistics. We conducted 103 interviews. We found that 54% of participants had fallen in the last year, and of those 21% required medical care, 81% were afraid of falling again, and 66% considered themselves at risk for falling again. Of all respondents, 52% had 5 or more of the 10 surveyed risk factors for falling; 4% had no risk factors. Of all respondents, 75% were afraid of falling. Talking with health care providers and participating in an exercise class were the preferred methods of health information delivery (78% and 65%, respectively). Older adult Latinos in this selected population frequently fall and are worried about falling. Risk factors are prevalent. A fall prevention program is warranted and should include exercise classes and a connection with local primary care providers. A partnership between an academic organization and a CC is an ideal collaboration for the future development of prevention program.

Urolithiasis risk: a comparison between healthcare providers and the general population.

PubMed

Chen, Ming-Hung; Weng, Shih-Feng; Hsu, Chien-Chin; Lin, Hung-Jung; Su, Shih-Bin; Wang, Jhi-Joung; Guo, How-Ran; Huang, Chien-Cheng

2016-07-18

Healthcare providers have many health-related risk factors that might contribute to urolithiasis: a heavy workload, a stressful workplace, and an unhealthy quality of life. However, the urolithiasis risk in healthcare providers is not clear. Using Taiwan's National Health Insurance Research Database, we identified 50,226 physicians, 20,677 pharmacists, 122,357 nurses, and 25,059 other healthcare providers as the study cohort and then randomly selected an identical number of patients who are not healthcare providers (general population) as the comparison cohort for this study. Conditional logistical regression analysis was used to compare the urolithiasis risk between healthcare providers and comparisons. Physician specialty subgroups were also analyzed. Physicians had a lower urolithiasis risk than did the general population (adjusted odds ratio [AOR]: 0.682; 95 % confidence interval [CI]: 0.634-0.732) and other healthcare providers (AOR: 0.661; 95 % CI 0.588-0.742) after adjusting for hypertension, diabetes, hyperlipidemia, coronary artery disease, and residence location. For pharmacists, nurses, and other healthcare providers, the urolithiasis risk was not significantly different than that for general population. Subgroup analysis showed that surgeons and family medicine physicians had a lower urolithiasis risk than did physician comparisons (AOR: 0.778; 95 % CI: 0.630-0.962 and AOR: 0.737; 95 % CI: 0.564-0.962, respectively). Although job stress and heavy workloads affect physicians' health, physicians had a lower urolithiasis risk than did the general population and other healthcare providers. This might be attributable to their greater medical knowledge and access to healthcare. Our findings provide useful information for public health policy makers about the disease risks of healthcare providers.

[Variables associated with the use of dental services among preschool population in Spain: a national health survey analysis].

PubMed

Barriuso Lapresa, Laura; Sanz-Barbero, Belén

2012-01-01

oral health is integral to health from the eruption of the first tooth. To achieving, it is necessary an early establishment of healthy oral habits as regular dental checkups. In developed countries, caries is the most prevalent chronic pediatric disease and it may be increasing in preschool age. a) assessing prevalence of oral health services use among Spanish preschool population, b) quantifying and analyzing the existence of variability among autonomous community and c) identifying variables associated with such use. cross-sectional study about Spanish National health Survey (2006). 2,172 children aged between 2 and 5 years (both inclusive). have gone to dental services at least once during life. sociodemographic, self-referred dental health, habits and family socioeconomic status variables. Multivariate logistic regression analysis. 20.8% of Spanish preschoolers reported had attended dental services. Probability of use increased with age (OR: 1,88; IC:1,53-2,31), frequency of daily tooth brushing (three or more times per day vrs less than once: OR: 2,94; IC: 1,47-5,87) and presence of caries (OR: 2,60; IC: 1,22-5,51). There is a socioeconomic gradient about probability of use: it increased with family socioeconomic status measured by social class (low vrs high: OR: 0,41; IC: 0,19-0,86) and maternal educational level (OR: 1,62; IC: 1,13-2,32). There was not variability in the oral health services use attributable to the autonomous community. the use of dental health services among Spanish preschool population is lower than desirable. The promotion of its use should be intensified in children from disadvantaged families.

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre.

PubMed

Stergiopoulos, Vicky; Saab, Dima; Francombe Pridham, Kate; Aery, Anjana; Nakhost, Arash

2018-01-24

Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.

Do as I do: exercise habits of physical therapists, physical therapist assistants, and student physical therapists.

PubMed

Chevan, Julia; Haskvitz, Esther M

2010-05-01

Physical therapy practitioners are among the many health care professionals who can counsel their patients to address the public health care concern of physical inactivity. Health care providers who are physically active themselves are more likely to counsel patients on the benefits of activity. The purposes of this study were: (1) to examine the leisure-time physical activity habits of physical therapists, physical therapist assistants, and student physical therapists in the United States using Centers for Disease Control and Prevention and American College of Sports Medicine (CDC-ACSM) recommendations and (2) to compare these habits with those of the general population and other health care professionals. A cross-sectional survey design was used. There were 2 data sources. A random sample of American Physical Therapy Association members completed an online survey that included questions about physical activity habits worded in same manner as the leisure-time activities section of the 2005 National Health Interview Survey (NHIS). The final study sample comprised 1,238 participants: 923 physical therapists, 210 student physical therapists, and 105 physical therapist assistants. The 2005 NHIS public use data files were the source for the same information about the general US population and for a subset of health care professionals. Rates of participation in vigorous and moderate physical activity were analyzed. Physical therapists, physical therapist assistants, and student physical therapists exercised at higher rates than adults and health-diagnosing professionals in the 2005 NHIS. Limitations The study may be limited by sampling and response bias. This study identified that physical therapists, physical therapist assistants, and student physical therapists are meeting CDC-ACSM physical activity guidelines at higher rates than the US adult population and health-diagnosing professionals. These rates exceed the physical activity targets set for adults in Healthy People 2010.

Looking Beyond Income and Education: Socioeconomic Status Gradients Among Future High-Cost Users of Health Care.

PubMed

Fitzpatrick, Tiffany; Rosella, Laura C; Calzavara, Andrew; Petch, Jeremy; Pinto, Andrew D; Manson, Heather; Goel, Vivek; Wodchis, Walter P

2015-08-01

Healthcare spending occurs disproportionately among a very small portion of the population. Research on these high-cost users (HCUs) of health care has been overwhelmingly cross-sectional in nature and limited to the few sociodemographic and clinical characteristics available in health administrative databases. This study is the first to bridge this knowledge gap by applying a population health lens to HCUs. We investigate associations between a broad range of SES characteristics and future HCUs. A cohort of adults from two cycles of large, nationally representative health surveys conducted in 2003 and 2005 was linked to population-based health administrative databases from a universal healthcare plan for Ontario, Canada. Comprehensive person-centered estimates of annual healthcare spending were calculated for the subsequent 5 years following interview. Baseline HCUs (top 5%) were excluded and healthcare spending for non-HCUs was analyzed. Adjusted for predisposition and need factors, the odds of future HCU status (over 5 years) were estimated according to various individual, household, and neighborhood SES factors. Analyses were conducted in 2014. Low income (personal and household); less than post-secondary education; and living in high-dependency neighborhoods greatly increased the odds of future HCUs. After adjustment, future HCU status was most strongly associated with food insecurity, personal income, and non-homeownership. Living in highly deprived or low ethnic concentration neighborhoods also increased the odds of becoming an HCU. Findings suggest that addressing social determinants of health, such as food and housing security, may be important components of interventions aiming to improve health outcomes and reduce costs. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Air pollution characteristics and health risks in Henan Province, China.

PubMed

Shen, Fuzhen; Ge, Xinlei; Hu, Jianlin; Nie, Dongyang; Tian, Li; Chen, Mindong

2017-07-01

Events of severe air pollution occurred frequently in China recently, thus understanding of the air pollution characteristics and its health risks is very important. In this work, we analyzed a two-year dataset (March 2014 - February 2016) including daily concentrations of six criteria pollutants (PM 2.5 , PM 10 , CO, SO 2 , NO 2 , and O 3 ) from 18 cities in Henan province. Results reveal the serious air pollution status in Henan province, especially the northern part, and Zhengzhou is the city with the worst air quality. Annual average PM 2.5 concentrations exceed the second grade of Chinese Ambient Air Quality Standard (75μg/m 3 ) at both 2014 and 2015. PM 2.5 is typically the major pollutant, but ozone pollution can be significant during summer. Furthermore, as the commonly used air quality index (AQI) neglects the mutual health effects from multiple pollutants, we introduced the aggregate air quality index (AAQI) and health-risk based air quality index (HAQI) to evaluate the health risks. Results show that based on HAQI, the current AQI system likely significantly underestimate the health risks of air pollution, highlighting that the general public may need stricter health protection measures. The population-weighted two-year average HAQI data further demonstrates that all population in the studied cities in Henan province live with polluted air - 72% of the population is exposed to air that is unhealthy for sensitive people, while 28% of people is exposed to air that can be harmful to healthy people; and the health risks are much greater during winter than during other seasons. Future works should further improve the HAQI algorithm, and validate the links between the clinical/epidemiologic data and the HAQI values. Copyright © 2017 Elsevier Inc. All rights reserved.

Septic tank additive impacts on microbial populations.

PubMed

Pradhan, S; Hoover, M T; Clark, G H; Gumpertz, M; Wollum, A G; Cobb, C; Strock, J

2008-01-01

Environmental health specialists, other onsite wastewater professionals, scientists, and homeowners have questioned the effectiveness of septic tank additives. This paper describes an independent, third-party, field scale, research study of the effects of three liquid bacterial septic tank additives and a control (no additive) on septic tank microbial populations. Microbial populations were measured quarterly in a field study for 12 months in 48 full-size, functioning septic tanks. Bacterial populations in the 48 septic tanks were statistically analyzed with a mixed linear model. Additive effects were assessed for three septic tank maintenance levels (low, intermediate, and high). Dunnett's t-test for tank bacteria (alpha = .05) indicated that none of the treatments were significantly different, overall, from the control at the statistical level tested. In addition, the additives had no significant effects on septic tank bacterial populations at any of the septic tank maintenance levels. Additional controlled, field-based research iswarranted, however, to address additional additives and experimental conditions.

Lactase persistence and dairy intake in Mapuche and Mestizo populations from southern Chile.

PubMed

Fernández, Catalina I; Flores, Sergio V

2014-11-01

Lactase persistence (LP) occurs at a very low frequency in indigenous populations from Latin America, offering an opportunity to understand the relationship between this genetic trait and patterns of dairy consumption. Here, the frequency of LP is analyzed from Mapuche and -an adjacent- mestizo population inhabiting the Araucanía region. In addition to genotyping for LP, participants were surveyed in relation to general perception and consumption habits of dairy products. Low LP frequency (10%) and very low dairy intake was found among the Mapuche population as compared with Mestizo populations inhabiting Chile. The survey reported that the main reasons for avoidance of dairy were the gastrointestinal symptoms after dairy intake and cultural dietary habits. The interaction between low LP genotype frequency, low dairy intake, and sociocultural determinants is here discussed in the light of their potential health outcomes. © 2014 Wiley Periodicals, Inc.

The health of irregular and illegal immigrants: analysis of day-hospital admissions in a department of migration medicine.

PubMed

Affronti, Mario; Affronti, Andrea; Pagano, Salvatore; Soresi, Maurizio; Giannitrapani, Lydia; Valenti, Miriam; La Spada, Emanuele; Montalto, Giuseppe

2013-10-01

It is difficult to trace full details of the path which irregular or illegal immigrants follow when seeking assistance in the network of the various hospital departments and health structures. The aim of this work was to analyze the health needs of immigrant people by reviewing the types of treatment given to them in the day-hospital of our Department of Migration Medicine. Our study analyzed day-hospital admissions between 2003 and 2009. The patient charts used for managing day-hospital activity were adopted in 2002 in conformity with the "OSI project". From these it is possible to draw up a scale picture of the distribution of each pathology in the immigrant population. The sample population consisted of 1,758 subjects, representing 7.4% of potential users. More than half came from Africa, followed by Asia, and then Europe. Gastroenterological diseases ranked first, with dyspeptic syndromes most frequently diagnosed. Infections and parasitic diseases ranked second, and the most frequent diagnoses were sexually transmitted diseases. Third were diseases of the genitourinary system. Metabolic disorders ranked fourth, among them, more than half of the cases were of diabetes mellitus, in patients from south-east Asia. Diseases of the circulatory system were sixth, with hypertension the most frequent pathology. Our data confirm a marked persistence of the phenomenon known as the "healthy immigrant effect" in these types of patients, as well as the prominent role played by "social determinants" in conditioning the health of immigrants, particularly in the case of some infectious diseases.

Alcohol use and selected health conditions of 1991 Gulf War veterans: survey results, 2003-2005.

PubMed

Coughlin, Steven S; Kang, Han K; Mahan, Clare M

2011-05-01

A sizable literature has analyzed the frequency of alcohol consumption and patterns of drinking among veterans. However, few studies have examined patterns of alcohol use in veterans of the first Gulf War or factors associated with problem drinking in this population. We examined the frequency and patterns of alcohol use in male and female veterans who served in the 1991 Gulf War or during the same era and the relationships between alcohol use and selected health conditions. We analyzed data from a follow-up survey of health information among population-based samples of 15,000 Gulf War and 15,000 Gulf Era veterans. Data had been collected from 9,970 respondents during 2003 through 2005 via a structured questionnaire or telephone survey. Posttraumatic stress disorder (PTSD), major depressive disorder (MDD), unexplained multisymptom illness (MSI), and chronic fatigue syndrome (CFS)-like illness were more frequent among veterans with problem drinking than those without problem drinking. Approximately 28% of Gulf War veterans with problem drinking had PTSD compared with 13% of Gulf War veterans without problem drinking. In multivariate analysis, problem drinking was positively associated with PTSD, MDD, unexplained MSI, and CFS-like illness after adjustment for age, sex, race/ethnicity, branch of service, rank, and Gulf status. Veterans who were problem drinkers were 2.7 times as likely to have PTSD as veterans who were not problem drinkers. These findings indicate that access to evidence-based treatment programs and systems of care should be provided for veterans who abuse alcohol and who have PTSD and other war-related health conditions and illnesses.

Access to medication in the Public Health System and equity: populational health surveys in São Paulo, Brazil.

PubMed

Monteiro, Camila Nascimento; Gianini, Reinaldo José; Barros, Marilisa Berti de Azevedo; Cesar, Chester Luiz Galvão; Goldbaum, Moisés

2016-03-01

Since 2003, the access to medication has been increasing in Brazil and particularly in São Paulo. The present study aimed to analyze the access to medication obtained in the public sector and the socioeconomic differences in this access in 2003 and 2008. Also, we explored the difference in access to medication from 2003 to 2008. Data were obtained from two cross-sectional population-based household surveys from São Paulo, Brazil (ISA-Capital 2003 and ISA-Capital 2008). Concentration curve and concentration index were calculated to analyze the associations between socioeconomic factors and access to medication in the public sector. Additionally, the differences between 2003 and 2008 regarding socioeconomic characteristics and access to medication were studied. Access to medication was 89.55% in 2003 and 92.99% in 2008, and the proportion of access to medication did not change in the period. Access in the public sector increased from 26.40% in 2003 to 48.55% in 2008 and there was a decrease in the concentration index between 2003 and 2008 in access to medication in the public sector. The findings indicate an expansion of Brazilian Unified Health System (Sistema Único de Saúde ) users, with the inclusion of people of higher socioeconomic position in the public sector. As the SUS gives more support to people of lower socioeconomic position in terms of medication provision, the SUS tends to equity. Nevertheless, universal coverage for medication and equity in access to medication in the public sector are still challenges for the Brazilian public health system.

The relationship between media literacy and health literacy among pregnant women in health centers of Isfahan

PubMed Central

Akbarinejad, Farideh; Soleymani, Mohammad Reza; Shahrzadi, Leila

2017-01-01

Background: The ability to access, analyze, evaluate, and convey information in various forms of media including print and nonprint requires media literacy, but the capacity to obtain, process, and understand basic information and services needed for appropriate decisions regarding health, considered an important element in a woman's ability to participate in health promotion and prevention activities for herself and her children, is needed to a level of health literacy. The purpose of this study was to determine the relationship between media literacy and health literacy among pregnant women in health centers in Isfahan. Materials and Methods: This study used a descriptive correlation study. Data collection tools include Shahin media literacy and functional health literacy in adults’ questionnaires. The population include pregnant women in health centers of Isfahan (4080 people). Ten out of the 351 health centers in Isfahan were selected as cluster. Data were analyzed using both descriptive and inferential statistics. Results: Media literacy of respondents in the five dimensions was significantly lower than average 61.5% of pregnant women have inadequate health literacy, 18.8% had marginal health literacy, and only 19.7% of them have had adequate health literacy. There was a significant positive relationship between media literacy and health literacy among pregnant women. Conclusion: This study showed that the majority of pregnant women covered by health centers had limited health literacy and media literacy. Since one of the basic requirements for the utilization of health information is needed for adequate media literacy, promotion of media literacy is necessary for the respondents. PMID:28546982

The relationship between media literacy and health literacy among pregnant women in health centers of Isfahan.

PubMed

Akbarinejad, Farideh; Soleymani, Mohammad Reza; Shahrzadi, Leila

2017-01-01

The ability to access, analyze, evaluate, and convey information in various forms of media including print and nonprint requires media literacy, but the capacity to obtain, process, and understand basic information and services needed for appropriate decisions regarding health, considered an important element in a woman's ability to participate in health promotion and prevention activities for herself and her children, is needed to a level of health literacy. The purpose of this study was to determine the relationship between media literacy and health literacy among pregnant women in health centers in Isfahan. This study used a descriptive correlation study. Data collection tools include Shahin media literacy and functional health literacy in adults' questionnaires. The population include pregnant women in health centers of Isfahan (4080 people). Ten out of the 351 health centers in Isfahan were selected as cluster. Data were analyzed using both descriptive and inferential statistics. Media literacy of respondents in the five dimensions was significantly lower than average 61.5% of pregnant women have inadequate health literacy, 18.8% had marginal health literacy, and only 19.7% of them have had adequate health literacy. There was a significant positive relationship between media literacy and health literacy among pregnant women. This study showed that the majority of pregnant women covered by health centers had limited health literacy and media literacy. Since one of the basic requirements for the utilization of health information is needed for adequate media literacy, promotion of media literacy is necessary for the respondents.

[Health and access to health care of 18-25 years old people not in employment, education or training (NEETs) attending the French 'missions locales'].

PubMed

Robert, S; Lesieur, S; Chastang, J; Kergoat, V; Dutertre, J; Chauvin, P

2017-08-01

In France, "missions locales" are public assistance units for young people aged 16-25 years not in employment, education or training (NEET). The health status of the more than 1.5 million young adults attending these units annually is unknown. The purpose of this study was to describe the health status and health care use of this population in comparison with the general population of the same age. The Presaje survey was conducted in 2011 on a randomized sample of 1453 young adults aged 18-25 years who attended five "missions locales" in mainland France. Data were analyzed and compared with those of participants of the same age interviewed in a French national health survey (Baromètre Santé 2010, n=2899) and in a regional cohort (SIRS, n=204) conducted in the Greater Paris area, both in 2010. The overall social profiles of this NEET population was diverse, but with globally more difficult living conditions than in the general population. Health-related vulnerability factors identified were: insufficient health insurance; low educational level; numerous adverse experiences during childhood and social isolation. Some of their health indicators were remarkably poor in comparison with participants in the Baromètre santé study: 19.2 % (CI95 %=[17.2-21.3]) had a chronic disease-versus 8.2 % (CI95 %=[7.0-9.4]) (P<0.001); 31.9 % (CI95 %=[26.8-37.4]) were overweight or obese-versus 17.9 % (CI95 %=[16.3-19.6]) (P<0.001) and 19.6 % (CI95 %=[15.2-23.9]) were depressed-versus 7.3 %(CI95 %=[3.8-10.9]) (P<0.001). Compared with participants of the SIRS survey, fewer (70.4 %) (CI95 %=[68.0-72.7]) had a family doctor-versus 79.7 % (CI95 %=[73.1-86.2]) (P<0.05). Among the women in the Presaje survey, 38.0 % [30.5-45.4] had a regular gynecological follow-up-versus 80.9 % (CI95 %=[71.5-90.4]) in the SIRS survey (P<0.001). Careful attention must be given to the young NEET population. Many of these youths are not familiar with health care services despite their important health care needs. Integrating health services into the "missions locales" may help detect health problems in this population, facilitating links to care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

"Don't know" responses to risk perception measures: implications for underserved populations.

PubMed

Waters, Erika A; Hay, Jennifer L; Orom, Heather; Kiviniemi, Marc T; Drake, Bettina F

2013-02-01

Risk perceptions are legitimate targets for behavioral interventions because they can motivate medical decisions and health behaviors. However, some survey respondents may not know (or may not indicate) their risk perceptions. The scope of "don't know" (DK) responding is unknown. Examine the prevalence and correlates of responding DK to items assessing perceived risk of colorectal cancer. Two nationally representative, population-based, cross-sectional surveys (2005 National Health Interview Survey [NHIS]; 2005 Health Information National Trends Survey [HINTS]), and one primary care clinic-based survey comprised of individuals from low-income communities. Analyses included 31,202 (NHIS), 1,937 (HINTS), and 769 (clinic) individuals. Five items assessed perceived risk of colorectal cancer. Four of the items differed in format and/or response scale: comparative risk (NHIS, HINTS); absolute risk (HINTS, clinic), and "likelihood" and "chance" response scales (clinic). Only the clinic-based survey included an explicit DK response option. "Don't know" responding was 6.9% (NHIS), 7.5% (HINTS-comparative), and 8.7% (HINTS-absolute). "Don't know" responding was 49.1% and 69.3% for the "chance" and "likely" response options (clinic). Correlates of DK responding were characteristics generally associated with disparities (e.g., low education), but the pattern of results varied among samples, question formats, and response scales. The surveys were developed independently and employed different methodologies and items. Consequently, the results were not directly comparable. There may be multiple explanations for differences in the magnitude and characteristics of DK responding. "Don't know" responding is more prevalent in populations affected by health disparities. Either not assessing or not analyzing DK responses could further disenfranchise these populations and negatively affect the validity of research and the efficacy of interventions seeking to eliminate health disparities.

Human health risk assessment with spatial analysis: study of a population chronically exposed to arsenic through drinking water from Argentina.

PubMed

Navoni, J A; De Pietri, D; Olmos, V; Gimenez, C; Bovi Mitre, G; de Titto, E; Villaamil Lepori, E C

2014-11-15

Arsenic (As) is a ubiquitous element widely distributed in the environment. This metalloid has proven carcinogenic action in man. The aim of this work was to assess the health risk related to As exposure through drinking water in an Argentinean population, applying spatial analytical techniques in addition to conventional approaches. The study involved 650 inhabitants from Chaco and Santiago del Estero provinces. Arsenic in drinking water (Asw) and urine (UAs) was measured by hydride generation atomic absorption spectrophotometry. Average daily dose (ADD), hazard quotient (HQ), and carcinogenic risk (CR) were estimated, geo-referenced and integrated with demographical data by a health composite index (HI) applying geographic information system (GIS) analysis. Asw covered a wide range of concentration: from non-detectable (ND) to 2000 μg/L. More than 90% of the population was exposed to As, with UAs levels above the intervention level of 100 μg/g creatinine. GIS analysis described an expected level of exposure lower than the observed, indicating possible additional source/s of exposure to inorganic arsenic. In 68% of the locations, the population had a HQ greater than 1, and the CR ranged between 5·10(-5) and 2,1·10(-2). An environmental exposure area through ADD geo-referencing defined a baseline scenario for space-time risk assessment. The time of residence, the demographic density and the potential health considered outcomes helped characterize the health risk in the region. The geospatial analysis contributed to delimitate and analyze the change tendencies of risk in the region, broadening the scopes of the results for a decision-making process. Copyright © 2014 Elsevier B.V. All rights reserved.

Factors influencing health care and service providers' and their respective "at risk" populations' adoption of the Air Quality Health Index (AQHI): a qualitative study.

PubMed

Radisic, Sally; Newbold, K Bruce

2016-03-31

The Air Quality Health Index (AQHI) provides air quality and health information such that the public can implement health protective behaviours (reducing and/or rescheduling outdoor activity) and decrease exposure to outdoor air pollution. The AQHI's health messages account for increased risk associated with "at risk" populations (i.e. young children, elderly and those with pre-existing respiratory and/or cardiovascular conditions) who rely on health care and service providers for guidance. Using Rogers' Diffusion of Innovations theory, our objective with respect to health care and service providers and their respective "at risk" populations was to explore: 1) level of AQHI knowledge; 2) factors influencing AQHI adoption and; 3) strategies that may increase uptake of AQHI, according to city divisions and socioeconomic status (SES). Semi-structured face-to-face interviews with health care (Registered Nurses and Certified Respiratory Educators) and service providers (Registered Early Childhood Educators) and focus groups with their respective "at risk" populations explored barriers and facilitators to AQHI adoption. Participants were selected using purposive sampling. Each transcript was analyzed using an Interpretive Description approach to identify themes. Analyses were informed by Rogers' Diffusion of Innovations theory. Fifty participants (6 health care and service providers, 16 parents, 13 elderly, 15 people with existing respiratory conditions) contributed to this study. AQHI knowledge, AQHI characteristics and perceptions of air quality and health influenced AQHI adoption. AQHI knowledge centred on numerical reliance and health protective intent but varied with SES. More emphasis on AQHI relevance with respect to health benefits was required to stress relative advantage over other indices and reduce index confusion. AQHI reporting at a neighbourhood scale was recognized as addressing geographic variability and uncertainty in perceived versus measured air quality impacting health. Participants predominantly expressed that they relied on sensory cues (i.e. feel, sight, taste) to determine when to implement health protective behaviours. Time constraints were identified as barriers; whereas local media reporting and wearable devices were identified as facilitators to AQHI adoption. Increasing knowledge, emphasizing relevance, and reporting AQHI information at a neighbourhood scale via local media sources and wearable devices may facilitate AQHI adoption while accounting for SES differences.

Utilization of outpatient services in refugee settlement health facilities: a comparison by age, gender, and refugee versus host national status

PubMed Central

2011-01-01

Background Comparisons between refugees receiving health care in settlement-based facilities and persons living in host communities have found that refugees have better health outcomes. However, data that compares utilization of health services between refugees and the host population, and across refugee settlements, countries and regions is limited. The paper will address this information gap. The analysis in this paper uses data from the United Nations High Commissioner of Refugees (UNHCR) Health Information System (HIS). Methods Data about settlement populations and the use of outpatient health services were exported from the UNHCR health information system database. Tableau Desktop was used to explore the data. STATA was used for data cleaning and statistical analysis. Differences in various indicators of the use of health services by region, gender, age groups, and status (host national vs. refugee population) were analyzed for statistical significance using generalized estimating equation models that adjusted for correlated data within refugee settlements over time. Results Eighty-one refugee settlements were included in this study and an average population of 1.53 million refugees was receiving outpatient health services between 2008 and 2009. The crude utilization rate among refugees is 2.2 visits per person per year across all settlements. The refugee utilization rate in Asia (3.5) was higher than in Africa on average (1.8). Among refugees, females have a statistically significant higher utilization rate than males (2.4 visits per person per year vs. 2.1). The proportion of new outpatient attributable to refugees is higher than that attributable to host nationals. In the Asian settlements, only 2% outpatient visits, on average, were attributable to host community members. By contrast, in Africa, the proportion of new outpatient (OPD) visits by host nationals was 21% on average; in many Ugandan settlements, the proportion of outpatient visits attributable to host community members was higher than that for refugees. There was no statistically significant difference between the size of the male and female populations across refugee settlements. Across all settlements reporting to the UNHCR database, the percent of the refugee population that was less than five years of age is 16% on average. Conclusions The availability of a centralized database of health information across UNHCR-supported refugee settlements is a rich resource. The SPHERE standard for emergencies of 1-4 visits per person per year appears to be relevant for Asia in the post-emergency phase, but not for Africa. In Africa, a post-emergency standard of 1-2 visits per person per year should be considered. Although it is often assumed that the size of the female population in refugee settlements is higher than males, we found no statistically significant difference between the size of the male and female populations in refugee settlements overall. Another assumption---that the under-fives make up 20% of the settlement population during the emergency phase---does not appear to hold for the post-emergency phase; under-fives made up about 16% of refugee settlement populations. PMID:21936911

Evaluation of a health sciences internship for Latino and Native American library students.

PubMed

Keselman, Alla; Quasem, Sanjana; Kelly, Janice E; Dutcher, Gale A

2016-10-01

This paper presents a qualitative evaluation of a graduate-level internship for Latino and Native American library science students or students who are interested in serving those populations. The authors analyzed semi-structured interviews with thirteen internship program graduates or participants. The analysis suggests that the program increased participants' interest in health sciences librarianship and led to improved career opportunities, both in health sciences libraries and other libraries with health information programming. It also highlights specific factors that are likely to contribute to the strength of career pipeline programs aiming to bring Latino and Native American students and students who are interested in serving those communities into health librarianship. Exposing graduate-level interns to a broad range of health sciences librarianship tasks, including outreach to Latino and Native American communities and formal mentorship, is likely to maximize interns' interests in both health sciences librarianship and service to these communities.