The Medicare Health Outcomes Survey (HOS) is the first Medicare managed care outcomes measure. CMS, in collaboration with NCQA, launched the Medicare HOS in the 1998 Health Plan Employer Data and Information Set (HEDIS?). The measure includes the most recent advances in summarizi...
Romero, L J; Lindeman, R D; Hundley, R; Koehler, K M; Baumgartner, R N; Allen, A S; Schade, D S; LaRue, A; Ortiz, I E; Garry, P J
The purpose of this paper is to report on the outcome of recruitment and participation rate in the New Mexico Elder Health Survey. This survey is the first community based epidemiological survey to examine health and health related issues of elderly (65 years or older) Hispanics and non-Hispanic whites in Bernalillo County (Albuquerque), New Mexico. This survey was conducted from May 1993 to September 1995. Subjects (N=2200) were randomly selected from the list of 50,700 Medicare recipients residing in Bernalillo County and stratified by ethnicity and gender. Hispanics were identified using a computer program that selects Hispanic surname patterns and ethnicity was verified by self report. Subjects participated in a home interview, followed by an interview and examination in a senior health clinic. Use of the Medicare list resulted in 75.7% (N=1666) of subjects being contacted. Of the 1666 subjects available, 1130 (67.8%) completed a home interview and 883 (54%) completed the full examination. There were no significant differences in participation by ethnicity, but there were significant differences by gender, with women less likely to participate. The mean age of participants was 74 years, age range 65 to 100. Hispanic elderly demonstrated greater economic poverty and lower levels of formal education. Our survey results show that the elderly and Hispanic elderly can be successfully recruited to participate in a research study. This paper is the first to summarize the details of the survey design, present the results of recruitment and participation, and describe the survey participants. PMID:9926905
Casiano, Hygiea; Kinley, D. Jolene; Katz, Laurence Y.; Chartier, Mariette J.; Sareen, Jitender
Objective: Examine the association between quantity of media use and health outcomes in adolescents. Method: Multiple logistic regression analyses were conducted with the Canadian Community Health Survey 1.1 (youth aged 12–19 (n=9137)) to determine the association between hours of use of television/videos, video games, and computers/Internet, and health outcomes including depression, alcohol dependence, binge drinking, suicidal ideation, help-seeking behaviour, risky sexual activity, and obesity. Results: Obesity was associated with frequent television/video use (Adjusted Odds Ratio (AOR) 1.10). Depression and risky sexual behaviour were less likely in frequent video game users (AOR 0.87 and 0.73). Binge drinking was less likely in frequent users of video games (AOR 0.92) and computers/Internet (AOR 0.90). Alcohol dependence was less likely in frequent computer/Internet users (AOR 0.89). Conclusions: Most health outcomes, except for obesity, were not associated with using media in youth. Further research into the appropriate role of media will help harness its full potential. PMID:23133464
Wigfall, Lisa T; Friedman, Daniela B
Cancer is a leading cause of death among adults in the United States. Only 54% of U.S. adults reported seeking cancer information in 2014. Cancer information seeking has been positively associated with cancer-related health outcomes such as screening adherence. We conducted a scoping review of studies that used data from the Health Information National Trends Survey (HINTS) in order to examine cancer information seeking in depth and the relationship between cancer information seeking and cancer-related health outcomes. We searched five databases and the HINTS website. The search yielded a total of 274 article titles. After review of 114 de-duplicated titles, 66 abstracts, and 50 articles, 22 studies met inclusion criteria. Cancer information seeking was the outcome in only four studies. The other 18 studies focused on a cancer-related health outcome. Cancer beliefs, health knowledge, and information seeking experience were positive predictors of cancer information seeking. Cancer-related awareness, knowledge, beliefs, preventive behaviors, and screening adherence were higher among cancer information seekers. Results from this review can inform other research study designs and primary data collection focused on specific cancer sites or aimed at populations not represented or underrepresented in the HINTS data (e.g., minority populations, those with lower socioeconomic status). PMID:27466828
Gorman, Emma; Leyland, Alastair H.; McCartney, Gerry; White, Ian R.; Katikireddi, Srinivasa Vittal; Rutherford, Lisa; Graham, Lesley; Gray, Linsay
Health surveys are an important resource for monitoring population health, but selective nonresponse may impede valid inference. This study aimed to assess nonresponse bias in a population-sampled health survey in Scotland, with a focus on alcohol-related outcomes. Nonresponse bias was assessed by examining whether rates of alcohol-related harm (i.e., hospitalization or death) and all-cause mortality among respondents to the Scottish Health Surveys (from 1995 to 2010) were equivalent to those in the general population, and whether the extent of any bias varied according to sociodemographic attributes or over time. Data from consenting respondents (aged 20–64 years) to 6 Scottish Health Surveys were confidentially linked to death and hospitalization records and compared with general population counterparts. Directly age-standardized incidence rates of alcohol-related harm and all-cause mortality were lower among Scottish Health Survey respondents compared with the general population. For all years combined, the survey-to-population rate ratios were 0.69 (95% confidence interval: 0.61, 0.76) for the incidence of alcohol-related harm and 0.89 (95% confidence interval: 0.83, 0.96) for all-cause mortality. Bias was more pronounced among persons residing in more deprived areas; limited evidence was found for regional or temporal variation. This suggests that corresponding underestimation of population rates of alcohol consumption is likely to be socially patterned. PMID:25227767
Bourke, Ashling; Boduszek, Daniel; Kelleher, Caroline; McBride, Orla; Morgan, Karen
This study investigated the relationship between school sex education and sexual health behaviours at first sex and later in adulthood, using nationally representative data. Respondents were adults from the 2010 Irish Contraception and Crisis Pregnancy Survey, a cross-sectional survey designed to assess knowledge, attitudes and behaviours relating…
Gorst, Sarah L.; Gargon, Elizabeth; Clarke, Mike; Blazeby, Jane M.; Altman, Douglas G.; Williamson, Paula R.
Background A COS represents an agreed minimum set of outcomes that should be measured and reported in all trials of a specific condition. The COMET (Core Outcome Measures in Effectiveness Trials) initiative aims to collate and stimulate the development and application of COS, by including data on relevant studies within a publically available internet-based resource. In recent years, there has been an interest in increasing the development of COS. Therefore, this study aimed to provide an update of a previous review, and examine the quality of development of COS. A further aim was to understand the reasons why individuals are searching the COMET database. Methods A multi-faceted search strategy was followed, in order to identify studies that sought to determine which outcomes/domains to measure in clinical trials of a specific condition. Additionally, a pop up survey was added to the COMET website, to ascertain why people were searching the COMET database. Results Thirty-two reports relating to 29 studies were eligible for inclusion in the review. There has been an improvement in the description of the scope of a COS and an increase in the proportion of studies using literature/systematic reviews and the Delphi technique. Clinical experts continue to be the most common group involved in developing COS, however patient and public involvement has increased. The pop-up survey revealed the most common reasons for visiting the COMET website to be thinking about developing a COS and planning a clinical trial. Conclusions This update demonstrates that recent studies appear to have adopted a more structured approach towards COS development and public representation has increased. However, there remains a need for developers to adequately describe details about the scope of COS, and for greater public engagement. The COMET database appears to be a useful resource for both COS developers and users of COS. PMID:26785121
Meier, Ann; Trinitapoli, Jenny; Svec, Joseph
In this paper, we first show how the Demographic and Health Surveys (DHS) can be integrated with other data sources to expand the types of variables available for analysis of population and health outcomes. Second, we demonstrate one particular example of such integration by modelling the social, physical, and built environment determinants of health outcomes at the district level in Ghana, Malawi, and Tanzania. To do so, we created district-level measures of a number of variables from the DHS, and then merged them with district-level data from the IPUMS, an environmental data set called TerraPopulus, and other sources. We find that it is feasible to combine the DHS with other data sources, and that many health and environment indicators are heterogeneous within countries, justifying further analysis at low levels of geography and suggesting benefits to using such techniques to design fine-grained programmatic interventions. PMID:27330245
This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.
Does Pre-Survey Training Impact Knowledge of Survey Administrators and Survey Outcomes in Developing Countries? Evaluation Findings of a Training of Trainers Workshop for National AIDS and Reproductive Health Survey-Plus in Nigeria
Oyedeji, Kolawole Solomon; Fagbamigbe, Adeniyi Francis; Ogboi, Johnbull Sonny; Bashorun, Adebobola Toluwalashe; Issa, Kawu Bolakale; Amida, Perpetua; Ogundiran, Adeniyi; Onoriode, Ezire
Background: Although, Nigeria had conducted various national surveys followed by central and state level trainings for survey administrators, prior pre-survey trainings have not been systematically evaluated to assess their impact on knowledge gain and final outcome of the survey. A central training of trainers’ session was organized for master trainers on the conduct of the 2012 National AIDS and Reproductive Health Survey. Objectives: To evaluate the impact of training on the quality of conduct of a national research survey in the 36 states and the Federal Capital Territory in Nigeria. Method: A total of 185 participants consisting of State AIDS Program Coordinators, Reproductive Health Coordinators, State Laboratory Scientists, Lead Supervisors and Counselor Testers were invited from the 36 states in Nigeria and the FCT for the central training of trainers in Abuja. The training lasted 5 days and the trainees were grouped into two on the basis of behavioral epidemiology and laboratory components. Training tools such as the developed protocol, training power point slides, practical sessions such as role plays, and usage of HIV rapid test kits were utilized during the training. The facilitators were drawn from Federal Ministry of Health (FMoH), universities and research Institutions as well as Non-Governmental Organizations (NGOs). The facilitators prepared and administered 25 structured questions for the behavioral group and 28 questions for the laboratory group at the beginning of the training to assess the participants’ knowledge of HIV and the survey. The same questions answered by Trainees responded to the same questions prior to the commencement and at the end of the trainings. Scores were aggregated to 100 for each test. We conducted paired t-test to determine statistically significant differences between pre-test and post-test results at 0.05 significance level and ANOVA to determine if there were differences in knowledge level among different groups
Do associations between employee self-reported organizational assessments and attitudinal outcomes change over time? An analysis of four Veterans Health Administration surveys using structural equation modelling.
Das, Sonali; Chen, Ming-Hui; Warren, Nicholas; Hodgson, Michael
This paper evaluates relationships between healthcare employees' perceptions of three hospital organizational constructs (Leadership, Support and Resources), and their assessment of two employee-related outcomes (employee satisfaction and retention) and two patient-related outcomes (patient satisfaction and quality of care). Using four all-employee surveys conducted by the Veterans Health Administration in the United States between 1997 and 2006, we examine the strength of these relationships and their changes over time. Exposure and outcome measures are employee-assessed in all the surveys. Because it can accommodate both latent and measured variables into the model, Structural Equation Modelling (SEM) is used to capture and quantify the relationship structure. The aim of the project is to identify possible intervention foci. The analyses revealed that employee-related outcomes are improved by increases in Leadership and Support, and, not surprisingly, the outcome variable of employee satisfaction reduced turnover intention. The employee assessed patient-related outcomes of satisfaction and quality of care were most improved by increases in Resources. Results also indicate that the three organizational constructs and the web of associations characterized by SEM underwent changes over the study period, perhaps in relation to changes in VHA policy emphases, changes in survey wording and other possible unmeasured factors. PMID:22025392
Background Past research examining the effects of childhood obesity has largely focused on its projected effects into adulthood. However, there is emerging evidence that childhood obesity may have more immediate effects on school-related outcomes. We examine a range of educational attainment indicators to examine the possible pathway between obesity status and academic performance, while investigating the proximal effects of childhood obesity on health and utilization of health services, and whether these variables attenuate the relationship between obesity status and educational outcomes. Methods Data for the current study come from the 2011-2012 National Survey of Children’s Health, which details the impacts of childhood obesity on a range of outcomes among a nationally representative sample of children and adolescents aged 10-17 years (N=45,255). Educational outcomes (school absences, school problems, repeating a grade and school engagement) were modeled by logistic regression as a function of BMI, overall health status, health care utilization, and a range of sociodemographic variables. Results BMI status was significantly associated with all educational outcomes (p<0.001 for all), overall health status (p<0.001), and health care utilization (p=0.016). Prior to adjustment for covariates, obese children were significantly more likely to have school absences and school problems, to repeat a grade, and to have lower school engagement than non-overweight children. After adjustment for sociodemographic and health/healthcare variables, these outcomes remained significant for all but repeating a grade. The odds of having school problems, repeating a grade, and low school engagement that were associated with obesity were attenuated by the addition of sociodemographic variables into the model, while the addition of health and health care variables in the model decreased the odds of school absences. Conclusions This study provides evidence that increased weight status
Seil, Kacie S.; Desai, Mayur M.; Smith, Megan V.
Objectives We examined associations between identifying as lesbian, gay, or bisexual (LGB) and lacking a connection with an adult at school on adolescent substance use and mental health outcomes including suicidality. Methods We analyzed data from the 2009 New York City Youth Risk Behavior Survey (n = 8910). Outcomes of interest included alcohol use, marijuana use, illicit drug use, depressive symptomatology, suicide ideation, and suicide attempt. Results The prevalence of each outcome was significantly higher among LGB adolescents than heterosexual adolescents and among those who lacked an adult connection at school than among those who did have such a connection. Even when LGB adolescents had an adult connection at school, their odds of most outcomes were significantly higher than for heterosexual adolescents. Those LGB adolescents who lacked a school adult connection had the poorest outcomes (about 45% reported suicide ideation; 31% suicide attempt). Conclusions Adolescents who are LGB, particularly those who lack a connection with school adults, are at high risk for substance use and poorer mental health outcomes. Interventions should focus on boosting social support and improving outcomes for this vulnerable group. PMID:25121812
Demographic and Health Surveys are nationally representative household surveys with large sample sizes of between 5,000 and 30,000 households, typically. DHS surveys provide data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, a...
Gundersen, Craig; Ziliak, James P
Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation's leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. We show that the literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes. PMID:26526240
van der Feltz-Cornelis, Christina M; van Os, Jim; Knappe, Susanne; Schumann, Gunter; Vieta, Eduard; Wittchen, Hans-Ulrich; Lewis, Shôn W; Elfeddali, Iman; Wahlbeck, Kristian; Linszen, Donald; Obradors-Tarragó, Carla; Haro, Josep Maria
Background The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders. Methods The research was conducted as an expert survey and expert panel discussion during a scientific workshop. Results Eighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The “subjectivity gap” between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required. Conclusion Innovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs. PMID:25061300
Pindyck, Talia; Kalishman, Summers; Flatow-Trujillo, Lainey; Thornton, Karla
Background: American Indians/Alaskan Natives have a high mortality associated with hepatitis C virus, yet treatment rates are low. The ECHO (Extension for Community Healthcare Outcomes) model™, a videoconferencing technology for primary care providers, is underutilized at Indian Health Service facilities. Purpose: To ascertain Indian Health Service providers’ benefit of and barriers to utilizing hepatitis C virus TeleECHO clinics. Methods: We electronically sent an Active Participant Survey to Indian Health Service providers utilizing hepatitis C virus TeleECHO clinic and a Non-Participant Survey to other Indian Health Service providers interested in this clinic. Results: In total, 100% of Active Participant Survey respondents perceive moderate to major benefit of hepatitis C virus TeleECHO clinic in managing hepatitis C virus, and 67% of Non-Participant Survey respondents reported lack of administrative time as the major barrier to utilizing this resource. Conclusion: Indian Health Service providers participating in hepatitis C virus TeleECHO clinic perceive this resource as highly beneficial, but widespread utilization may be impractical without allocating time for participation. PMID:26770809
Background Reported ethnic discrimination is higher among indigenous and minority adult populations. There is a paucity of nationally representative prevalence studies of ethnic discrimination among adolescents. Experiencing ethnic discrimination has been associated with a range of adverse health outcomes. NZ has a diverse ethnic population. There are health inequalities among young people from Māori and Pacific ethnic groups. Methods 9107 randomly selected secondary school students participated in a nationally representative cross-sectional health and wellbeing survey conducted in 2007. The prevalence of ethnic discrimination by health professionals, by police, and ethnicity-related bullying were analysed. Logistic regression was used to examine the associations between ethnic discrimination and six health/wellbeing outcomes: self-rated health status, depressive symptoms in the last 12 months, cigarette smoking, binge alcohol use, feeling safe in ones neighbourhood, and self-rated school achievement. Results There were significant ethnic differences in the prevalences of ethnic discrimination. Students who experienced ethnic discrimination were less likely to report excellent/very good/good self-rated general health (OR 0.51; 95% CI 0.39, 0.65), feel safe in their neighbourhood (OR 0.48; 95% CI 0.40, 0.58), and more likely to report an episode of binge drinking in the previous 4 weeks (OR 1.77; 95% CI 1.45, 2.17). For all these outcomes the odds ratios for the group who were 'unsure' if they had experienced ethnic discrimination were similar to those of the 'yes' group. Ethnicity stratified associations between ethnic discrimination and the depression, cigarette smoking, and self-rated school achievement are reported. Within each ethnic group participants reporting ethnic discrimination were more likely to have adverse outcomes for these three variables. For all three outcomes the direction and size of the association between experience of ethnic discrimination
Willett, Lynn H.
A survey was conducted to determine the need for health occupations personnel in the Moraine Valley Community College district, specifically to: (1) describe present employment for selected health occupations; (2) project health occupation employment to 1974; (3) identify the supply of applicants for the selected occupations; and (4) identify…
... When compared to those with adequate health literacy skills, studies have shown that patients with limited health literacy ... literacy skills. 12 Back to Top Health status Studies demonstrate that persons with limited health literacy skills are significantly more likely than persons with adequate ...
... and Health Promotion relied extensively on both the Institute of Medicine (2004) and the Agency for Healthcare Research and Quality (2004) reports, which include comprehensive reviews of the literature on health literacy and ...
Houston, S; Fleschler, R
Outcomes management uses a quality and research approach to reducing costs in health care. Populations may be targeted for high volumes or their potential for cost savings. Outcomes are identified and measured through data collection and analysis. System and care processes that drive these outcomes are analyzed. Tenets related to outcomes management include questioning practice, administrative and physician involvement; recognizing that change is necessary; accepting uncontrollable factors; and valuing the outcomes management process. Resources necessary for managing outcomes include the use of collaborative practice teams, outcomes assessment, information systems, and educational support services. The women's health population can benefit from an outcomes management effort by improving and standardizing care for mothers and infants across the continuum. There is the opportunity to affect the wellness of this population even before the pregnancy occurs. PMID:9170599
Background Child health in many low- and middle-income countries lags behind international goals and affects children’s education, well-being, and general development. Large-scale school health programmes can be effective in reducing preventable diseases through cost-effective interventions. This paper outlines the baseline and 1-year results of a longitudinal health study assessing the impact of the Fit for School Programme in the Philippines. Methods A longitudinal 4-year cohort study was conducted in the province of Camiguin, Mindanao (experimental group); an external concurrent control group was studied in Gingoog, Mindanao. The study has three experimental groups: group 1—daily handwashing with soap, daily brushing with fluoride toothpaste, biannual deworming with 400 mg albendazole (Essential Health Care Program [EHCP]); group 2—EHCP plus twice-a-year access to school-based Oral Urgent Treatment; group 3—EHCP plus weekly toothbrushing with high-fluoride concentration gel. A non-concurrent internal control group was also included. Baseline data on anthropometric indicators to calculate body mass index (BMI), soil-transmitted helminths (STH) infection in stool samples, and dental caries were collected in August 2009 and August 2010. Data were analysed to assess validity of the control group design, baseline, and 1-year results. Results In the cohort study, 412 children were examined at baseline and 341 1 year after intervention. The baseline results were in line with national averages for STH infection, BMI, and dental caries in group 1 and the control groups. Children lost to follow-up had similar baseline characteristics in the experimental and control groups. After 1 year, group 1 showed a significantly higher increase in mean BMI and lower prevalence of moderate to heavy STH infection than the external concurrent control group. The increases in caries and dental infections were reduced but not statistically significant. The results for groups 2
Macdowall, Wendy; Jones, Kyle G; Clifton, Soazig; Copas, Andrew J; Mercer, Catherine H; Palmer, Melissa J; Lewis, Ruth; Datta, Jessica; Mitchell, Kirstin R; Field, Nigel; Sonnenberg, Pam; Johnson, Anne M; Wellings, Kaye
Objectives To examine variation in source of information about sexual matters by sociodemographic factors, and associations with sexual behaviours and outcomes. Design Cross-sectional probability sample survey. Setting British general population. Participants 3408 men and women, aged 17–24 years, interviewed from 2010–2012 for third National Survey of Sexual Attitudes and Lifestyles. Main outcome measures Main source of information (school, a parent, other); age and circumstances of first heterosexual intercourse; unsafe sex and distress about sex in past year; experience of sexually transmitted infection (STI) diagnoses, non-volitional sex or abortion (women only) ever. Results Citing school was associated with younger age, higher educational level and having lived with both parents. Citing a parent was associated, in women, with lower educational level and having lived with one parent. Relative to other sources, citing school was associated with older age at first sex (adjusted HR 0.73 (95% CI 0.65 to 0.83) men, 0.73 (0.65 to 0.82) women), lower likelihood of unsafe sex (adjusted OR 0.58 (0.44 to 0.77) men, 0.69 (0.52 to 0.91) women) and previous STI diagnosis (0.55 (0.33 to 0.91) men, 0.58 (0.43 to 0.80) women) and, in women, with lower likelihood of lack of sexual competence at first sex; and experience of non-volitional sex, abortion and distress about sex. Citing a parent was associated with lower likelihood of unsafe sex (0.53 (0.28 to 1.00) men; 0.69 (0.48 to 0.99) women) and, in women, previous STI diagnosis. Conclusions Gaining information mainly from school was associated with lower reporting of a range of negative sexual health outcomes, particularly among women. Gaining information mainly from a parent was associated with some of these, but fewer cited parents as a primary source. The findings emphasise the benefit of school and parents providing information about sexual matters and argue for a stronger focus on the needs of men. PMID:25743154
Mautner, Eva; Ashida, Chie; Greimel, Elfriede; Lang, Uwe; Kolman, Christina; Alton, Daniela; Inoue, Wataru
The aim of the current study was to investigate differences in quality of life outcomes and depression of mothers in East-Asia and Central Europe. 170 women in Japan and 226 women in Austria with children between 3 and 5 answered the same cross-culturally validated questionnaires. The Quality of Life Questionnaire from the WHO (WHOQOL-Bref), the Patient Health Questionnaire (PHQ-2), the Sense of Coherence Scale (SOC-13), a Social Support Scale (MSPSS), and questions on gender orientation were used. In all dimensions of QOL (physical, psychological, social, and environmental) Japanese women had lower QOL scores compared to Austrian mothers (P < 001). Seven percent of women in both countries experienced major depression. In both countries sense of coherence, experienced stress level, satisfaction with income, social support, and gender roles had an influence on QOL and depressive symptoms. Mothers in Japan consider life events less comprehensible, manageable, and meaningful and experience less support. Consequently, creating an environment where fathers could be more involved in child rearing and mothers have more opportunities to choose between life styles and working and social environments would improve QOL not only in Japanese mothers but also in other countries all over the world. PMID:25525606
Pathammavong, Ratsamy; Leatherdale, Scott T.; Ahmed, Rashid; Griffith, Jane; Nowatzki, Janet; Manske, Steve
This study examined whether student tobacco, alcohol, marijuana use, and sedentary behaviour were associated with the educational outcomes of health-related absenteeism, truancy, and academic motivation in a nationally representative sample of Canadian youth. Descriptive analyses indicate a high proportion of students missed school due to health,…
Revisiting the Surveillance Epidemiology and End Results Cancer Registry and Medicare Health Outcomes Survey (SEER-MHOS) Linked Data Resource for Patient-Reported Outcomes Research in Older Adults with Cancer.
Kent, Erin E; Malinoff, Rochelle; Rozjabek, Heather M; Ambs, Anita; Clauser, Steven B; Topor, Marie A; Yuan, Gigi; Burroughs, James; Rodgers, Anne B; DeMichele, Kimberly
Researchers and clinicians are increasingly recognizing the value of patient-reported outcome (PRO) data to better characterize people's health and experiences with illness and care. Considering the rising prevalence of cancer in adults aged 65 and older, PRO data are particularly relevant for older adults with cancer, who often require complex cancer care and have additional comorbid conditions. A data linkage between the Surveillance Epidemiology and End Results (SEER) cancer registry and the Medicare Health Outcomes Survey (MHOS) was created through a partnership between the National Cancer Institute and the Centers for Medicare and Medicaid Services that created the opportunity to examine PROs in Medicare Advantage enrollees with and without cancer. The December 2013 linkage of SEER-MHOS data included the linked data for 12 cohorts, bringing the number of individuals in the linked data set to 95,723 with cancer and 1,510,127 without. This article reviews the features of the resource and provides information on some descriptive characteristics of the individuals in the data set (health-related quality of life, body mass index, fall risk management, number of unhealthy days in the past month). Individuals without (n=258,108) and with (n=3,440) cancer (1,311 men with prostate cancer, 982 women with breast cancer, 689 with colorectal cancer, 458 with lung cancer) were included in the current descriptive analysis. Given increasing longevity, advances in effective therapies and earlier detection, and population growth, the number of individuals aged 65 and older with cancer is expected to reach more than 12 million by 2020. SEER-MHOS provides population-level, self-reported, cancer registry-linked data for person-centered surveillance research on this growing population. PMID:26782871
Bouhnik, Anne-Deborah; Bendiane, Marc-Karim; Cortaredona, Sebastien; Sagaon Teyssier, Luis; Rey, Dominique; Berenger, Cyril; Seror, Valerie; Peretti-Watel, Patrick; Aparicio, Thomas
Introduction Today, a growing need exists for greater research into cancer survivorship, focusing on different spheres of the day-to-day life of diagnosed patients. This article describes the design and implementation of VICAN (VIe après le CANcer), a national survey on French cancer survivors. Method and analysis The target population included patients aged 18–82, diagnosed with cancer between January and June 2010, and registered in one of the three main French Health Insurance Schemes. It was restricted to 12 tumour sites. Sampling was stratified using a non-proportional allocation, based on age at diagnosis (18–52 and 53–82) and tumour site. Data were collected from telephone interviews with patients 2 and 5 years after diagnosis, a medical survey completed by the physician who initiated cancer treatment, and information from the national medicoadministrative database on reimbursement data and hospital discharge records. First data collection, 2 years after diagnosis, occurred between March and December 2012. Second data collection, 5 years after diagnosis, will be conducted in 2015. Analyses will be conducted on various outcomes: quality of life, health status and psychosocial conditions, with a particular focus on the impact of cancer diagnosis on the labour market. The variety of measurements included in the survey will enable us to control a wide range of factors. Ethics and dissemination The methodology of the VICAN survey was approved by three national ethics commissions. Results of the study will be disseminated through national and international research conferences, and in articles published in international peer-reviewed journals. PMID:25805526
The National Pregnancy and Health Survey conducted by NIDA is a nationwide hospital survey to determine the extent of drug abuse among pregnant women in the United States. The primary objective of the National Pregnancy and Health Survey (NPHS) was to produce national annual esti...
Smith, Tammy Jorgensen; Reid, Joan A.; Henry, Ryan G.; Dixon, Charlotte G.; Wright, Tennyson J.
Alumni of a Council on Rehabilitation Education (CORE)-accredited graduate rehabilitation counselor education (RCE) program were surveyed to evaluate career outcomes, job satisfaction, licensure and certification rates, client populations served, and RCE program satisfaction and effectiveness. Results indicate a high level of satisfaction with the…
Rheingold, Alyssa A.; Zinzow, Heidi; Hawkins, Alesia; Saunders, Benjamin E.; Kilpatrick, Dean G.
Background: Each homicide leaves behind several friends and family members, or homicide survivors. However, limited information is available on the impact of homicide on adolescent survivors. The purpose of the current study was to identify the prevalence of homicide survivorship and to determine mental health outcomes within a sample of US…
Mullany, Luke C; Richards, Adam K; Lee, Catherine I; Suwanvanichkij, Voravit; Maung, Cynthia; Mahn; Beyrer, Chris; Lee, Thomas J
Background Case reports of human rights violations have focused on individuals' experiences. Population‐based quantification of associations between rights indicators and health outcomes is rare and has not been documented in eastern Burma. Objective We describe the association between mortality and morbidity and the household‐level experience of human rights violations among internally displaced persons in eastern Burma. Methods Mobile health workers in conflict zones of eastern Burma conducted 1834 retrospective household surveys in 2004. Workers recorded data on vital events, mid‐upper arm circumference of young children, malaria parasitaemia status of respondents and household experience of various human rights violations during the previous 12 months. Results Under‐5 mortality was 218 (95% confidence interval 135 to 301) per 1000 live births. Almost one‐third of households reported forced labour (32.6%). Forced displacement (8.9% of households) was associated with increased child mortality (odds ratio = 2.80), child malnutrition (odds ratio = 3.22) and landmine injury (odds ratio = 3.89). Theft or destruction of the food supply (reported by 25.2% of households) was associated with increased crude mortality (odds ratio = 1.58), malaria parasitaemia (odds ratio = 1.82), child malnutrition (odds ratio = 1.94) and landmine injury (odds ratio = 4.55). Multiple rights violations (14.4% of households) increased the risk of child (incidence rate ratio = 2.18) and crude (incidence rate ratio = 1.75) mortality and the odds of landmine injury (odds ratio = 19.8). Child mortality risk was increased more than fivefold (incidence rate ratio = 5.23) among families reporting three or more rights violations. Conclusions Widespread human rights violations in conflict zones in eastern Burma are associated with significantly increased morbidity and mortality. Population‐level associations can be quantified using standard
Validation of the National Institutes of Health Patient-Reported Outcomes Measurement Information System Survey as a Quality-of-Life Instrument for Patients with Malignant Brain Tumors and Their Caregivers.
Romero, Melissa M; Flood, Lisa Sue; Gasiewicz, Nanci K; Rovin, Richard; Conklin, Samantha
At present there is a lack of well-validated surveys used to measure quality of life in patients with malignant brain tumors and their caregivers. The main objective of this pilot study was to validate the National Institutes of Health Patient-Reported Outcomes Measurement Information System (NIH PROMIS) survey for use as a quality-of-life measure in this population. This article presents the rationale for using the NIH PROMIS instrument as a quality-of-life measure for patients with malignant brain tumors and their caregivers. PMID:26596656
Kant, Ashima K
A systematic review of the literature on dietary patterns (multiple dietary components operationalized as a single exposure) in relation to nutrient adequacy, lifestyle and demographic variables, and health outcome was conducted. Most of the published reports on the subject have used one of two methods to determine dietary patterns: (a) diet indexes or scores that assess compliance with prevailing dietary guidance as dietary patterns, and (b) data-driven methods that use factor or cluster analysis to derive dietary patterns. Irrespective of the approach used, patterns characterized by fruit/vegetable/whole grain/fish/poultry consumption generally have been reported to relate to micronutrient intake, and to selected biomarkers of dietary exposure and disease risk in the expected direction. Age, income, and education have been reported to be among positive predictors of the so-called more healthful dietary patterns. An inverse association of healthful dietary patterns with all-cause mortality and cardiovascular disease risk was reported in most studies. However, the magnitude of risk reduction was modest and was attenuated after control for confounders. Few published studies showed an association between risk of most incident cancers and dietary patterns. Both of the currently used approaches for extracting dietary patterns have limitations, are subject to dietary measurement errors, and have not generated new diet and disease hypotheses. PMID:15054348
The article locates analysing health outcomes within a set of elements covering evaluating equity in health and suggests some orientations for such analysis. The model of analysis for examining equity in health which has been adopted by the
The China Health and Nutrition Survey is designed to examine the effects of health, nutrition, and family planning policies and programs as they have been implemented by national and local governments. It is designed to examine how both the social and economic transformation of C...
Perkins, N A
Outcomes analysis in health care has historically meant the examination of clinical results of inpatient hospitalization. In response to climbing health care and health insurance costs, the organization of health care providers, the location of service delivery and reimbursement mechanisms have changed. As the health care industry changes, so too must the definition of outcomes. This article presents a conceptual framework for the analysis of health outcomes as health industry outputs, with an emphasis on the ways in which such outputs are being assessed and improved. PMID:10116955
Currie, Janet; Stabile, Mark; Manivong, Phongsack; Roos, Leslie L.
Research has shown a strong connection between birth weight and future outcomes. We ask how health problems after birth affect outcomes using data from public health insurance records for 50,000 children born between 1979 and 1987 in the Canadian province of Manitoba. We compare children to siblings born an average of three years apart. We find…
Health Education (Washington D.C.), 1988
Results are reported from a national survey of teenaged youth on their attitudes toward a variety of health related issues. Topics covered were Acquired Immune Deficiency Syndrome; sexually transmitted diseases, violence, suicide, injury prevention, drug abuse, nutrition, and consumer education. (JD)
The FDA conducts this periodic omnibus survey of American consumers to track consumer attitudes, knowledge, and reported behaviors related to diet and health issues including cholesterol awareness of diet-disease risk factors, food label use, dietary supplement use, and awarenes...
Guindon, G Emmanuel
In recent years, a number of low- and middle-income country governments have introduced health insurance schemes. Yet not a great deal is known about the impact of such policy shifts. Vietnam's recent health insurance experience including a health insurance scheme for the poor in 2003 and a compulsory scheme that provides health insurance to all children under six years of age combined with Vietnam's commitment to universal coverage calls for research that examines the impact of health insurance. Taking advantage of Vietnam's unique policy environment, data from the 2002, 2004 and 2006 waves of the Vietnam Household Living Standard Survey and single-difference and difference-in-differences approaches are used to assess whether access to health insurance--for the poor, for children and for students--impacts on health services utilization and health outcomes in Vietnam. For the poor and for students, results suggest health insurance increased the use of inpatient services but not of outpatient services or health outcomes. For young children, results suggest health insurance increased the use of outpatient services (including the use of preventive health services such as vaccination and check-up) but not of inpatient services. PMID:24661805
Sann, A; Landua, D
The objective of this survey is to record and describe the current development status of municipal support systems targeting early childhood prevention in Germany. Nearly all participating youth welfare offices and a large number of the participating public health departments report ongoing activities in setting up and strengthening such support systems. Most of them declare to be part of interdisciplinary networks acting across departments. However, comprehension of the actual implications of early prevention varies broadly among participants and is marked by two contradictory statements: early empowerment for all parents (to be) on the one hand and preventive child protection for families at risk on the other. Cooperation with many different partners is common and mostly found within the own system but sometimes also by crossing borders. Mandatory cooperation, however, is an exclusive attribute of the youth welfare system, originating from the legal requirements. One of the most striking results is the almost complete ignorance of the powers and resources of public health departments' by the youth welfare offices, mainly in charge for organizing municipal support systems for children and families. Improving the legal basis for funding and efforts for better qualification will be crucial for a sustainable development. PMID:20936446
Southern Regional Education Board, Atlanta, GA.
Outcome evaluation assesses the results or benefits of mental health services received by clients or communities by comparing descriptive data on the mental health status of clients at different points in time. It aids clinicians and managers in planning programs and managing clinical services. A mental health center should establish goal-oriented…
Environmental exposures range across multiple domains to affect human health. In an effort to learn how environmental factors combine to contribute to health outcomes we constructed a multiple environmental domain index (MEDI) for use in health research. We used principal compone...
Hellinger, F J
Studies of people's attitude towards risk in the health sector often involve a comparison of the desirability of alternative medical treatments. Since the outcome of a medical treatment cannot be known with certainty, patients and physicians must make a choice that involves risk. Each medical treatment may be characterized as a gamble (or risky option) with a set of outcomes and associated probabilities. Expected utility theory (EUT) is the standard method to predict people's choices under uncertainty. The author presents the results of a survey that suggests people are very risk averse towards gambles involving health-related outcomes. The survey also indicates that there is significant variability in the risk attitudes across individuals for any given gamble and that there is significant variability in the risk attitudes of a given individual across gambles. The variability of risk attitudes of a given individual suggests that risk attitudes are not absolute but are functions of the parameters in the gamble. PMID:2927183
An exploratory study examined the relationship between individual, family, and work variables and working mothers' health. The study also investigated the relationship between health management strategies and health. A cross-sectional survey design was used to gather data from 85 women who were married, employed 20 hours a week or more, and had…
Varekojis, Sarah M.; Miller, Larry; Schiller, M. Rosita; Stein, David
Purpose: This paper aims to describe the relationship between functional health literacy level and smoking cessation outcomes. Design/methodology/approach: Participants in an inpatient smoking cessation program in a mid-western city in the USA were enrolled and the Short Test of Functional Health Literacy in Adults was administered while the…
Yin, H Shonna; Jay, Melanie; Maness, Leslie; Zabar, Sondra; Kalet, Adina
We have previously proposed that by identifying a set of Educationally Sensitive Patient Outcomes (ESPOs), medical education outcomes research becomes more feasible and likely to provide meaningful guidance for medical education policy and practice. ESPOs are proximal outcomes that are sensitive to provider education, measurable, and linked to more distal health outcomes. Our previous model included Patient Activation and Clinical Microsystem Activation as ESPOs. In this paper, we discuss how Health Literacy, defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions," is another important ESPO. Between one-third and one-half of all US adults have limited health literacy skills. Providers can be trained to adopt a "universal precautions approach" to addressing patient health literacy, through the acquisition of specific skills (e.g., teachback, "chunking" information, use of plain language written materials) and by learning how to take action to improve the "health literacy environment." While there are several ways to measure health literacy, identifying which measurement tools are most sensitive to provider education is important, but challenging and complex. Further research is needed to test this model and identify additional ESPOs. PMID:26173523
Reeve, Bryce B
There is a great need in health outcomes research to develop instruments that accurately measure a person's health status with minimal response burden. This need for psychometrically sound and clinically meaningful measures calls for better analytical tools beyond the methods available from traditional measurement theory. Applications of item response theory (IRT) modeling have increased considerably because of its utility for instrument development and evaluation, scale scoring, assessment of cultural equivalence, instrument linking and computerized adaptive testing. IRT models the relationship between a person's response to a survey question and their standing on a health construct, such as fatigue or depression. This review will discuss the theory and basics of IRT models and applications of these models to health outcomes measurement. PMID:19807361
A survey of reproductive health issues was conducted on 15 year old Hutt Valley secondary school girls by means of a self-administered anonymous questionnaire. The prevalence of sexual intercourse in the sample was 29%. Sixteen percent of the sexually active respondents used no method of contraception. Knowledge of reproductive health facts and contraception was poor both amongst sexually experienced and inexperienced respondents. Twenty-six percent relied on peers for this information, with mothers, teachers and books being other important sources cited. Respondents requested more information on sexually transmitted diseases, contraception and sexual relationships. Most would like this information more readily accessible. Preferred sources of information mentioned were: parents, books, films/videos, family planning clinics and friends. PMID:3455514
Tsasis, Peter; Evans, Jenna M; Forrest, David; Jones, Richard Keith
Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care. PMID:23526058
Tsasis, Peter; Evans, Jenna M; Forrest, David; Jones, Richard Keith
Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care. PMID:23526058
Humphreys, Brad R; McLeod, Logan; Ruseski, Jane E
Health production models include participation in physical activity as an input. We investigate the relationship between participation in physical activity and health using a bivariate probit model. Participation is identified with an exclusion restriction on a variable reflecting sense of belonging to the community. Estimates based on data from Cycle 3.1 of the Canadian Community Health Survey indicate that participation in physical activity reduces the reported incidence of diabetes, high blood pressure, heart disease, asthma, and arthritis as well as being in fair or poor health. Increasing the intensity above the moderate level and frequency of participation in physical activity appears to have a diminishing marginal impact on adverse health outcomes. Our results provide support for guidelines about engaging in exercise regularly to achieve health benefits. PMID:23364850
Simmons-Mackie, Nina; Threats, Travis T.; Kagan, Aura
There has been a marked increase in attention to the measurement of ''outcomes'' after speech-language intervention for adult aphasia. Consumers, speech-language pathologists (SLPs), and funding sources desire evidence of therapy outcomes that improve communication and enhance the quality of life for people with aphasia. While many assessment…
Annim, Samuel Kobina; Awusabo-Asare, Kofi; Amo-Adjei, Joshua
This study uses three key anthropometric measures of nutritional status among children (stunting, wasting and underweight) to explore the dual effects of household composition and dependency on nutritional outcomes of under-five children in Ghana. The objective is to examine changes in household living arrangements of under-five children to explore the interaction of dependency and nucleation on child health outcomes. The concept of nucleation refers to the changing structure and composition of household living arrangements, from highly extended with its associated socioeconomic system of production and reproduction, social behaviour and values, towards single-family households - especially the nuclear family, containing a husband and wife and their children alone. A negative relationship between levels of dependency, as measured by the number of children in the household, and child health outcomes is premised on the grounds that high dependency depletes resources, both tangible and intangible, to the disadvantage of young children. Data were drawn from the last four rounds of the Ghana Demographic and Health Surveys (GDHSs), from 1993 to 2008, for the first objective - to explore changes in household composition. For the second objective, the study used data from the 2008 GDHS. The results show that, over time, households in Ghana have been changing towards nucleation. The main finding is that in households with the same number of dependent children, in nucleated households children under age 5 have better health outcomes compared with children under age 5 in non-nucleated households. The results also indicate that the effect of dependency on child health outcomes is mediated by household nucleation and wealth status and that, as such, high levels of dependency do not necessarily translate into negative health outcomes for children under age 5, based on anthropometric measures. PMID:25167165
Zhao, Mingjie; Kim, Yang-Seon; Srebric, Jelena
Indoor Environmental Quality (IEQ) in commercial buildings, such as retail stores, can affect employee satisfaction, productivity, and health. This study administered an IEQ survey to retail employees and found correlations between measured IEQ parameters and the survey responses. The survey included 611 employees in 14 retail stores located in Pennsylvania (climate zone 5A) and Texas (climate zone 2A). The survey questionnaire featured ratings of different aspects of IEQ, including thermal comfort, lighting and noise level, indoor smells, overall cleanness, and environmental quality. Simultaneously with the survey, on-site physical measurements were taken to collect data of relative humidity levels, air exchange rates, dry bulb temperatures, and contaminant concentrations. This data was analyzed using multinomial logit regression with independent variables being the measured IEQ parameters, employees’ gender, and age. This study found that employee perception of stuffy smells is related to formaldehyde and PM10 concentrations. Furthermore, the survey also asked the employees to report an annual frequency of common colds as a health indicator. The regression analysis showed that the cold frequency statistically correlates with the measured air exchange rates, outdoor temperatures, and indoor PM concentrations. Overall, the air exchange rate is the most influential parameter on the employee perception of the overall environmental quality and self-reported health outcome.
Kindig, D A
OBJECTIVE: To review the concept of population health, including its definition, measurement, and determinants, and to suggest an approach for aligning financial incentives toward this goal. DATA SOURCE, STUDY DESIGN, DATA EXTRACTION. Literature review, policy analysis PRINCIPAL FINDINGS: The article presents the argument that a major reason for our slow progress toward health outcome improvement is that there is no operational definition of population health and that financial incentives are not aligned to this goal. Current attempts at process measures as indicators of quality or outcome are not adequate for the task. It is suggested that some measure of health-adjusted life expectancy be adopted for this purpose, and that integrated delivery systems and other agents responsible for nonmedical determinants be rewarded for improvement in this measure. This will require the development of an investment portfolio across the determinants of health based on relative marginal return to health, with horizontal integration strategies across sectoral boundaries. A 20-year three-phase development strategy is proposed, including components of research and acceptance, integrated health system implementation, and cross-sectoral integration. CONCLUSIONS: The U.S. healthcare system is a $1 trillion industry without a definition of its product. Until population outcome measures are developed and rewarded for, we will not solve the twenty-first century challenge of maximizing health outcome improvement for the resources available. Images Figure 1 PMID:9618669
Our analysis is based on the 2008 Athens Area Study and exploits detailed information regarding health impairments and labour market outcomes for Greek males. Distinguishing between healthy and heath-impaired employees who have or do not have work limitations, the unobserved productivity effect of health is separated from discrimination. We then estimate a regression model that includes terms to correct for employment selection and endogenous stratification of self-reported health condition. A penalty for productivity limitation exists. Evidence of wage discrimination is also found. Both findings are statistically significant and highlight the necessity for instituting active policies against unequal treatment. PMID:19771458
Reddy, S S
Outcome evaluation is of great interest throughout the healthcare field, but which outcomes are important depends on the viewpoint one holds. For the healthcare organisation costs and resource utilisation are paramount, whereas patients may be interested in being able to work and lead a productive life without long-term complications. Healthcare policy decisions are influenced by varying degrees of social forces, existing regulations and outcome research findings. Ideally, all three are in agreement but often they may be competitive or may not even be included in policy decision making. With respect to improving outcomes, much energy has been spent on developing diabetes care guidelines. However, these have had minimal impact on physician behaviour. Soon after onset or diagnosis of diabetes, we are most concerned with process measures such as micro-albumin levels, blood pressure monitoring, routine eye and foot examinations and lipid profiles. These process measures are related to the development of intermediate outcomes--proteinuria, retinopathy, foot ulcers and dyslipidaemia. Diabetes is an expensive disease but there is accumulating evidence that improved care can lead to better quality of life and reduction in health care resource utilisation. The UKPDS demonstrated that for one percentage point decrease in HbA1c there was a 35% reduction in the risk of complications. Preliminary data from various diabetes management programmes indicate that instituting standardised care may lead to cost savings and improved health. Rationing health care resources wisely requires consideration of multiple factors including quality of life years (QALYs) and healthy year equivalents (HYEs). Formal quantitative methods are used to measure overall desirability of a medical intervention. Questions to be answered include predictability of responsiveness or adverse events to drug therapy. Outcomes research will have a key role in future development of models of diabetes care. PMID
Lavy, V; Strauss, J; Thomas, D; de Vreyer, P
This paper analyzes the effect of quality and accessibility of health services and other public infrastructure on the health of children in Ghana. We focus on child survival, child height and weight using data from the Ghana Living Standards Survey. The results suggest an important role for public health policy in eliminating the rural-urban disparities in health status and particularly in improving the health status of rural children and reducing their mortality rates. Increased availability of birth services and other related child programs, as well as Improved water and sanitation infrastructure would have an immediate payoff. PMID:10159445
Bhutta, Zulfiqar A; Lassi, Zohra S; Blanc, Ann; Donnay, France
Some interventions in women before and during pregnancy may reduce perinatal and neonatal deaths, and recent research has established linkages of reproductive health with maternal, perinatal, and early neonatal health outcomes. In this review, we attempted to analyze the impact of biological, clinical, and epidemiologic aspects of reproductive and maternal health interventions on perinatal and neonatal outcomes through an elucidation of a biological framework for linking reproductive, maternal and newborn health (RHMNH); care strategies and interventions for improved perinatal and neonatal health outcomes; public health implications of these linkages and implementation strategies; and evidence gaps for scaling up such strategies. Approximately 1000 studies (up to June 15, 2010) were reviewed that have addressed an impact of reproductive and maternal health interventions on perinatal and neonatal outcomes. These include systematic reviews, meta-analyses, and stand-alone experimental and observational studies. Evidences were also drawn from recent work undertaken by the Child Health Epidemiology Reference Group (CHERG), the interconnections between maternal and newborn health reviews identified by the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS), as well as relevant work by the Partnership for Maternal, Newborn and Child Health. Our review amply demonstrates that opportunities for assessing outcomes for both mothers and newborns have been poorly realized and documented. Most of the interventions reviewed will require more greater-quality evidence before solid programmatic recommendations can be made. However, on the basis of our review, birth spacing, prevention of indoor air pollution, prevention of intimate partner violence before and during pregnancy, antenatal care during pregnancy, Doppler ultrasound monitoring during pregnancy, insecticide-treated mosquito nets, birth and newborn care preparedness via community-based intervention
Puac-Polanco, Victor D.; Lopez-Soto, Victor A.; Kohn, Robert; Xie, Dawei; Richmond, Therese S.
Objectives. We analyzed a probability sample of Guatemalans to determine if a relationship exists between previous violent events and development of mental health outcomes in various sociodemographic groups, as well as during and after the Guatemalan Civil War. Methods. We used regression modeling, an interaction test, and complex survey design adjustments to estimate prevalences and test potential relationships between previous violent events and mental health. Results. Many (20.6%) participants experienced at least 1 previous serious violent event. Witnessing someone severely injured or killed was the most common event. Depression was experienced by 4.2% of participants, with 6.5% experiencing anxiety, 6.4% an alcohol-related disorder, and 1.9% posttraumatic stress disorder (PTSD). Persons who experienced violence during the war had 4.3 times the adjusted odds of alcohol-related disorders (P < .05) and 4.0 times the adjusted odds of PTSD (P < .05) compared with the postwar period. Women, indigenous Maya, and urban dwellers had greater odds of experiencing postviolence mental health outcomes. Conclusions. Violence that began during the civil war and continues today has had a significant effect on the mental health of Guatemalans. However, mental health outcomes resulting from violent events decreased in the postwar period, suggesting a nation in recovery. PMID:25713973
Flynn, Jennifer A.; Fujiwara, Saeko
This study was conducted to identify characteristics associated with treatment for osteoporosis among women aged 50 years and older in Japan and to explore differences among patients according to treatment regimen. Data were provided by a large annual survey representative of Japanese aged 18 and older; all measures were by self-report. Women aged 50 and older who reported diagnosed osteoporosis (N = 900) were compared based on current treatment status using bivariate statistics and logistic regression. Approximately 1 in 3 women in this study reporting diagnosed osteoporosis were currently untreated. Factors associated with current treatment for osteoporosis included having ≥1 physician visit in the prior 6 months (OR = 5.4, P < 0.001), self-rated moderate or severe osteoporosis (OR = 2.8, P < 0.001), completion of menopause (OR = 1.6, P < 0.05), and family history of osteoporosis (OR = 1.5, P < 0.05), while longer duration of osteoporosis diagnosis (OR = 0.9, P < 0.05) and arthritis (OR = 0.7, P < 0.05) were associated with lower odds of treatment. These findings suggest that diagnosed patients are not being actively managed in the longer term, and efforts need to be made to ensure that patients stay engaged with their healthcare providers. PMID:25587485
Washington State Dept. of Social and Health Services, Olympia.
The 1992 Washington State Survey of Adolescent Health Behaviors (WSSAHB) was created to collect information regarding a variety of adolescent health behaviors among students in the state of Washington. It expands on two previous administrations of a student tobacco, alcohol, and other drug survey and includes questions about medical care, safety,…
The National Employer Health Insurance Survey (NEHIS) was developed to produce estimates on employer-sponsored health insurance data in the United States. The NEHIS was the first Federal survey to represent all employers in the United States by State and obtain information on all...
Brooks, Benjamin PC; Hanlon, Michael
Abstract Objective To quantify the effects of household expenditure survey characteristics on the estimated share of a household’s expenditure devoted to health. Methods A search was conducted for all country surveys reporting data on health expenditure and total household expenditure. Data on total expenditure and health expenditure were extracted from the surveys to generate the health expenditure share (i.e. fraction of the household expenditure devoted to health). To do this the authors relied on survey microdata or survey reports to calculate the health expenditure share for the particular instrument involved. Health expenditure share was modelled as a function of the survey’s recall period, the number of health expenditure items, the number of total expenditure items, the data collection method and the placement of the health module within the survey. Data exists across space and time, so fixed effects for territory and year were included as well. The model was estimated by means of ordinary least squares regression with clustered standard errors. Findings A one-unit increase in the number of health expenditure questions was accompanied by a 1% increase in the estimated health expenditure share. A one-unit increase in the number of non-health expenditure questions resulted in a 0.2% decrease in the estimated share. Increasing the recall period by one month was accompanied by a 6% decrease in the health expenditure share. Conclusion The characteristics of a survey instrument examined in the study affect the estimate of the health expenditure share. Those characteristics need to be accounted for when comparing results across surveys within a territory and, ultimately, across territories. PMID:23825879
... 45 Public Welfare 4 2013-10-01 2013-10-01 false NYTD Youth Outcome Survey B Appendix B to Part 1356 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS,...
Zotti, Marianne E.; Williams, Amy M.; Robertson, McKaylee; Horney, Jennifer; Hsia, Jason
We examined methodological issues in studies of disaster-related effects on reproductive health outcomes and fertility among women of reproductive age and infants in the United States (US). We conducted a systematic literature review of 1,635 articles and reports published in peer-reviewed journals or by the government from January 1981 through December 2010. We classified the studies using three exposure types: (1) physical exposure to toxicants; (2) psychological trauma; and (3) general exposure to disaster. Fifteen articles met our inclusion criteria concerning research focus and design. Overall studies pertained to eight different disasters, with most (n = 6) focused on the World Trade Center attack. Only one study examined pregnancy loss, i.e., occurrence of spontaneous abortions post-disaster. Most studies focused on associations between disaster and adverse birth outcomes, but two studies pertained only to post-disaster fertility while another two examined it in addition to adverse birth outcomes. In most studies disaster-affected populations were assumed to have experienced psychological trauma, but exposure to trauma was measured in only four studies. Furthermore, effects of both physical exposure to toxicants and psychological trauma on disaster-affected populations were examined in only one study. Effects on birth outcomes were not consistently demonstrated, and study methodologies varied widely. Even so, these studies suggest an association between disasters and reproductive health and highlight the need for further studies to clarify associations. We postulate that post-disaster surveillance among pregnant women could improve our understanding of effects of disaster on the reproductive health of US pregnant women. PMID:22752348
Friel, Catherine J
According to the National Assessment of Adult Literacy (2003), only 12% of U.S. adults have a proficient level of health literacy, with adults 65 years and older more likely to have a below basic or a basic health literacy level. An estimated 5.8 million individuals in the United States have heart failure (HF) and it is one of the most common reasons for those aged 65 and over to be hospitalized. Many patients with HF are at risk for poor health outcomes due to low health literacy. This article reviews the literature with regard to the effectiveness of methods used to address low health literacy among HF patients and describes a pilot study implemented by a home care agency in the northeast to address high HF readmission rates. PMID:27580282
Hincapie, A.; Warholak, T.
Background and Objective Healthcare professionals, industry and policy makers have identified Health Information Exchange (HIE) as a solution to improve patient safety and overall quality of care. The potential benefits of HIE on healthcare have fostered its implementation and adoption in the United States. However,there is a dearth of publications that demonstrate HIE effectiveness. The purpose of this review was to identify and describe evidence of HIE impact on healthcare outcomes. Methods A database search was conducted. The inclusion criteria included original investigations in English that focused on a HIE outcome evaluation. Two independent investigators reviewed the articles. A qualitative coding approach was used to analyze the data. Results Out of 207 abstracts retrieved, five articles met the inclusion criteria. Of these, 3 were randomized controlled trials, 1 involved retrospective review of data, and 1 was a prospective study. We found that HIE benefits on healthcare outcomes are still sparsely evaluated, and that among the measurements used to evaluate HIE healthcare utilization is the most widely used. Conclusions Outcomes evaluation is required to give healthcare providers and policy-makers evidence to incorporate in decision-making processes. This review showed a dearth of HIE outcomes data in the published peer reviewed literature so more research in this area is needed. Future HIE evaluations with different levels of interoperability should incorporate a framework that allows a detailed examination of HIE outcomes that are likely to positively affect care. PMID:23616891
Bond, Meg A; Punnett, Laura; Pyle, Jean L; Cazeca, Dianne; Cooperman, Manuela
This cross-sectional study of nonfaculty university employees examined associations among gendered work conditions (e.g., sexism and discrimination), job demands, and employee job satisfaction and health. Organizational responsiveness and social support were examined as effect modifiers. Comparisons were made by gender and by the male-female ratio in each job category. The relationship of gendered conditions of work to outcomes differed on the basis of respondents' sex and the job sex ratio. Although the same predictors were hypothesized for job satisfaction, physical health, and psychological distress, there were some differing results. The strongest correlate of job satisfaction was social support; perceived sexism in the workplace also contributed for both men and women. Organizational factors associated with psychological distress differed between female- and male-dominated jobs. PMID:14700456
Jennings, B M
Policy makers are targeting patient outcomes and the effectiveness of interventions as possible ways to curb spiraling health care costs. Quality assurance/improvement programs are focusing on patient outcomes as a way to evaluate and improve care delivery. Consequently, members of the Military Health Services System need a solid understanding of the current emphasis on the outcomes of care to be knowledgeable participants in the health care changes precipitated by highlighting patient outcomes. PMID:8502389
Nelson-Peterman, Jerusha L; Toof, Robin; Liang, Sidney L; Grigg-Saito, Dorcas C
Refugees in the United States have high rates of chronic disease. Both long-term effects of the refugee experience and adjustment to the U.S. health environment may contribute. While there is significant research on health outcomes of newly resettled refugees and long-term mental health experiences of established refugees, there is currently little information about how the combined effects of the refugee experience and the U.S. health environment are related to health practices of refugees in the years and decades after resettlement. We examined cross-sectional survey data for Cambodian refugee and immigrant women 35 to 60 years old (n = 160) from an established refugee community in Lowell, Massachusetts, to examine the potential contributors to health behaviors and outcomes among refugees and immigrants postresettlement. In our representative sample, we found that smoking and betel nut use were very low (4% each). Fewer than 50% of respondents walked for at least 10 minutes on 2 or more days/week. Using World Health Organization standards for overweight/obese for Asians, 73% of respondents were overweight/obese and 56% were obese, indicating increased risk of chronic disease. Depression was also high in this sample (41%). In multivariate models, higher acculturation and age were associated with walking more often; lower education and higher acculturation were related to higher weight; and being divorced/separated or widowed and being older were related to higher risk of depression. The interrelated complex of characteristics, health behaviors, and health outcomes of refugees merits a multifaceted approach to health education and health promotion for long-term refugee health. PMID:26157042
Bonsel, Gouke J.
Background Intersectoral perspectives of health are present in the rhetoric of the sustainable development goals. Yet its descriptions of systematic approaches for an intersectoral monitoring vision, joining determinants of health, and barriers or facilitators to accessing healthcare services are lacking. Objective To explore models of associations between health outcomes and health service coverage, and health determinants and health systems responsiveness, and thereby to contribute to monitoring, analysis, and assessment approaches informed by an intersectoral vision of health. Design The study is designed as a series of ecological, cross-country regression analyses, covering between 23 and 57 countries with dependent health variables concentrated on the years 2002–2003. Countries cover a range of development contexts. Health outcome and health service coverage dependent variables were derived from World Health Organization (WHO) information sources. Predictor variables representing determinants are derived from the WHO and World Bank databases; variables used for health systems’ responsiveness are derived from the WHO World Health Survey. Responsiveness is a measure of acceptability of health services to the population, complementing financial health protection. Results Health determinants’ indicators – access to improved drinking sources, accountability, and average years of schooling – were statistically significant in particular health outcome regressions. Statistically significant coefficients were more common for mortality rate regressions than for coverage rate regressions. Responsiveness was systematically associated with poorer health and health service coverage. With respect to levels of inequality in health, the indicator of responsiveness problems experienced by the unhealthy poor groups in the population was statistically significant for regressions on measles vaccination inequalities between rich and poor. For the broader determinants, the
Karras, Bryant T.; Tufano, James T.
This paper describes the development process of an evaluation framework for describing and comparing web survey tools. We believe that this approach will help shape the design, development, deployment, and evaluation of population-based health interventions. A conceptual framework for describing and evaluating web survey systems will enable the…
Mackenbach, J D; Lakerveld, J; van Lenthe, F J; Kawachi, I; McKee, M; Rutter, H; Glonti, K; Compernolle, S; De Bourdeaudhuij, I; Feuillet, T; Oppert, J-M; Nijpels, G; Brug, J
We compared ecometric neighbourhood scores of social capital (contextual variation) to mean neighbourhood scores (individual and contextual variation), using several health-related outcomes (i.e. self-rated health, weight status and obesity-related behaviours). Data were analysed from 5,900 participants in the European SPOTLIGHT survey. Factor analysis of the 13-item social capital scale revealed two social capital constructs: social networks and social cohesion. The associations of ecometric and mean neighbourhood-level scores of these constructs with self-rated health, weight status and obesity-related behaviours were analysed using multilevel regression analyses, adjusted for key covariates. Analyses using ecometric and mean neighbourhood scores, but not mean neighbourhood scores adjusted for individual scores, yielded similar regression coefficients. Higher levels of social network and social cohesion were not only associated with better self-rated health, lower odds of obesity and higher fruit consumption, but also with prolonged sitting and less transport-related physical activity. Only associations with transport-related physical activity and sedentary behaviours were associated with mean neighbourhood scores adjusted for individual scores. As analyses using ecometric scores generated the same results as using mean neighbourhood scores, but different results when using mean neighbourhood scores adjusted for individual scores, this suggests that the theoretical advantage of the ecometric approach (i.e. teasing out individual and contextual variation) may not be achieved in practice. The different operationalisations of social network and social cohesion were associated with several health outcomes, but the constructs that appeared to represent the contextual variation best were only associated with two of the outcomes. PMID:26879117
Ravens-Sieberer, Ulrike; Freeman, John; Kokonyei, Gyongyi; Thomas, Christiane A.; Erhart, Michael
Purpose: The purpose of this paper is to investigate whether students' perceptions of their school environment and their adjustment to school are associated with health outcomes across gender and age groups. Design/methodology/approach: Data from the cross-sectional international Health Behavior in School-aged Children Survey of the year 2002…
Hevey, D; French, D P
People tend to be comparatively optimistic (i.e., believe that negative outcomes are less likely for themselves than for typical others) regarding their susceptibility to negative health outcomes. The present study investigates the extent to which perceptions of the severity of these health outcomes show similar comparative optimism. A student sample (study 1; N = 200) and a healthy non-student adult sample (study 2; N = 257) completed self-report measures of susceptibility, severity, worry, control and experience in relation to negative health outcomes. Participants in both studies demonstrated significant levels of comparative optimism for both perceived likelihood and severity of health outcomes. Comparative optimism concerning severity was very strongly associated (r = 0.85 to 0.89) with comparative optimism concerning susceptibility. In addition to being comparatively optimistic over their chances of experiencing negative health outcomes, people are also comparatively optimistic regarding how severe the health outcomes will be. PMID:22111753
Background The ‘human resources for health’ crisis has highlighted the need for more health (care) professionals and led to an increased interest in health professional education, including master’s degree programmes. The number of these programmes in low- and middle-income countries (LMIC) is increasing, but questions have been raised regarding their relevance, outcome and impact. We conducted a systematic review to evaluate the outcomes and impact of health-related master’s degree programmes. Methods We searched the databases Scopus, Pubmed, Embase, CINAHL, ERIC, Psychinfo and Cochrane (1999 - November 2011) and selected websites. All papers describing outcomes and impact of health-related Master programmes were included. Three reviewers, two for each article, extracted data independently. The articles were categorised by type of programme, country, defined outcomes and impact, study methods used and level of evidence, and classified according to outcomes: competencies used in practice, graduates’ career progression and impact on graduates’ workplaces and sector/society. Results Of the 33 articles included in the review, most originated from the US and the UK, and only one from a low-income country. The programmes studied were in public health (8), nursing (8), physiotherapy (5), family practice (4) and other topics (8). Outcomes were defined in less than one third of the articles, and impact was not defined at all. Outcomes and impact were measured by self-reported alumni surveys and qualitative methods. Most articles reported that competencies learned during the programme were applied in the workplace and alumni reported career progression or specific job changes. Some articles reported difficulties in using newly gained competencies in the workplace. There was limited evidence of impact on the workplace. Only two articles reported impact on the sector. Most studies described learning approaches, but very few described a mechanism to ensure outcome
Craig, Benjamin M.; Reeve, Bryce B.; Brown, Paul M.; Cella, David; Hays, Ron D.; Lipscomb, Joseph; Pickard, A. Simon; Revicki, Dennis A.
Objectives Health valuation studies enhance economic evaluations of treatments by estimating the value of health-related quality of life (HRQoL). The Patient-Reported Outcomes Measurement Information System® (PROMIS) includes a 29-item short-form HRQOL measure, the PROMIS-29. Methods To value PROMIS-29 responses on a quality-adjusted life year (QALY) scale, we conducted a national survey (N=7557) using quota sampling based on the US 2010 Census. Based on 541 paired comparisons with over 350 responses each, pair-specific probabilities were incorporated into a weighted least-squared estimator. Results All losses in HRQoL influenced choice; however, respondents valued losses in physical function, anxiety, depression, sleep, and pain more than those in fatigue and social functioning. Conclusions This paper introduces a novel approach to valuing HRQoL for economic evaluations using paired comparisons and provides a tool to translate PROMIS-29 responses into QALYs. PMID:25498780
Posada-Villa, Jose; Camacho, Juan Camilo; Valenzuela, Jose Ignacio; Arguello, Arturo; Cendales, Juan Gabriel; Fajardo, Roosevelt
A community survey in 4,426 adults was undertaken as part of the World Mental Health Survey Initiative reporting the prevalence and risk factors for suicide-related outcomes in Colombia. Lifetime prevalence estimates of suicide ideation, plans, attempts, and risk factors for suicide-related outcomes were assessed. Retrospective reports of…
The National Maternal and Infant Health Survey (NMIHS) provides data on maternal and infant health, including prenatal care, birth weight, fetal loss, and infant mortality. The objective of the NMIHS is to collect data needed by Federal, State, and private researchers to study fa...
The Guatemalan Survey of Family Health, known as EGSF from its name in Spanish, was designed to examine the way in which rural Guatemalan families and individuals cope with childhood illness and pregnancy, and the role of ethnicity, poverty, and social support and health beliefs ...
The Hispanic Health and Nutrition Examination Survey (HHANES) was a nationwide probability sample of approximately 16,000 persons, 6 months-74 years of age. Hispanics were included in past health and nutrition examinations, but neither in sufficient numbers to produce estimates o...
Harrell, Camara Jules P.; Burford, Tanisha I.; Cage, Brandi N.; Nelson, Travette McNair; Shearon, Sheronda; Thompson, Adrian; Green, Steven
This commentary discusses advances in the conceptual understanding of racism and selected research findings in the social neurosciences. The traditional stress and coping model holds that racism constitutes a source of aversive experiences that, when perceived by the individual, eventually lead to poor health outcomes. Current evidence points to additional psychophysiological pathways linking facets of racist environments with physiological reactions that contribute to disease. The alternative pathways emphasize prenatal experiences, subcortical emotional neural circuits, conscious and preconscious emotion regulation, perseverative cognitions, and negative affective states stemming from racist cognitive schemata. Recognition of these pathways challenges change agents to use an array of cognitive and self-controlling interventions in mitigating racism’s impact. Additionally, it charges policy makers to develop strategies that eliminate deep-seated structural aspects of racism in society. PMID:22518195
Greene, Sandra B.; Mays, Glen P.; Ricketts, Thomas C.; Davis, Mary V.
We explored the association between changes in local health department (LHD) resource levels with changes in health outcomes via a retrospective cohort study. We measured changes in expenditures and staffing reported by LHDs on the 1997 and 2005 National Association of County and City Health Officials surveys and assessed changes in state-level health outcomes with the America's Health Rankings reports for those years. We used pairwise correlation and multivariate regression to analyze the association of changes in LHD resources with changes in health outcomes. Increases in LHD expenditures were significantly associated with decreases in infectious disease morbidity at the state level (P = .037), and increases in staffing were significantly associated with decreases in cardiovascular disease mortality (P = .014), controlling for other factors. PMID:20558799
Lipson, J G; Omidian, P A; Paul, S M
This study assessed the health concerns and needs for health education in the Afghan refugee and immigrant community of the San Francisco Bay Area. The study used a telephone survey, seven community meetings and a survey administered to 196 Afghan families through face-to-face interviews. Data were analyzed qualitatively and statistically. Health problems of most concern are mental health problems and stress related to past refugee trauma and loss, current occupational and economic problems, and culture conflict. Physical health problems include heart disease, diabetes and dental problems. Needed health education topics include dealing with stress, heart health, nutrition, raising children in the United States (particularly adolescents), aging in the United States, and diabetes. Using coalition building and involving Afghans in their community assessment, we found that the Afghan community is eager for culture- and language-appropriate health education programs through videos, television, lectures, and written materials. Brief health education talks in community meetings and a health fair revealed enthusiasm and willingness to consider health promotion and disease-prevention practices. PMID:7596962
Pereira Lima, Vera Lucia Góes; Arruda, José Maria; Barroso, Maria Auxiliadora Bessa; Lobato Tavares, Maria de Fátima; Ribeiro Campos, Nora Zamith; Zandonadil, Regina Celi Moreira Basílio; da Rocha, Rosa Maria; Parreira, Clélia Maria de Souza Ferreira; Cohen, Simone Cynamon; Kligerman, Débora Cynamon; Sperandio, Ana Maria Girotti; Correa, Carlos Roberto Silveira; Serrano, Miguel Malo
This article focuses on health promotion (HP) outcomes, illustrated through evaluation of case studies and identification of strategies which have contributed to their success and sustainability. Evaluation research and practice in three distinct sceneries are discussed: (i) institutional and governmental agencies; (ii) communities in the "Manguinhos Complex" and Nova Iguaqu Municipality, and (iii) building of potentially healthy municipality networks. The effectiveness of a social program in a health promotion perspective was based in the "School for Parents" program, undertaken by the First Court of Childhood and Youth of Rio de Janeiro, between 2001 and 2004. The analysis was grounded in the monitoring of 48 parents in charge of children under 18, who were victims of abuse, violence or negligence, and social exclusion, most of all. The study's objectives were: illustrating the evidence of effectiveness of health promotion, discussing the concept of HP effectiveness under macro unfavorable conditions, and identifying strategies that foster sustainability of results. Institutional resources included a multi-professional staff, multidisciplinary approaches, participatory workshops, family case management, partnership with public and private institutions, and volunteer and civil society sponsorship of the families. Evaluation was based on social impact indicators, and psychosocial and contextual determinants. Evaluation methods included program monitoring and quantitative-qualitative methods, through a longitudinal evaluation of 3 years, including one year post program. The evaluation showed highly favorable results concerning "family integration', "quality of family relations" and "human rights mobilization". Unsatisfactory results such as "lack of access to formal employment" are likely related to structural factors and the need for new public policies in areas such as education, professional training, housing, and access to formal employment. The training process
Garfinkel, Michele S.; Sarewitz, Daniel; Porter, Alan L.
The linkages between decisions about health research and policy and actual health outcomes may be extraordinarily difficult to specify. We performed a pilot application of a “road mapping” and technology assessment technique to perinatal health to illustrate how this technique can clarify the relations between available options and improved health outcomes. We used a combination of data-mining techniques and qualitative analyses to set up the underlying structure of a societal health outcomes road map. Societal health outcomes road mapping may be a useful tool for enhancing the ability of the public health community, policymakers, and other stakeholders, such as research administrators, to understand health research and policy options. PMID:16449589
Sellers, Katie; Leider, Jonathon P.; Harper, Elizabeth; Castrucci, Brian C.; Bharthapudi, Kiran; Liss-Levinson, Rivka; Jarris, Paul E.; Hunter, Edward L.
Context: Public health practitioners, policy makers, and researchers alike have called for more data on individual worker's perceptions about workplace environment, job satisfaction, and training needs for a quarter of a century. The Public Health Workforce Interests and Needs Survey (PH WINS) was created to answer that call. Objective: Characterize key components of the public health workforce, including demographics, workplace environment, perceptions about national trends, and perceived training needs. Design: A nationally representative survey of central office employees at state health agencies (SHAs) was conducted in 2014. Approximately 25 000 e-mail invitations to a Web-based survey were sent out to public health staff in 37 states, based on a stratified sampling approach. Balanced repeated replication weights were used to account for the complex sampling design. Setting and Participants: A total of 10 246 permanently employed SHA central office employees participated in PH WINS (46% response rate). Main Outcome Measures: Perceptions about training needs; workplace environment and job satisfaction; national initiatives and trends; and demographics. Results: Although the majority of staff said they were somewhat or very satisfied with their job (79%; 95% confidence interval [CI], 78-80), as well as their organization (65%; 95% CI, 64-66), more than 42% (95% CI, 41-43) were considering leaving their organization in the next year or retiring before 2020; 4% of those were considering leaving for another job elsewhere in governmental public health. The majority of public health staff at SHA central offices are female (72%; 95% CI, 71-73), non-Hispanic white (70%; 95% CI, 69-71), and older than 40 years (73%; 95% CI, 72-74). The greatest training needs include influencing policy development, preparing a budget, and training related to the social determinants of health. Conclusions: PH WINS represents the first nationally representative survey of SHA employees. It
Cowing, Michelle; Davino-Ramaya, Carrie M; Ramaya, Krishnan; Szmerekovsky, Joseph
As competition intensifies within the health care industry, patient satisfaction and service quality are providing the evidentiary basis for patient outcomes. We propose a conceptual model of three interrelated areas, service, health outcomes, and resource stewardship, all affected by the clinician-patient relationship. Our model considers the perspectives of the health care organization, the clinician, and the patient to define a more comprehensive measure of health care delivery performance. Research and managerial aspects, including implementation, are discussed. PMID:20740107
Kobau, R; Cui, W; Kadima, N; Zack, MM; Sajatovic, M; Kaiboriboon, K; Jobst, B
Objective This study provides population-based estimates of psychosocial health among U.S. adults with epilepsy from the 2010 National Health Interview Survey. Methods Multinomial logistic regression was used to estimate the prevalence of the following measures of psychosocial health among adults with and those without epilepsy: 1) the Kessler-6 scale of Serious Psychological Distress; 2) cognitive limitation; the extent of impairments associated with psychological problems; and work limitation; 3) Social participation; and 4) the Patient Reported Outcome Measurement Information System Global Health scale. Results Compared with adults without epilepsy, adults with epilepsy, especially those with active epilepsy, reported significantly worse psychological health, more cognitive impairment, difficulty in participating in some social activities, and reduced health-related quality of life (HRQOL). Conclusions These disparities in psychosocial health in U.S. adults with epilepsy serve as baseline national estimates of their HRQOL, consistent with Healthy People 2020 national objectives on HRQOL. PMID:25305435
Trent, Ava M.
Provides a brief overview of the process of outcomes assessment and examples of its application in professional health science education. Provides a background for other articles in this issue describing ongoing activities in outcomes assessment in veterinary education and for programs considering developing a plan. Focuses on health professions…
Dutton, Mary Ann; Green, Bonnie L.; Kaltman, Stacey I.; Roesch, Darren M.; Zeffiro, Thomas A.; Krause, Elizabeth D.
The high prevalence of adverse health outcomes related to intimate partner violence (IPV) is well documented. Yet we know little about the pathways that lead to adverse health outcomes. Research concerning the psychological, biological, neurological, behavioral, and physiological alterations following exposure to IPV--many of which are associated…
Albanese, Mark A.; Dast, Laura
Over the past 30 years, problem-based learning (PBL) has become a major force in health professions education and even in the broader educational world. This article focuses on the outcomes that have been found from using PBL in the health professions based on at least 20 reviews done since 1990. The outcomes identified in these reviews are…
... 42 Public Health 4 2010-10-01 2010-10-01 false Participant health outcomes data. 460.202 Section 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) Data Collection, Record Maintenance, and Reporting § 460.202 Participant...
... 42 Public Health 4 2011-10-01 2011-10-01 false Participant health outcomes data. 460.202 Section 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) Data Collection, Record Maintenance, and Reporting § 460.202 Participant...
... 42 Public Health 4 2014-10-01 2014-10-01 false Participant health outcomes data. 460.202 Section 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) Data Collection, Record Maintenance, and Reporting § 460.202 Participant...
... 42 Public Health 4 2012-10-01 2012-10-01 false Participant health outcomes data. 460.202 Section 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) Data Collection, Record Maintenance, and Reporting § 460.202 Participant...
... 42 Public Health 4 2013-10-01 2013-10-01 false Participant health outcomes data. 460.202 Section 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) Data Collection, Record Maintenance, and Reporting § 460.202 Participant...
Kang, Yang Wha; Ko, Yun Sil; Kim, Yoo Jin; Sung, Kyoung Mi; Kim, Hyo Jin; Choi, Hyung Yun; Sung, Changhyun; Jeong, Eunkyeong
In 2008, Korea Centers for Disease Control and Prevention initiated the first nationwide survey, Korea Community Health Survey (KCHS), to provide data that could be used to plan, implement, monitor, and evaluate community health promotion and disease prevention programs. This community-based cross-sectional survey has been conducted by 253 community health centers, 35 community universities, and 1500 interviewers. The KCHS standardized questionnaire was developed jointly by the Korea Centers for Disease Control and Prevention staff, a working group of health indicators standardization subcommittee, and 16 metropolitan cities and provinces with 253 regional sites. The questionnaire covers a variety of topics related to health behaviors and prevention, which is used to assess the prevalence of personal health practices and behaviors related to the leading causes of disease, including smoking, alcohol use, drinking and driving, high blood pressure control, physical activity, weight control, quality of life (European Quality of Life-5 Dimensions, European Quality of Life-Visual Analogue Scale, Korean Instrumental Activities of Daily Living ), medical service, accident, injury, etc. The KCHS was administered by trained interviewers, and the quality control of the KCHS was improved by the introduction of a computer-assisted personal interview in 2010. The KCHS data allow a direct comparison of the differences of health issues among provinces. Furthermore, the provinces can use these data for their own cost-effective health interventions to improve health promotion and disease prevention. For users and researchers throughout the world, microdata (in the form of SAS files) and analytic guidelines can be downloaded from the KCHS website (http://KCHS.cdc.go.kr/) in Korean. PMID:26430619
Sorenson, Shawn C.; Romano, Russell; Scholefield, Robin M.; Schroeder, E. Todd; Azen, Stanley P.; Salem, George J.
Context Self-report questionnaires are an important method of evaluating lifespan health, exercise, and health-related quality of life (HRQL) outcomes among elite, competitive athletes. Few instruments, however, have undergone formal characterization of their psychometric properties within this population. Objective To evaluate the validity and reliability of a novel health and exercise questionnaire, the Trojan Lifetime Champions (TLC) Health Survey. Design Descriptive laboratory study. Setting A large National Collegiate Athletic Association Division I university. Patients or Other Participants A total of 63 university alumni (age range, 24 to 84 years), including former varsity collegiate athletes and a control group of nonathletes. Intervention(s) Participants completed the TLC Health Survey twice at a mean interval of 23 days with randomization to the paper or electronic version of the instrument. Main Outcome Measure(s) Content validity, feasibility of administration, test-retest reliability, parallel-form reliability between paper and electronic forms, and estimates of systematic and typical error versus differences of clinical interest were assessed across a broad range of health, exercise, and HRQL measures. Results Correlation coefficients, including intraclass correlation coefficients (ICCs) for continuous variables and κ agreement statistics for ordinal variables, for test-retest reliability averaged 0.86, 0.90, 0.80, and 0.74 for HRQL, lifetime health, recent health, and exercise variables, respectively. Correlation coefficients, again ICCs and κ, for parallel-form reliability (ie, equivalence) between paper and electronic versions averaged 0.90, 0.85, 0.85, and 0.81 for HRQL, lifetime health, recent health, and exercise variables, respectively. Typical measurement error was less than the a priori thresholds of clinical interest, and we found minimal evidence of systematic test-retest error. We found strong evidence of content validity, convergent
Pasick, R. J.; Stewart, S. L.; Bird, J. A.; D'Onofrio, C. N.
OBJECTIVE: There has been insufficient research on the influence of ethno-cultural and language differences in public health surveys. Using data from three independent studies, the authors examine methods to assess data quality and to identify causes of problematic survey questions. METHODS: Qualitative and quantitative methods were used in this exploratory study, including secondary analyses of data from three baseline surveys (conducted in English, Spanish, Cantonese, Mandarin, and Vietnamese). Collection of additional data included interviews with investigators and interviewers; observations of item development; focus groups; think-aloud interviews; a test-retest assessment survey; and a pilot test of alternatively worded questions. RESULTS: The authors identify underlying causes for the 12 most problematic variables in three multiethnic surveys and describe them in terms of ethnic differences in reliability, validity, and cognitive processes (interpretation, memory retrieval, judgment formation, and response editing), and differences with regard to cultural appropriateness and translation problems. CONCLUSIONS: Multiple complex elements affect measurement in a multiethnic survey, many of which are neither readily observed nor understood through standard tests of data quality. Multiethnic survey questions are best evaluated using a variety of quantitative and qualitative methods that reveal different types and causes of problems. PMID:11889288
Lytle, R S; Mokwa, M P
An integrative model of health care quality is presented. "Health care quality" is defined as provider conformance to patient requirements at three benefit levels: core, intangible, and tangible. The model is operationalized and tested in a clinical setting, a large center for fertility studies with more than 5000 patients. Health care "process variables" such as physician and patient interactions were not as important in patients' evaluations of health care quality when successful outcomes occurred (pregnancy). However, when patients experienced unsuccessful outcomes (no pregnancy), health care "process variables" were important and had a significant influence on patient perceptions of health care quality. Hence, service outcomes can significantly affect the measurement and interpretation of health care quality. Implications for health care management and research are discussed. PMID:10116754
Primack, Brian A.; Carroll, Mary V.; McNamara, Megan; Klem, Mary Lou; King, Brandy; Rich, Michael O.; Chan, Chun W.; Nayak, Smita
Context Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it may also be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes. Evidence acquisition Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source), sample data (e.g., number of study participants, demographics), intervention and control details, outcomes data, and quality measures were abstracted independently by two researchers. Evidence synthesis Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of <12 weeks, and only 11% of studies blinded researchers. Conclusions There is potential promise for video games to improve
The objective of this study was to pilot test a Nutrition Health Outcomes Questionnaire (NHOQ) designed to identify overweight/obese persons at risk for funcitonal decline and increased healthcare use. The NHOQ is a 14-item self-administered survey that queries body weight/weight change, dietary pr...
Hurster, Madeline M.; Whitmore, Robert M.
A survey of members of the Health Education Section, American College Health Association, indicates that they feel the major object of health education programs is to make the student aware that his health is primarily his responsibility and that colleges aid the student in assuming this responsibility. (MB)
War-related traumas impact refugees' mental health. Recent literature suggests that structural and sociocultural factors related to the resettlement also become critical in shaping refugees' mental health. So far, there is limited empirical evidence to support this claim among resettled refugees. Resettlement contextual factors that influence mental health outcomes were examined using Latino and Asian refugees (n = 656) from a nationally representative survey. Linear and logistic regressions predicted factors associated with the study's outcomes (self-reported mental health, mood disorders, and anxiety disorders). Post-resettlement traumas were significantly associated with mental health outcomes, but pre-resettlement traumas were not. Unemployment, everyday discrimination, and limited English were significantly associated with mental health outcomes among both Latino and Asian refugees. The outcomes indicate that resettlement contextual factors have a significant association with refugees' mental health. Therefore, future studies with refugees must pay closer attention to structural and sociocultural factors after resettlement. PMID:26169507
Achmad, S I; Westley, S B
The Baseline Survey of Young Adult Reproductive Welfare in Indonesia, conducted from September to December 1998, provides information about young Indonesians on topics concerning work, education, marriage, family life, sexuality, fertility, and HIV/AIDS and other sexually transmitted diseases. The survey interviewed 4106 men and 3978 women aged 15-24 years in three provinces of Java. Survey findings showed that 42% of the women and 8% of the men are currently or have been married. There was a strong inverse relationship between marriage and schooling, which suggests that greater educational attainment and a higher average age at marriage are likely to go together. Although most young couples prefer to delay and space births, only half of currently married young women are using any type of contraception. These results indicate that there is a need for better reproductive health care as well as improved reproductive health education. Moreover, the current economic crisis has lead to a decline in the use of the private sector for health care. Instead, young people are using the less-expensive government services, and young women are turning to pharmacies and midwives rather than to private doctors to obtain contraceptives. These findings have several policy implications including the need for reproductive health programs that provide services needed by young people. PMID:12295693
McGrath, Jennifer J.
Objective To examine the effects of provincial income inequality (disparity between rich and poor), independent of provincial income and family socioeconomic status, on multiple adolescent health outcomes. Methods Participants (aged 12–17 years; N = 11,899) were from the Canadian National Longitudinal Survey of Children and Youth. Parental education, household income, province income inequality, and province mean income were measured. Health outcomes were measured across a number of domains, including self-rated health, mental health, health behaviors, substance use behaviors, and physical health. Results Income inequality was associated with injuries, general physical symptoms, and limiting conditions, but not associated with most adolescent health outcomes and behaviors. Income inequality had a moderating effect on family socioeconomic status for limiting conditions, hyperactivity/inattention, and conduct problems, but not for other outcomes. Conclusions Province-level income inequality was associated with some physical and mental health outcomes in adolescents, which has research and policy implications for this age-group. PMID:25324533
Chen, Ding-Geng(Din); Lin, Feng; Chen, Xinguang (Jim); Tang, Wan; Kitzman, Harriet
Background Although health outcomes may have fundamentally nonlinearly relationships with relevant behavioral, psychological, cognitively, or biological predictors, most analytical models assume a linear relationship. Further, some health outcomes may have multimodal distributions but most statistical models in commun use assume a unimodal, normal distribution. Suitable nonlinear models should be developed to explain health outcomes. Objective The aim of this study is to provide an overview of a cusp catastrophe model for examining health outcomes, and to present an example using grip strength as an indicator of a physical functioning outcome to illustrate how the technique may be used. Results using linear regression, nonlinear logistic model and the cusp catastrophe model were compared. Methods Data from 935 participants from the Survey of Midlife Development in the United States (MIDUS) were analyzed. The outcome was grip strength; executive function (EF) and the inflammatory cytokine interleukin-6 (IL-6) were predictor variables. Results Grip strength was bimodally distributed. Based on fit and model selection criteria, the cusp model was superior to the linear model and the nonlinear logistic regression model. The cusp catastrophe model identified IL-6 as a significant asymmetry factor and EF as a significant bifurcation factor. Conclusion The cusp catastrophe model is a useful alternative for for explaining the nonlinear relationships commonly seen between health outcome and its predictors. Considerations for the use of cusp catastrophe model in nursing research are discussed and recommended. PMID:24785249
Adams, Richard E; Boscarino, Joseph A
A number of studies have assessed the association between acculturation and psychological outcomes following a traumatic event. Some suggest that low acculturation is associated with poorer health outcomes, while others show no differences or that low acculturation is associated with better outcomes. One year after the terrorist attacks on the World Trade Center, we surveyed a multi-ethnic population of New York City adults (N= 2,368). We assessed posttraumatic stress disorder (PTSD), major depression, panic attack, anxiety symptoms, and general physical and mental health status. We classified study respondents into "low," "moderate," or "high" acculturation, based on survey responses. Bivariate results indicated that low acculturation individuals were more likely to experience negative life events, have low social support, and less likely to have pre-disaster mental health disorders. Those in the low acculturation group were also more likely to experience post-disaster perievent panic attacks, have higher anxiety, and have poorer mental health status. However, using logistic regression to control for confounding, and adjusting for multiple comparisons, we found that none of these outcomes were associated with acculturation status. Thus, our study suggests that acculturation was not associated with mental health outcomes following a major traumatic event. PMID:24558696
Stanhope, Victoria; Barrenger, Stacey L.; Salzer, Mark S.; Marcus, Stephen C.
Background: Self-determination within mental health services is increasingly recognized as an ethical imperative, but we still know little about the impact of choice on outcomes among people with severe mental illnesses. This study examines whether choice predicts outcomes and whether this relationship is mediated by therapeutic alliance. Method: The study sample of 396 participants completed a survey measuring choice, therapeutic alliance, recovery, quality of life and functioning. Multivariate analyses examined choice as a predictor of outcomes, and Sobel tests assessed alliance as a mediator. Results: Choice variables predicted recovery, quality of life and perceived outcomes. Sobel tests indicated that the relationship between choice and outcome variables was mediated by therapeutic alliance. Implications: The study demonstrates that providing more choice and opportunities for collaboration within services does improve consumer outcomes. The results also show that collaboration is dependent on the quality of the relationship between the provider and consumer. PMID:25562652
Ross, Alyson; Friedmann, Erika; Bevans, Margaret; Thomas, Sue
Summary Objectives to describe yoga practice and health characteristics of individuals who practice yoga, and to explore their beliefs regarding the effects of their yoga practice on their health. Design a cross-sectional design with anonymous online surveys Setting 4307 randomly selected individuals from 15 US Iyengar yoga studios (n = 18,160), representing 41 states; 1087 individuals responded, with 1045 (24.3%) surveys completed. Outcome Measures Freiberg Mindfulness Inventory, Mental Health Continuum (subjective well-being), Multi-factor Screener (diet), PROMIS sleep disturbance, fatigue, and social support, International Physical Activity Questionnaire. Results Age: 19 to 87 years (M = 51.7 ± 11.7), 84.2% female, 89.2% white, 87.4% well educated (≥ bachelor’s degree). Mean years of yoga practice = 11.4 (± 7.5). BMI = 12.1–49.4 (M = 23.1 ± 3.9). Levels of obesity (4.9%), smoking (2%), and fruit and vegetable consumption (M = 6.1 ± 1.1) were favorable compared to national norms. 60% reported at least one chronic/serious health condition, yet most reported very good (46.3%) or excellent (38.8%) general health. Despite high levels of depression (24.8 %), nearly all were moderately mentally healthy (55.2%) or flourishing (43.8%). Participants agreed yoga improved: energy (84.5%), happiness (86.5%), social relationships (67%), sleep (68.5%), and weight (57.3%), and beliefs did not differ substantially according to race or gender. The more they practiced yoga, whether in years or in amount of class or home practice, the higher their odds of believing yoga improved their health. Conclusions Individuals who practice yoga are not free of health concerns, but most believe their health improved because of yoga. Yoga might be beneficial for a number of populations including elderly women and those with chronic health conditions. PMID:23876562
Dobel-Ober, D; Brimblecombe, N; Bradley, E
Mental health nurses can now train to become independent prescribers as well as supplementary prescribers. Independent nurse prescribing can potentially help to reorganize mental health services, increase access to medicines and improve service user information, satisfaction and concordance. However, mental health nursing has been slow to undertake prescribing roles, and there has been little work conducted to look at where nurse prescribing is proving successful, and those areas where it is less so. This survey was designed to collect information from directors of nursing in mental health trusts about the numbers of mental health prescribers in England, gather views about prescribing in practice, and elicit intentions with regards to the development of nurse prescribing. In some Trusts, the number of mental health nurse prescribers has increased to the point where wider impacts on workforce, the configuration of teams and services are inevitable. Currently, the way that prescribing is used within different organizations, services and teams varies and it is unclear which setting is most appropriate for the different modes of prescribing. Future work should focus on the impact of mental health nurse prescribing on service delivery, as well as on service users, colleagues and nurses themselves. PMID:20633075
Bierman, A S; Lawrence, W F; Haffer, S C; Clancy, C M
OBJECTIVE: the Medicare Health Outcomes Survey (HOS), a new quality measure in the Health Plan Employer Data and Information Set, is designed to assess physical and mental functional health outcomes of Medicare beneficiaries enrolled in Medicare+Choice organizations. We discuss the rationale for the HOS measure together with methodologic challenges in its use and interpretation, using descriptive data from the baseline Medicare HOS to illustrate some of these challenges. DATA SOURCES/STUDY DESIGN: The 1999 Cohort 2 Medicare HOS baseline data were used for a cross-sectional descriptive analysis. A random sample of 1,000 beneficiaries from each health plan with a Medicare+Choice contract was surveyed (N = 156,842; 282 organizations included in these analyses) . PRINCIPAL FINDINGS: The HOS measure is designed to assess a previously unmeasured dimension of quality. Plan-level variation was seen across all baseline measures of sociodemographic characteristics and illness burden. At the individual level socioeconomic position as measured by educational attainment was strongly associated with functional status. The least educated beneficiaries had the highest burden of illness on all measures examined, and there was a consistent and significant gradient in health and functional status across all levels of education. In analyses stratified by race and ethnicity, socioeconomic gradients in f un ct ion persist ed. CONCLUSIONS Despite limitations, by focusing at t en t ion on the need to improve functional health out comes among elderly Medicare beneficiaries enrolled in Medicare+Choice, the HOS can serve as an important new tool to support efforts to improve health care quality. The HOS provides valuable information at the federal, state, and health plan levels that can be used to identify, prioritize, and evaluate quality improvement interventions and monitor progress for the program overall as well as for vulnerable subgroups. To interpret the HOS as a quality measure
Reed, Danielle; Reno, Jessica; Green, Dan
Research has consistently demonstrated a relationship between history of forced sex and poor behavioral health outcomes. The objectives of this study were to describe this relationship among high school students and to explore the impact of resiliency factors. Using data from the 2013 New Mexico Youth Risk and Resiliency Survey, we found that history of forced sex was associated with negative behavioral health outcomes for males and females, regardless of sexual orientation and disability status. Furthermore, the presence of a caring adult at home appeared to reduce the risk of substance abuse and suicidality among students with and without a history of forced sex. PMID:26882412
The purpose of this study was to determine the use and perceived usefulness of outcomes assessment methods in health information management programs. Additional characteristics of the outcomes assessment practices were recognized. The findings were evaluated for significant differences in results based on age of the program, type of institution,…
Eskandari, Manije; Abbaszadeh, Abbas; Borhani, Fariba
Background: Health care systems in rural areas face numerous challenges in meeting the community's needs and adequate attention has not been paid to this problem. The aim of this study was to describe the outcomes of health care process in rural society. Materials and Methods: Twenty-six participants including twenty-one rural health care providers and five clients were selected according to purposive sampling. The data were collected via semi-structured individual interviews and a mini focus group. Data were analyzed by using qualitative content analysis based on methods described by Granheme and Landman. Results: Data analysis eventually led to formation of one category of inefficiency in health care process in rural society including subcategories such as arbitrary self-therapy, slow care process, dissatisfaction with the care process, superficial caring, job stress and burn out of caregivers, and ineffective caring relationship. Conclusion: Outcomes in health care in rural society of Iran represents inefficiency of the current health care process. These outcomes are related to the cultural and social context of rural communities and the structure of the health system. These outcomes in health care in the rural society of Iran represent impairment of the current health care process. The necessity of modifying the existing care trend with new models designed to improve the health care process is felt. PMID:24403941
Background One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. Methods This study uses a unique dataset, based on the ‘ActiZ Benchmark in Healthcare’, a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. Results It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the ‘black box’ between HRM and performance. Conclusion The results underscore the importance of HRM in the health care sector, especially for HR and
Lardinois, Nicholas; Chatterjee, Debanjana
Introduction Reducing racial health disparities is often stated as a population health goal, but specific targets for such improvement are seldom set. It is often assumed that improving overall health outcomes will be linked to disparity reduction, but this is not necessarily the case. Methods We compared the annual change from 1999 through 2013 in combined-race (black and white) mortality with the annual change in absolute and relative racial mortality disparities for US states. Results Median annual improvement in combined-race mortality was 1.08% per year. Annual overall mortality rate reductions ranged from 0.24% per year in Oklahoma to 1.83% per year in Maryland. For disparities, the median for the black–white absolute gap was 3.60% per year, and the median for the relative black-to-white ratio was 1.19% per year. There was no significant correlation between the combined-race measure and either the absolute (0.03) or relative disparity measure reductions (−0.17). Conclusion For mortality in US states over a recent period, improvement in the population mean and disparity reduction do not usually occur together. The disparity reduction rates observed may provide realistic guidance for public and private policy makers in setting goals for reducing population health disparity and creating investment priorities. As a starting point for discussion, the observed national median annual percentage improvement of 1.1 per year combined, 3.6% per year absolute gap reduction, and 1.2% per year relative gap reduction would be modest and reasonable goals. PMID:27560720
von Arx, Lill-Brith Wium; Gydesen, Helge; Skovlund, Søren
Objective While the prevalence of type 2 diabetes is growing, it is increasingly well recognized that treatment outcomes in primary care practice are often suboptimal. The aim of this study is to examine the extent to which treatment beliefs and health behaviors predict diabetes health outcome as measured by glycated hemoglobin (HbA1c) level, blood pressure, and lipid profile. Research design and methods This was a large-scale cross-sectional, registry-based study involving a well-defined type 2 diabetes population, in the county of Funen, Denmark. Registry data were combined with a 27-item self-reported survey administered to all insulin-treated people in the registry (n=3160). The survey was constructed to operationalize key concepts of diabetes management, diabetes treatment beliefs, and health behaviors. Results In total, 1033 respondents answered the survey. The majority of treatment beliefs and health behaviors examined were predictors of glycemic control and, to a large extent, lipid profile. Absence from, or a low frequency of, self-measured blood glucose, non-adherence to general medical advice and the prescribed treatment, a low primary care utilization, and perceived low treatment efficacy were factors positively associated with HbA1c levels, s-cholesterol, and low-density lipoprotein. Conversely, infrequent self-measured blood glucose was associated with a significantly higher likelihood of having a blood pressure below 130/80 mm Hg. Perceived low treatment efficacy was the only health belief associated with poorer levels of health outcome other than HbA1c. Conclusions Health behaviors were stronger predictors for health outcomes than treatment beliefs. Self-reported adherence to either the treatment regimen or general medical advice most consistently predicted both glycemic control and cardiovascular risk factors. PMID:27110367
Aberer, Werner; Bouillet, Laurence; Caballero, Teresa; Maurer, Marcus; Fabien, Vincent; Zanichelli, Andrea
Objective To characterize the management and outcomes of life-threatening laryngeal attacks of hereditary angioedema (HAE) treated with icatibant in the observational Icatibant Outcome Survey (NCT01034969) registry. Methods This retrospective analysis was based on data from patients with HAE type I/II who received healthcare professional-administered or self-administered icatibant to treat laryngeal attacks between September 2008 and May 2013. Results Twenty centers in seven countries contributed data. Overall, 42 patients with HAE experienced 67 icatibant-treated laryngeal attacks. Icatibant was self-administered for 62.3% of attacks (healthcare professional-administered, 37.7%). One icatibant injection was used for 87.9% of attacks, with rescue or concomitant medication used for 9.0%. The median time to treatment was 2.0 h (n=31 attacks) and the median time to resolution was 6.0 h (n=35 attacks). Conclusions This analysis describes successful use of icatibant for the treatment of laryngeal HAE attacks in a real-world setting. PMID:27116379
The National Survey of Children with Special Health Care Needs (CSHCN) was sponsored and funded by the Maternal and Child Health Bureau of the Health Resources and Services. Administration. The survey was conducted by the National Center for Health Statistics of the Centers for D...
Berkman, Nancy D; Sheridan, Stacey L; Donahue, Katrina E; Halpern, David J; Viera, Anthony; Crotty, Karen; Holland, Audrey; Brasure, Michelle; Lohr, Kathleen N; Harden, Elizabeth; Tant, Elizabeth; Wallace, Ina; Viswanathan, Meera
OBJECTIVES To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined. DATA SOURCES We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010. REVIEW METHODS We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence. RESULTS We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level
Mancoske, Ronald J.; Lewis, Marva L.; Bowers-Stephens, Cheryll; Ford, Almarie
This study describes the relationships between clients' perception of cultural competency of mental health providers and service outcomes. A study was conducted of a public children's mental health program that used a community-based, systems of care approach. Data from a subsample (N = 111) of families with youths (average age 12.3) and primarily…
Participant adherence is a major threat to intervention effectiveness. Most researchers have reported effects of a single adherence measure on health outcomes. The objective of this analysis was to evaluate two adherence measures, separately and in combination, for predicting changes in health out...
Andersen, R M; Davidson, P L
An expanded version of Andersen's Behavioral Model of Health Services Utilization is used as the theoretical and analytical framework for the International Collaborative Study of Oral Health Outcomes (ICS-II). The conceptual framework for understanding determinants of oral health is based on a "systems" perspective. The framework posits that characteristics of the external environment, the dental care delivery system, and the personal characteristics of the population influence oral health behaviors. The expanded behavioral model conceptualizes health behaviors (oral hygiene practices and dental services utilization) as intermediate dependent variables, which in turn influence oral health outcomes (evaluated, perceived, patient satisfaction). The framework is presented with an increased focus on the effects of race-ethnicity and age cohort, the major exogenous variables used in this study for systematic assessment of the differences in the multitude of factors influencing oral health. The framework can be applied by policy analysis and health services managers to help describe, predict, and explain population-based health behaviors and health outcomes. PMID:9549985
Zhang, Bing; Zhai, Fengying; Du, Shufa; Popkin, Barry M.
The China Health and Nutrition Survey (CHNS) began in 1989 with the goal of creating a multilevel method of data collection from individuals and households and their communities to understand how the wide-ranging social and economic changes in China affect a wide array of nutrition and health-related outcomes. Initiated with a partial sample in 1989, the full survey runs from 1991 to 2011, and this issue documents the CHNS history. The CHNS cohort includes new household formation and replacement communities and households; all household members are studied. Furthermore in-depth community data are collected. The sample began with eight provinces and added a ninth, Heilongjiang, in 1997 and three autonomous cities, Beijing, Shanghai, and Chongqing, in 2011. The in-depth community contextual measures have allowed us to create a unique measure of urbanicity that captures major dimensions of modernization across all 288 communities currently in the CHNS sample. The standardized, validated urbanicity measure captures the changes in 12 dimensions: population density; economic activity; traditional markets; modern markets; transportation infrastructure; sanitation; communications; housing; education; diversity; health infrastructure; and social services. Each is based on numerous measures applicable to each dimension. They are used jointly and separately in hundreds of studies. PMID:24341753
Background Master of Public Health programs have been developed across Canada in response to the need for graduate-level trained professionals to work in the public health sector. The University of Guelph recently conducted a five-year outcome assessment using the Core Competencies for Public Health in Canada as an evaluative framework to determine whether graduates are receiving adequate training, and identify areas for improvement. Methods A curriculum map of core courses and an online survey of University of Guelph Master of Public Health graduates comprised the outcome assessment. The curriculum map was constructed by evaluating course outlines, assignments, and content to determine the extent to which the Core Competencies were covered in each course. Quantitative survey results were characterized using descriptive statistics. Qualitative survey results were analyzed to identify common themes and patterns in open-ended responses. Results The University of Guelph Master of Public Health program provided a positive learning environment in which graduates gained proficiency across the Core Competencies through core and elective courses, meaningful practicums, and competent faculty. Practice-based learning environments, particularly in collaboration with public health organizations, were deemed to be beneficial to students’ learning experiences. Conclusions The Core Competencies and graduate surveys can be used to conduct a meaningful and informative outcome assessment. We encourage other Master of Public Health programs to conduct their own outcome assessments using a similar framework, and disseminate these results in order to identify best practices and strengthen the Canadian graduate public health education system. PMID:25078124
Mohanty, Itismita; Edvardsson, Martin; Abello, Annie; Eldridge, Deanna
Introduction This paper studies the relationship between the risk of child social exclusion, as measured by the Child Social Exclusion (CSE) index and its individual domains, and child health outcomes at the small area level in Australia. The CSE index is Australia’s only national small-area index of the risk of child social exclusion. It includes five domains that capture different components of social exclusion: socio-economic background, education, connectedness, housing and health services. Methods The paper used data from the National Centre for Social and Economic Modelling (NATSEM), University of Canberra for the CSE Index and its domains and two key Australian Institute of Health and Welfare (AIHW) data sources for the health outcome measures: the National Hospital Morbidity Database and the National Mortality Database. Results The results show positive associations between rates of both of the negative health outcomes: potentially preventable hospitalisations (PPH) and avoidable deaths, and the overall risk of child social exclusion as well as with the index domains. This analysis at the small-area level can be used to identify and study areas with unexpectedly good or bad health outcomes relative to their estimated risk of child social exclusion. We show that children’s health outcomes are worse in remote parts of Australia than what would be expected solely based on the CSE index. Conclusions The results of this study suggest that developing composite indices of the risk of child social exclusion can provide valuable guidance for local interventions and programs aimed at improving children’s health outcomes. They also indicate the importance of taking a small-area approach when conducting geographic modelling of disadvantage. PMID:27152596
Pronk, Nicolaas P.
Objective To describe integrated worker health protection and promotion (IWHPP) program characteristics, to discuss the rationale for integration of OSH and WHP programs, and to summarize what is known about the impact of these programs on health and economic outcomes. Methods A descriptive assessment of the current state of the IWHPP field and a review of studies on the effectiveness of IWHPP programs on health and economic outcomes. Results Sufficient evidence of effectiveness was found for IWHPP programs when health outcomes are considered. Impact on productivity-related outcomes is considered promising, but inconclusive, whereas insufficient evidence was found for health care expenditures. Conclusions Existing evidence supports an integrated approach in terms of health outcomes but will benefit significantly from research designed to support the business case for employers of various company sizes and industry types. PMID:24284747
Bush, Robert; Gaston, Kevin J.; Dean, Julie H.; Barber, Elizabeth; Fuller, Richard A.
There is mounting concern for the health of urban populations as cities expand at an unprecedented rate. Urban green spaces provide settings for a remarkable range of physical and mental health benefits, and pioneering health policy is recognizing nature as a cost-effective tool for planning healthy cities. Despite this, limited information on how specific elements of nature deliver health outcomes restricts its use for enhancing population health. We articulate a framework for identifying direct and indirect causal pathways through which nature delivers health benefits, and highlight current evidence. We see a need for a bold new research agenda founded on testing causality that transcends disciplinary boundaries between ecology and health. This will lead to cost-effective and tailored solutions that could enhance population health and reduce health inequalities. PMID:25602866
Shanahan, Danielle F; Lin, Brenda B; Bush, Robert; Gaston, Kevin J; Dean, Julie H; Barber, Elizabeth; Fuller, Richard A
There is mounting concern for the health of urban populations as cities expand at an unprecedented rate. Urban green spaces provide settings for a remarkable range of physical and mental health benefits, and pioneering health policy is recognizing nature as a cost-effective tool for planning healthy cities. Despite this, limited information on how specific elements of nature deliver health outcomes restricts its use for enhancing population health. We articulate a framework for identifying direct and indirect causal pathways through which nature delivers health benefits, and highlight current evidence. We see a need for a bold new research agenda founded on testing causality that transcends disciplinary boundaries between ecology and health. This will lead to cost-effective and tailored solutions that could enhance population health and reduce health inequalities. PMID:25602866
Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D
Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. PMID:27227131
Beheshtian, Maryam; Khosravi, Ardeshir; Olyaeemanesh, Alireza; Malekafzali, Hossein; Bonakdar Esfahani, Shirin; Hosseiny Ghavamabad, Leila; Aghamohammadi, Saeideh; Nouri, Mahnaz; Kazemi, Elaheh; Zakeri, Mohammadreza; Sagha, Fatemeh
Background: An obvious gradient in health outcomes has been implicated in many evidences relating to social and economic factors. Proper data are requested to convince policy-makers calling for intersectoral action for health. Recently, I.R. of Iran has come up with 52 health equity indicators to monitor health equity through the country. Conducting regular surveys on 14 out of 52 national health equity indicators is needed to provide a basis for the health inequality analysis through the country. We aimed to introduce a survey tool and its related protocols on health equity indicators. Methods: This study was conducted through addressing the literature and expertise of health and demographic surveys at the national and international levels. Also, we conducted technical and consultative committee meetings, a final consensus workshop and a pilot study to finalize the survey tool. Results: We defined the study design, sampling method, reliable questionnaires and instructions, data collection and supervision procedure. We also defined the data analysis protocol on health equity indicators, generated from non-routine data. Conclusion: A valid and reliable tool, which could be employed at the national and sub-national levels, was designed to measure health equity in Iran. Policy-makers can use this survey tool to generate useful information and evidence to design appropriate required intervention and reduce health inequality across the country. PMID:26913268
Peters, D. H.; Elmendorf, A. E.; Kandola, K.; Chellaraj, G.
There is limited information on national health expenditures, services, and outcomes in African countries during the 1990s. We intend to make statistical information available for national level comparisons. National level data were collected from numerous international databases, and supplemented by national household surveys and World Bank expenditure reviews. The results were tabulated and analysed in an exploratory fashion to provide benchmarks for groupings of African countries and individual country comparison. There is wide variation in scale and outcome of health care spending between African countries, with poorer countries tending to do worse than wealthier ones. From 1990-96, the median annual per capita government expenditure on health was nearly US$ 6, but averaged US$ 3 in the lowest-income countries, compared to US$ 72 in middle-income countries. Similar trends were found for health services and outcomes. Results from individual countries (particularly Ethiopia, Ghana, Côte d'Ivoire and Gabon) are used to indicate how the data can be used to identify areas of improvement in health system performance. Serious gaps in data, particularly concerning private sector delivery and financing, health service utilization, equity and efficiency measures, hinder more effective health management. Nonetheless, the data are useful for providing benchmarks for performance and for crudely identifying problem areas in health systems for individual countries. PMID:10916913
This article uses survey data to investigate health effects of racialization in Canada. The operative sample was comprised of 91,123 Canadians aged 25 and older who completed the 2003 Canadian Community Health Survey. A "racial and cultural background" survey question contributed a variable that differentiated respondents who identified with Aboriginal, Black, Chinese, Filipino, Latin American, South Asian, White, or jointly Aboriginal and White racial/cultural backgrounds. Indicators of diabetes, hypertension and self-rated health were used to assess health. The healthy immigrant effect suppressed some disparity in risk for diabetes by racial/cultural identification. In logistic regression models also containing gender, age, and immigrant status, no racial/cultural identifications corresponded with significantly better health outcomes than those reported by survey respondents identifying as White. Subsequent models indicated that residential locale did little to explain the associations between racial/cultural background and health and that socioeconomic status was only implicated in relatively poor health outcomes for respondents identifying as Aboriginal or Aboriginal/White. Sizable and statistically significant relative risks for poor health for respondents identifying as Aboriginal, Aboriginal/White, Black, Chinese, or South Asian remained unexplained by the models, suggesting that other explanations for health disparities by racialized identity in Canada - perhaps pertaining to experiences with institutional racism and/or the wear and tear of experiences of racism and discrimination in everyday life - also deserve empirical investigation in this context. PMID:19560246
Aim Recently, interest has grown in the association between contextual factors and health outcomes. This study questions whether mental health complaints vary according to the socio-economic characteristics of the residential area where people live. The gender-specific patterns are studied. Methods Complaints of depression and generalized anxiety were measured by means of the relevant subscales of the Symptoms Checklist 90-Revised. Multilevel models were estimated with PASW statistics 18, based on a unique dataset, constructed by merging data from the Belgian Health Interview Surveys from 2001 and 2004 with data from 264 municipalities derived from Statistics Belgium and the General Socio-Economic Survey. Main findings The results of this exploratory study indicate that the local unemployment rate is associated with complaints of depression among women. Conclusion This study suggests that policy should approach the male and female population differently when implementing mental health prevention campaigns. PMID:22958473
da Silva, Isis Tande; de Almeida-Pititto, Bianca; Ferreira, Sandra Roberta G
Introduction Non-communicable chronic diseases (NCCDs) represent a burden for public health. Alongside the established cardiometabolic risk factors such as high blood pressure and disorders of glucose and lipid metabolism, living habits and nutritional status at different stages of life are seen as contributors to this scenario. Gut microbiota composition and subclinical inflammation have been pointed out as underlying mechanisms of NCCDs. Studies involving health professionals have brought relevant contributions to the knowledge about risk factors. Technological advances facilitate data collection and analysis for big samples. A web-based survey addressed to collect data from a cohort study, which is able to identify NCCDs risk factors, is highly desirable. The objective of the Brazilian Nutritionists’ Health Study (NutriHS) is to gather online information on early life events, daily habits, emergent cardiometabolic risk factors and health outcomes of a specific subset of the Brazilian population. Methods and analysis NutriHS, developed at the School of Public Health—University of Sao Paulo, Brazil, is a research initiative that enrols undergraduates of nutrition courses from Brazilian universities and graduated volunteers. A web-based self-administered system was designed to collect health-related data. After fulfilling online questionnaires (socioeconomic, early life events and lifestyle data), participants are invited to a clinical visit for physical examination and laboratory procedures (blood sampling, faeces collection and body composition). At a 3-year interval, they will be invited to repeat similar procedures. Ethics and dissemination The NutriHS research protocol was approved by the Institutional Ethics Committee and is providing promising data which contribute to the understanding of pathophysiological links between early life events, body composition, gut microbiota, and inflammatory and metabolic risk profile. The combination of a friendly tool
Maantay, Juliana A.; Chakraborty, Jayajit
How living near environmental hazards contributes to poorer health and disproportionate health outcomes is an ongoing concern. We conducted a substantive review and critique of the literature regarding residential proximity to environmental hazards and adverse pregnancy outcomes, childhood cancer, cardiovascular and respiratory illnesses, end-stage renal disease, and diabetes. Several studies have found that living near hazardous wastes sites, industrial sites, cropland with pesticide applications, highly trafficked roads, nuclear power plants, and gas stations or repair shops is related to an increased risk of adverse health outcomes. Government agencies should consider these findings in establishing rules and permitting and enforcement procedures to reduce pollution from environmentally burdensome facilities and land uses. PMID:22028451
National Assembly on School-Based Health Care, 2012
The National Assembly on School-Based Health Care (NASBHC) surveys state public health and Medicaid offices every three years to assess state-level public policies and activities that promote the growth and sustainability of school-based health services. The FY2011 survey found 18 states (see map below) reporting investments explicitly dedicated…
National Health Interview Survey-Disability Survey was developed to collect data that can be used to understand disability, to develop public health policy, to produce simple prevalence estimates of selected health conditions, and to provide descriptive baseline statistics on the...
Herrick, Amy L.; Stall, Ron; Chmiel, Joan S.; Guadamuz, Thomas E.; Penniman, Typhanye; Shoptaw, Steven; Ostrow, David; Plankey, Michael w.
Health disparities research among gay and bisexual men has focused primarily on risk and deficits. However, a focus on resiliencies within this population may greatly benefit health promotion. We describe a pattern of resilience (internalized homophobia (IHP) resolution) over the life-course and its associations with current health outcomes. 1,541 gay and bisexual men from the Multi-Center AIDS Cohort study, an ongoing prospective study of the natural and treated histories of HIV, completed a survey about life-course events thought to be related to health. The majority of men resolved IHP over time independent of demographics. Men who resolved IHP had significantly higher odds of positive health outcomes compared to those who did not. These results provide evidence of resilience among participants that is associated with positive health outcomes. Understanding resiliencies and incorporating them into interventions may help to promote health and well-being among gay and bisexual men. PMID:23283578
Webster, D C; Brennan, T
Several researchers have discussed the need to define "outcomes" in health care more holistically, particularly from women's health, chronic illness, and self-care perspectives. Interstitial cystitis (IC), a chronic illness that primarily affects women, is a poorly understood condition that can produce hopelessness and suicidal ideation. Management of IC usually requires behavioral changes in all life dimensions. Multidimensional health outcomes were examined in a survey of 138 women with IC. Item-item and item-factor correlations were used to identify relationships between indicators of health outcomes and self-reported effectiveness of more than 300 self-care strategies used to manage IC. The effectiveness of behavioral and cognitive self-care strategies correlated differentially with dimensions of health. Uncertainty correlated most strongly with the quality of relationships with health care providers. Psychiatric nurses are well prepared to address the complex body-mind phenomena of IC, promoting effective self-care strategies while maintaining a supportive therapeutic relationship. PMID:9782865
Strauss, P.; Orris, P.; Buckley, L. )
The prevalence of respiratory and other health problems in a cohort of highway toll booth workers was surveyed by mailed questionnaire. In a low proportion of respondents (43.2%), a high prevalence of central nervous system complaints (headaches, irritability, or anxiety, and unusual tiredness), mucous membrane irritation (eye irritation, nasal congestion, and dry throat), and musculoskeletal problems (joint and back pains) was found. We believe these symptoms are reflective of the acute irritant and central nervous system effects of exposure to motor vehicle exhaust. The musculoskeletal complaints are likely the result of bending, reaching, and leaning out of the toll booth. The need for in-depth evaluation of the ventilation systems and the ergonomic and job stressors of work at toll booths is suggested by these results.
Andrews, W H; Wilson, C R; Poelma, P L; Romero, A; Mislivec, P B
A bacteriological survey was performed on 1,960 food samples encompassing 60 types of health foods available in the Baltimore-Washington, D.C., metropolitan area. No consistent bacteriological distinction (aerobic plate counts, total coliform and fecal coliform most probable numbers) was observed between foods labeled as organic (raised on soil with compost or nonchemical fertilizer and without application of pesticides, fungicides, and herbicides) and their counterpart food types bearing no such label. Types and numbers of samples containing Salmonella were: sunflower seeds, 4; soy flour, 3; soy protein powder, 2; soy milk powder, 1; dried active yeast, 1; brewers' years, 1; rye flour, 1; brown rice, 1; and alfalfa seeds,1. The occurrence of this pathogen in three types of soybean products should warrant further investigation of soybean derivatives as potentially significant sources of Salmonella. PMID:572198
Ding, Ding; Gebel, Klaus; Phongsavan, Philayrath; Bauman, Adrian E.; Merom, Dafna
Background Driving is a common part of modern society, but its potential effects on health are not well understood. Purpose The present cross-sectional study (n = 37,570) examined the associations of driving time with a series of health behaviors and outcomes in a large population sample of middle-aged and older adults using data from the Social, Economic, and Environmental Factor Study conducted in New South Wales, Australia, in 2010. Methods Multiple logistic regression was used in 2013 to examine the associations of usual daily driving time with health-related behaviors (smoking, alcohol use, diet, physical activity, sedentary behavior, sleep) and outcomes (obesity, general health, quality of life, psychological distress, time stress, social functioning), adjusted for socio-demographic characteristics. Results Findings suggested that longer driving time was associated with higher odds for smoking, insufficient physical activity, short sleep, obesity, and worse physical and mental health. The associations consistently showed a dose-response pattern and more than 120 minutes of driving per day had the strongest and most consistent associations with the majority of outcomes. Conclusion This study highlights driving as a potential lifestyle risk factor for public health. More population-level multidisciplinary research is needed to understand the mechanism of how driving affects health. PMID:24911017
Moscelli, Giuseppe; Siciliani, Luigi; Tonei, Valentina
Long waiting times for non-emergency services are a feature of several publicly-funded health systems. A key policy concern is that long waiting times may worsen health outcomes: when patients receive treatment, their health condition may have deteriorated and health gains reduced. This study investigates whether patients in need of coronary bypass with longer waiting times are associated with poorer health outcomes in the English National Health Service over 2000-2010. Exploiting information from the Hospital Episode Statistics (HES), we measure health outcomes with in-hospital mortality and 28-day emergency readmission following discharge. Our results, obtained combining hospital fixed effects and instrumental variable methods, find no evidence of waiting times being associated with higher in-hospital mortality and weak association between waiting times and emergency readmission following a surgery. The results inform the debate on the relative merits of different types of rationing in healthcare systems. They are to some extent supportive of waiting times as an acceptable rationing mechanism, although further research is required to explore whether long waiting times affect other aspects of individuals' life. PMID:27299977
Rust, George; Levine, Robert S.; Fry-Johnson, Yvonne; Baltrus, Peter; Ye, Jiali; Mack, Dominic
U.S. health disparities are real, pervasive, and persistent, despite dramatic improvements in civil rights and economic opportunity for racial and ethnic minority and lower socioeconomic groups in the United States. Change is possible, however. Disparities vary widely from one community to another, suggesting that they are not inevitable. Some communities even show paradoxically good outcomes and relative health equity despite significant social inequities. A few communities have even improved from high disparities to more equitable and optimal health outcomes. These positive-deviance communities show that disparities can be overcome and that health equity is achievable. Research must shift from defining the problem (including causes and risk factors) to testing effective interventions, informed by the natural experiments of what has worked in communities that are already moving toward health equity. At the local level, we need multi-dimensional interventions designed in partnership with communities and continuously improved by rapid-cycle surveillance feedback loops of community-level disparities metrics. Similarly coordinated strategies are needed at state and national levels to take success to scale. We propose ten specific steps to follow on a health equity path toward optimal and equitable health outcomes for all Americans. PMID:22643550
Dixon-Gordon, Katherine L.; Whalen, Diana J.; Layden, Brianne K.; Chapman, Alexander L.
Personality disorders have been associated with a wide swath of adverse health outcomes and correspondingly high costs to healthcare systems. To date, however, there has not been a systematic review of the literature on health conditions among individuals with personality disorders. The primary aim of this article is to review research documenting the associations between personality disorders and health conditions. A systematic review of the literature revealed 78 unique empirical English-language peer-reviewed articles examining the association of personality disorders and health outcomes over the past 15 years. Specifically, we reviewed research examining the association of personality disorders with sleep disturbance, obesity, pain conditions, and other chronic health conditions. In addition, we evaluated research on candidate mechanisms underlying health problems in personality disorders and potential treatments for such disorders. Results underscore numerous deleterious health outcomes associated with PD features and PD diagnoses, and suggest potential biological and behavioural factors that may account for these relations. Guidelines for future research in this area are discussed. PMID:26456998
Gilbert, G H; Longmate, J; Branch, L G
The authors investigated sources of bias in health surveys by examining responses to their 1989 questionnaire mailed to 1,255 Massachusetts men who were eligible for dental care provided by the Department of Veterans Affairs. After a maximum of three mailings and one telephone call to nonrespondents, a total of 1,049 veterans had responded out of 1,228 finally determined to be eligible, a response rate of 85 percent. The investigators found that small differences in univariate estimates would have occurred had the field phase been terminated after the first mailing, which had a response rate of 61 percent. To evaluate multivariate distributions, they duplicated their previously published logistic regression model for sources of dental care, using only those who responded to the first and second mailings. Although model fits would have been substantively the same had the field phase been terminated after the first or the second mailings, analysis of parameter estimates and their statistical significances suggested bias that would have led to different substantive conclusions, in some instances. Another potential source of bias in surveys was found to be item omission. Fifty-eight percent of respondents answered all 46 survey questions, and 90 percent answered at least 91 percent of the questions. Fewer questions were answered by those whose responses were received last, but trends regarding missing data by age or education were not statistically significant. Although the survey using this methodology met all objectives, subject nonresponses, the ineligibility of potential respondents, item nonresponses, and skewed distributions of outcome variables combined to reduce the statistical power to detect differences among groups or to alter the analysis of the differences. These factors need to be planned for by investigators undertaking similar surveys. PMID:1410240
Li, Ian W; Awofeso, Niyi
Little information is available on the public health workforce. This study contributes to the gap in the literature and examines the demographic characteristics, career destinations and earnings of Masters in Public Health (MPH) graduates in Australia, using data from the 1999-2009 waves of the Graduate Destination Survey. It was found that public health graduates had a high amount of female representation and very low proportions of indigenous representation. Public health graduates experienced a relatively low unemployment rate and 85% were employed within 120 days of graduation. However, close to half of the graduates did not work in the health industry or in health-related roles. The mean salaries of public health graduates working in public health roles were relatively low compared to those in other occupations, but they had a range comparable to that observed for public health professionals in the USA and were higher than those of other Masters graduates in some other health fields. The results indicate strong demand and positive employment prospects for public health graduates in Australia. Strategies to target recruitment and/or retention of female or indigenous graduates in the public health workforce should be a priority. Mapping of public health graduate destinations and employment prospects should might be prioritised, given its strong potential to facilitate workforce planning and provide potential public health workers with more comprehensive career trajectories. PMID:23782503
Dandona, Rakhi; Pandey, Anamika; Dandona, Lalit
Several rounds of national health surveys have generated a vast amount of data in India since 1992. We describe and compare the key health information gathered, assess the availability of health data in the public domain, and review publications resulting from the National Family Health Survey (NFHS), the District Level Household Survey (DLHS) and the Annual Health Survey (AHS). We highlight issues that need attention to improve the usefulness of the surveys in monitoring changing trends in India's disease burden: (i) inadequate coverage of noncommunicable diseases, injuries and some major communicable diseases; (ii) modest comparability between surveys on the key themes of child and maternal mortality and immunization to understand trends over time; (iii) short time intervals between the most recent survey rounds; and (iv) delays in making individual-level data available for analysis in the public domain. We identified 337 publications using NFHS data, in contrast only 48 and three publications were using data from the DLHS and AHS respectively. As national surveys are resource-intensive, it would be prudent to maximize their benefits. We suggest that India plan for a single major national health survey at five-year intervals in consultation with key stakeholders. This could cover additional major causes of the disease burden and their risk factors, as well as causes of death and adult mortality rate estimation. If done in a standardized manner, such a survey would provide useable and timely data to inform health interventions and facilitate assessment of their impact on population health. PMID:27034522
Background Respiratory disease can impose a significant burden on the health of rural populations. The Saskatchewan Rural Health Study (SRHS) is a new large prospective cohort study of ages 6 and over currently being conducted in farming and non-farming communities to evaluate potential health determinants associated with respiratory outcomes in rural populations. In this article, we describe the rationale and methodology for the adult component. The study is being conducted over 5 years (2009–15) in two phases, baseline and longitudinal. The baseline survey consists of two components, adults and children. The adult component consists of a questionnaire-based evaluation of individual and contextual factors of importance to respiratory health in two sub populations (a Farm Cohort and a Small Town Cohort) of rural families in Saskatchewan Rural Municipalities (RMs). Clinical studies of lung function and allergy tests are being conducted on selected sub-samples of the two cohorts based on the positive response to the last question on the baseline questionnaire: “Would you be willing to be contacted about having breathing and/or allergy tests at a nearby location?”. We adopted existing population health theory to evaluate individual factors, contextual factors, and principal covariates on the outcomes of chronic bronchitis, chronic obstructive pulmonary disease, asthma and obstructive sleep apnea. Findings Of the RMs selected to participate, 32 (89%) out of 36 RMs and 15 (94%) out of 16 small towns within the RMs agreed to participate. Using the mail out survey method developed by Dillman, we obtained completed questionnaires from 4264 households (8261 individuals). We obtained lung function measurements on 1609 adults, allergy skin test information on 1615 adults; both measurements were available on 1549 adults. We observed differences between farm and non-farm rural residents with respect to individual, contextual factors and covariates. Discussion There are
Luse, Tina M; Slosek, Jean; Rennix, Christopher
The Department of Defense (DoD) requires service members to complete regular health assessments for identification of deployment-related physical/behavioral issues and environmental/occupational exposures. Compliance among active duty Department of the Navy personnel varies; however, and the impact of incomplete assessments on generalizability of results is unclear. This study examines the differences between Navy and Marine Corps service members who completed both the Post-Deployment Health Assessment and Post-Deployment Health Reassessment (n = 9,452) as compared to service members who never attempted either form (n = 5,603) in fiscal year 2010. Deployment rosters, assessments, and clinical data were analyzed to determine certified assessment completion rates and incidence of certain health conditions in these populations. Only 38.9% of applicable personnel met the completion and certification criteria for the required assessments. Service members who did not complete the forms were distinctly different demographically and at increased risk for psychotropic drug use, post-traumatic stress disorder diagnosis, and traumatic brain injury diagnosis following deployment. The prevailing assumption that the risk of adverse health effects on operational forces can be estimated using the population that completed the required assessments is incorrect, and the true operational impact and medical burden of these conditions may be underestimated. PMID:26837080
Mewton, Louise; Andrews, Gavin
Objectives It is hypothesised that across two national surveys poor self-rated health will be independently associated with somatisation and will result in high rates of service use after adjusting for established diagnoses. Design Two cross-sectional population-based surveys were conducted in 1997 and 2007. The use of both surveys allowed replication of results. Setting Australia. Participants The 1997 and 2007 National Surveys of Mental Health and Well-Being were based on stratified, multistage area probability samples of persons living in private dwellings in Australia. The 1997 survey included 10 641 respondents aged 18–75 years, a response rate of 78%. The 2007 survey included 8841 respondents aged 16–85 years, a response rate of 60%. Main outcome measures Self-rated health. Results Approximately 15% of the Australian population rated their health as fair or poor in both surveys. The independent relationship between self-rated health and somatisation was replicated across both surveys in multivariate analyses. Individuals with negative self-rated health were 4.1 times as likely to screen positive for health anxiety (OR 4.1, 95% CI 2.8 to 5.9) and 3.4 times as likely to be diagnosed with neurasthenia (OR 3.4, 95% CI 2.2 to 5.2), when compared with individuals who rated their health positively. Individuals with negative self-rated health were also more likely to use health services after controlling for demographics and mental and physical illness. Conclusions These results confirm both of the study hypotheses: (1) that negative self-rated health was powerfully and independently associated with somatisation and (2) that this relationship manifested itself in high rates of service use, even after adjusting for an extensive range of demographics and psychiatric and physical conditions. PMID:23811174
Connolly, Kathleen Kihmm
The purpose of this research project was to understand, explore and describe the digital divide and the relationship between technology utilization and health outcomes. Diabetes and diabetic eye disease was used as the real-life context for understanding change and exploring the digital divide. As an investigational framework, a telemedicine…
Pedersen, Daphne E.
Objective: Using a stress carry-over perspective, this study examines the relationship between stress stemming from school and family domains and physical and mental health outcomes. Methods: The study sample included 268 undergraduate men and women from a Midwestern university. Participants completed an anonymous online questionnaire. OLS…
Coopman, Stephanie J.
Examines interdisciplinary health care teams, focusing on perceptions of team processes and their relationship to assessments of team performance and individual outcomes. Suggests that hospice interdisciplinary teams are perceived by their members as only somewhat democratic in the practice of decision making. (SG)
Verhaaff, Ashley; Scott, Hannah
Objective: This study examined which individual factors predict mental health court diversion outcome among a sample of persons with mental illness participating in a postcharge diversion program. Method: The study employed secondary analysis of existing program records for 419 persons with mental illness in a court diversion program. Results:…
Bonaiuto, Maria M.
Educators and health care professionals alike understand that healthy students are likely to be successful learners. The goal of school nurse case management is to support students so that they are ready to learn. This article describes the outcomes of a 4-year process improvement project designed to show the impact of school nurse case management…
Gallicchio, Lisa; Miller, Susan R; Greene, Teresa; Zacur, Howard; Flaws, Jodi A
The purpose of this study was to examine adverse health outcomes, including those related to cardiovascular and skin health as well as respiratory functions, among cosmetologists aged 21 to 55 yr and to compare data to women of the same age working in other occupations. Self-reported data were analyzed from 450 cosmetologists and 511 women in other occupations who participated in the Reproductive Outcomes of Salon Employees (ROSE) study in Maryland. Odds ratios (OR) and 95% confidence intervals (95% CI) were computed using logistic regression to examine the associations between cosmetologist occupation and each adverse health outcome adjusted for age, education, and smoking status. Cosmetologists were at significantly increased risk of depression compared to noncosmetologists after adjustment for age, education, and smoking status (OR 1.49; 95% CI 1.10, 2.00). There were no statistically significant associations between cosmetology occupation and the other adverse health outcomes, including those related to allergies and skin disorders, in both the unadjusted and adjusted analyses. Cosmetologists may be exposed to chemicals in the salon that lead to depression. Future study needs to be conducted to examine specific chemical exposures in the salon. This will help to provide information required for the development of best occupational safety practices among salon workers. PMID:21120748
Brown, Tyson H.; O'Rand, Angela M.; Adkins, Daniel E.
Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from…
Nelson-Peterman, Jerusha L.; Toof, Robin; Liang, Sidney L.; Grigg-Saito, Dorcas C.
Refugees in the United States have high rates of chronic disease. Both long-term effects of the refugee experience and adjustment to the U.S. health environment may contribute. While there is significant research on health outcomes of newly resettled refugees and long-term mental health experiences of established refugees, there is currently…
“Air Pollution and Health: Bridging the Gap from Sources to Health Outcomes,” an international specialty conference sponsored by the American Association for Aerosol Research, was held to address key uncertainties in our understanding of adverse health effects related to air po...
Introduction In all countries people experience different social circumstances that result in avoidable differences in health. In New Zealand, Māori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity and inequitable health outcomes. Whilst the health system can enable a fairer distribution of good health, limited national data is available to measure health equity. Therefore, we sought to find out whether health services in New Zealand were equitable by measuring the level of development of components of chronic care management systems across district health boards. Variation in provision by geography, condition or ethnicity can be interpreted as inequitable. Methods A national survey of district health boards (DHBs) was undertaken on macro approaches to chronic condition management with detail on cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke and diabetes. Additional data from expert informant interviews on program reach and the cultural needs of Māori and Pacific peoples was sought. Survey data were analyzed on dimensions of health equity relevant to strategic planning and program delivery. Results are presented as descriptive statistics and free text. Interviews were transcribed and NVivo 8 software supported a general inductive approach to identify common themes. Results Survey responses were received from the majority of DHBs (15/21), some PHOs (21/84) and 31 expert informants. Measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Māori is embedded in policy, this is not so for other ethnic groups or
Speizer, Ilene S.; Fotso, Jean-Christophe; Akiode, Akinsewa; Saad, Abdulmumin; Calhoun, Lisa; Irani, Laili
Objectives To date, limited evidence is available for urban populations in sub-Saharan Africa, specifically research into the association between urban women’s empowerment and reproductive health outcomes. The objective of this study is to investigate whether women’s empowerment in urban Nigerian settings is associated with family planning use and maternal health behaviors. Moreover, we examine whether different effects of empowerment exist by region of residence. Methods This study uses baseline household survey data from the Measurement, Learning & Evaluation Project (MLE) for the Nigerian Urban Reproductive Health Initiative (NURHI) being implemented in six major cities. We examine four dimensions of empowerment: economic freedom, attitudes towards domestic violence, partner prohibitions and decision-making. We determine if the empowerment dimensions have different effects on reproductive health outcomes by region of residence using multivariate analyses. Results Results indicate that more empowered women are more likely to use modern contraception, deliver in a health facility and have a skilled attendant at birth. These trends vary by empowerment dimension and by city/region in Nigeria. Conclusions We conclude by discussing the implications of these findings on future programs seeking to improve reproductive health outcomes in urban Nigeria and beyond. PMID:23576403
Corroon, Meghan; Speizer, Ilene S; Fotso, Jean-Christophe; Akiode, Akinsewa; Saad, Abdulmumin; Calhoun, Lisa; Irani, Laili
To date, limited evidence is available for urban populations in sub-Saharan Africa, specifically research into the association between urban women's empowerment and reproductive health outcomes. The objective of this study is to investigate whether women's empowerment in urban Nigerian settings is associated with family planning use and maternal health behaviors. Moreover, we examine whether different effects of empowerment exist by region of residence. This study uses baseline household survey data from the Measurement, Learning and Evaluation Project for the Nigerian Urban Reproductive Health Initiative being implemented in six major cities. We examine four dimensions of empowerment: economic freedom, attitudes towards domestic violence, partner prohibitions and decision-making. We determine if the empowerment dimensions have different effects on reproductive health outcomes by region of residence using multivariate analyses. Results indicate that more empowered women are more likely to use modern contraception, deliver in a health facility and have a skilled attendant at birth. These trends vary by empowerment dimension and by city/region in Nigeria. We conclude by discussing the implications of these findings on future programs seeking to improve reproductive health outcomes in urban Nigeria and beyond. PMID:23576403
Kesternich, Iris; Siflinger, Bettina; Smith, James P.; Winter, Joachim K.
We investigate long-run effects of World War II on socio-economic status and health of older individuals in Europe. We analyze data from SHARELIFE, a retrospective survey conducted as part of SHARE in Europe in 2009. SHARELIFE provides detailed data on events in childhood during and after the war for over 20,000 individuals in 13 European countries. We construct several measures of war exposure—experience of dispossession, persecution, combat in local areas, and hunger periods. Exposure to war and more importantly to individual-level shocks caused by the war significantly predicts economic and health outcomes at older ages. PMID:24850973
Alves, Maria Cecilia Goi Porto; Escuder, Maria Mercedes Loureiro; Claro, Rafael Moreira; da Silva, Nilza Nunes
OBJECTIVE To compare the efficiency and accuracy of sampling designs including and excluding the sampling of individuals within sampled households in health surveys. METHODS From a population survey conducted in Baixada Santista Metropolitan Area, SP, Southeastern Brazil, lowlands between 2006 and 2007, 1,000 samples were drawn for each design and estimates for people aged 18 to 59 and 18 and over were calculated for each sample. In the first design, 40 census tracts, 12 households per sector, and one person per household were sampled. In the second, no sampling within the household was performed and 40 census sectors and 6 households for the 18 to 59-year old group and 5 or 6 for the 18 and over age group or more were sampled. Precision and bias of proportion estimates for 11 indicators were assessed in the two final sets of the 1000 selected samples with the two types of design. They were compared by means of relative measurements: coefficient of variation, bias/mean ratio, bias/standard error ratio, and relative mean square error. Comparison of costs contrasted basic cost per person, household cost, number of people, and households. RESULTS Bias was found to be negligible for both designs. A lower precision was found in the design including individuals sampling within households, and the costs were higher. CONCLUSIONS The design excluding individual sampling achieved higher levels of efficiency and accuracy and, accordingly, should be first choice for investigators. Sampling of household dwellers should be adopted when there are reasons related to the study subject that may lead to bias in individual responses if multiple dwellers answer the proposed questionnaire. PMID:24789641
Lombe, Margaret; Nebbitt, Von Eugene; Sinha, Aakanksha; Reynolds, Andrew
Evidence documenting effects of food assistance programs, household food insecurity, and nutrition knowledge on health outcomes is building. Using data from a sub-sample of adults who are 185% of the poverty line from the 2007-2008 National Health and Nutrition Examination Survey (N = 2,171), we examine whether household food insecurity, food stamp take-up, and use of informal food supports are associated with health risk among low-income households. Findings indicate that while nutrition knowledge provides protection against health risk in food secure households, the health benefits of nutrition knowledge were not evident in food insecure households. We discuss these findings in light of current policy and practice interventions that recognize the importance of providing healthy, affordable food options for food insecure households. PMID:27045462
Lee, Shih-Yu; Vasireddi, Mugdha; Chen, Yu Ping; Wang, Yong Tai; Hilliard, Julia
Sleep disturbance has been found to trigger a stress response with a subsequent activation of the psychoneuroimmunological (PNI) pathway associated with adverse health outcomes. This study aimed to assess the association among selected PNI biomarkers, sleep disturbances, and adverse health outcomes (depressive symptoms, physical symptoms). A stratified, quota sample (14 poor sleepers and 15 good sleepers) was drawn from a pool of healthy college women from a larger scale of study. The participants reported their sleep, stress, depressive, and physical symptoms. Wrist actigraphy was used to collect objective sleep data, and the Enzyme-Linked ImmunoSorbent Assay was used to assess PNI biomarkers. Poor sleep quality, higher stress perception, elevated serum serotonin, and lower serum interleukin-10 explained 75.3% of the variances for the depressive symptoms. Poor sleep quality along with delayed peak activity rhythms accounted 31.4% of the physical symptoms. High serotonin and tumor necrosis factor-α were the significant predictors for poor sleep efficiency, and serotonin was the single significant predictor for poor daytime functioning. Stress and sleep disturbances negatively impact the health of college women and should be as part of regular check-ups on campus. PNI effects on health outcomes should be further explored. Educational materials in the areas of sleep hygiene, health impacts from sleep disturbances, and strategies to maintain synchronized circadian rhythms should be mandatorily included in the college curriculum.
Pillemer, Karl; Fuller-Rowell, Thomas E.; Reid, M. C.; Wells, Nancy M.
Purpose: This study tested the hypothesis that volunteering in environmental organizations in midlife is associated with greater physical activity and improved mental and physical health over a 20-year period. Design and Methods: The study used data from two waves (1974 and 1994) of the Alameda County Study, a longitudinal study of health and mortality that has followed a cohort of 6,928 adults since 1965. Using logistic and multiple regression models, we examined the prospective association between environmental and other volunteerism and three outcomes (physical activity, self-reported health, and depression), with 1974 volunteerism predicting 1994 outcomes, controlling for a number of relevant covariates. Results: Midlife environmental volunteering was significantly associated with physical activity, self-reported health, and depressive symptoms. Implications: This population-based study offers the first epidemiological evidence for a significant positive relationship between environmental volunteering and health and well-being outcomes. Further research, including intervention studies, is needed to confirm and shed additional light on these initial findings. PMID:20172902
Park, Hyojun; Roubal, Anne M; Jovaag, Amanda; Gennuso, Keith P; Catlin, Bridget B
Although many researchers agree that multiple determinants impact health, there is no consensus regarding the magnitude of the relative contributions of individual health factors to health outcomes. This study presents a method to empirically estimate the relative contributions of health behaviors, clinical care, social and economic factors, and the physical environment to health outcomes using nationally representative county-level data and statistical approaches that account for potential sources of bias. The analyses for this study were conducted in 2014. Data were from the 2010-2013 County Health Rankings & Roadmaps. Data covered 2,996 of 3,141 U.S. counties. Ordinary least squares modeling was used as a baseline model. Multilevel latent growth curve modeling was used to estimate the relative contributions of health factors to health outcomes while accounting for measurement errors and state-specific characteristics. Almost half of the variance of health outcomes was due to state-level variation rather than county-level variation. When adjusted for measurement errors and state-level variation using multilevel latent growth curve modeling, the relative contribution of clinical care decreased and that of social and economic factors increased compared with the baseline model. This study presents how potential sources of bias affected the estimates of the relative contributions of a set of modifiable health factors to health outcomes at the county level. Further verification of these approaches with other data sources could lead to a better understanding of the impact of specific health determinants to health outcomes, and will provide useful information on policy interventions. PMID:26590942
You, Sukkyung; Shin, Kyulee
For many years, body dissatisfaction and mental health were thought of as Western phenomena and were studied mostly in Caucasian women. Recent studies, however, suggest that these issues are also present in men and in other ethnic groups. This study examined the association between body dissatisfaction and mental health outcomes, with personality traits and neuroticism playing possible predictive roles, using a Korean sample. A total of 545 college students, from five private universities in South Korea, completed assessment measures for depression, self-esteem, neuroticism, and body esteem scales. After controlling for covariates including body mass index and exercise time, body dissatisfaction was seen to play a mediating role between neuroticism and mental health outcomes. Differences between the sexes were also found in this relationship. For men, body dissatisfaction acted as a mediator between neuroticism and depression. For women, body dissatisfaction acted as a mediator between neuroticism and both depression and self-esteem. PMID:27173851
Edelstein, Burton L.
The mouth is an obvious portal of entry to the body, and oral health reflects and influences general health and well being. Maternal oral health has significant implications for birth outcomes and infant oral health. Maternal periodontal disease, that is, a chronic infection of the gingiva and supporting tooth structures, has been associated with preterm birth, development of preeclampsia, and delivery of a small-for-gestational age infant. Maternal oral flora is transmitted to the newborn infant, and increased cariogenic flora in the mother predisposes the infant to the development of caries. It is intriguing to consider preconception, pregnancy, or intrapartum treatment of oral health conditions as a mechanism to improve women's oral and general health, pregnancy outcomes, and their children's dental health. However, given the relationship between oral health and general health, oral health care should be a goal in its own right for all individuals. Regardless of the potential for improved oral health to improve pregnancy outcomes, public policies that support comprehensive dental services for vulnerable women of childbearing age should be expanded so that their own oral and general health is safeguarded and their children's risk of caries is reduced. Oral health promotion should include education of women and their health care providers ways to prevent oral disease from occurring, and referral for dental services when disease is present. PMID:16816998
Morris, Anne; Bloom, Joan R; Kang, Soo
The impact of organizational and individual factors on outcomes of care were assessed for 424 adult consumers with chronic mental illness who were receiving services from one of 14 Community Mental Health Organizations (CMHOs) in Colorado over a 30-month period, as part of a larger statewide evaluation of the impact of Medicaid capitation on mental health services. Data on organizational culture and climate were aggregated from surveys of staff and administrators conducted within CMHOs over a two-year period corresponding to the collection of consumer outcome and service utilization data. Growth curve analyses were conducted on consumer perceptions of physical and mental health, and on quality of life (QOL). Analyses indicated a significant cross-level effect of organizational culture and climate on improvements in consumer perceptions of physical and mental health, but not on a "quasi-objective" index of QOL. Individual characteristics, such as age, diagnosis, gender, and ethnicity, were significant predictors of outcomes. Being older, female, an ethnic minority, and having a diagnosis of schizophrenia all predicted poorer outcomes among consumers. These findings are discussed in terms of their implications for policy and future research. PMID:17096194
Hastings, S. Nicole; Whitson, Heather E.; Purser, Jama L.; Sloane, Richard J.; Johnson, Kimberly S.
Objectives To determine the relationship between the reason for an emergency department (ED) visit and subsequent risk of adverse health outcomes in older adults discharged from the ED. Design Secondary analysis of data from the Medicare Current Beneficiary Survey. Setting ED. Participants One thousand eight hundred fifty-one community-dwelling Medicare fee-for-service enrollees aged 65 and older discharged from the ED between January 2000 and September 2002. Measurements Independent variables were ED discharge diagnosis groups: injury or musculoskeletal (MSK) (e.g., fracture, open wound), chronic condition (e.g., chronic obstructive pulmonary disorder, heart failure), infection, non-MSK symptom (e.g., chest pain, abdominal pain), and unclassified. Adverse health outcomes were hospitalization or death within 30 days of the index ED visit. Results Injury or MSK was the largest ED diagnosis group (31.4%), followed by non-MSK symptom (22.2%), chronic condition (20.9%), and infection (7.8%); 338 (17.8%) had ED discharge diagnoses that were unclassified. In adjusted analyses, a discharge diagnosis of injury or MSK condition was associated with lower risk of subsequent adverse health outcomes (hazard ratio (HR) = 0.69, 95% confidence interval (CI) = 0.50–0.96) than for all other diagnosis groups. Patients seen in the ED for chronic conditions were at greater risk of adverse outcomes (HR = 1.86, 95% CI = 1.37–2.52) than all others. There were no significant differences in risk between patients with infections, those with non-MSK symptoms, and the unclassified group. Conclusion Adverse health outcomes were common in older patients with an ED discharge diagnosis classified as a chronic condition. ED discharge diagnosis may improve risk assessment and inform the development of targeted interventions to reduce adverse health outcomes in older adults discharged from the ED. PMID:19694872
English, Mike; Shepperd, Sasha
Objective Do newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters are used to inform diagnosis and treatment (excluding surgical care) compared with health facilities where pulse oximeters are not used? Design Studies were obtained for this systematic literature review by systematically searching the Database of Abstracts of Reviews of Effects, Cochrane, Medion, PubMed, Web of Science, Embase, Global Health, CINAHL, WHO Global Health Library, international health organisation and NGO websites, and study references. Patients Children 0–19 years presenting for the first time to hospitals, emergency departments or primary care facilities. Interventions Included studies compared outcomes where pulse oximeters were used for diagnosis and/or management, with outcomes where pulse oximeters were not used. Main outcome measures: mortality, morbidity, length of stay, and treatment and management changes. Results The evidence is low quality and hypoxaemia definitions varied across studies, but the evidence suggests pulse oximeter use with children can reduce mortality rates (when combined with improved oxygen administration) and length of emergency department stay, increase admission of children with previously unrecognised hypoxaemia, and change physicians’ decisions on illness severity, diagnosis and treatment. Pulse oximeter use generally increased resource utilisation. Conclusions As international organisations are investing in programmes to increase pulse oximeter use in low-income settings, more research is needed on the optimal use of pulse oximeters (eg, appropriate oxygen saturation thresholds), and how pulse oximeter use affects referral and admission rates, length of stay, resource utilisation and health outcomes. PMID:26699537
Di Fabio, R P; Boissonnault, W
Assessing both physical and mental health is necessary in clinical settings to quantify the scope of disability and to evaluate the effectiveness of treatment programs. Changes in health-related quality of life following physical therapy treatment for many patients with orthopaedic-related diagnoses is not known. The purposes of this study were to describe changes in health-related quality of life between the initial assessment and the time of discharge from physical therapy for the most common orthopaedic diagnoses and to compare the patterns of deficit among diagnostic categories. Patient outcomes in this study were evaluated from a large database generated by the Focus on Therapeutic Outcomes (FOTO) network. Health-related and employment outcomes were described for adult patients who were classified using ICD-9-CM codes. The most common orthopaedic diagnostic categories were sacroiliac sprain, back sprain, low back pain (radiating and nonradiating), neck sprain, neck pain (radiating and nonradiating), adhesive capsulitis of the shoulder, rotator cuff injury, shoulder sprain, knee dislocation, knee sprain, and knee derangement. The primary outcome measure was a 17-item questionnaire (the MOS-17) derived from the RAND 36-Item Health Survey (SF-36) and the 12-item Short Form Health Survey (SF-12). The comparison of each cohort to population norms was made by calculating a standard score on patient data adjusted for age and gender. An effect size was calculated to measure the change in health or employment status between the initial assessment and discharge from physical therapy. For all diagnostic categories, health-related quality of life with respect to norms and employment status showed a consistent pattern of improvement at the time of discharge compared with the initial assessment. There were only small changes in physical function for neck and shoulder diagnostic categories. Nearly all of the diagnostic categories had large reductions in bodily pain. The
McCauley, Linda A.; Anger, W. Kent; Keifer, Matthew; Langley, Rick; Robson, Mark G.; Rohlman, Diane
A major goal of studying farmworkers is to better understand how their work environment, including exposure to pesticides, affects their health. Although a number of health conditions have been associated with pesticide exposure, clear linkages have yet to be made between exposure and health effects except in cases of acute pesticide exposure. In this article, we review the most common health end points that have been studied and describe the epidemiologic challenges encountered in studying these health effects of pesticides among farmworkers, including the difficulties in accessing the population and challenges associated with obtaining health end point data. The assessment of neurobehavioral health effects serves as one of the most common and best examples of an approach used to study health outcomes in farmworkers and other populations exposed to pesticides. We review the current limitations in neurobehavioral assessment and strategies to improve these analytical methods. Emerging techniques to improve our assessment of health effects associated with pesticide exposure are reviewed. These techniques, which in most cases have not been applied to farmworker populations, hold promise in our ability to study and understand the relationship between pesticide exposure and a variety of health effects in this population. PMID:16760000
Mekonnen, Robin; Noonan, Kathleen; Rubin, David
This article reviews the challenges health care systems face as they attempt to improve health care outcomes for children in foster care. It discusses several of the promising health care strategies occurring outside the perimeter of child welfare and identifies some of the key impasses in working alongside efforts in child welfare reform. The authors posit that the greatest impasse in establishing a reasonable quality of health care for these children is placement instability, in which children move frequently among multiple homes and in and out of the child welfare system. The authors propose potential strategies in which efforts to improve placement stability can serve as a vehicle for multidisciplinary reform across the health care system. PMID:19358924
System Development Corp., Santa Monica, CA.
The report documents the results of a 1967 survey of health professionals in the four-State Western Interstate Commission for Higher Education (WICHE) Mountain States Regional Medical Program (MS/RMP). Addressed to health professionals in each of the four States--Idaho, Montana, Nevada, and Wyoming--the survey focuses primarily on the…
THE HARRISBURG AREA COMMUNITY COLLEGE COOPERATED WITH TWO HOSPITALS IN A SURVEY OF THE AREA'S NEEDS FOR HEALTH TECHNICIANS. DATA, COLLECTED BY QUESTIONNAIRE SURVEYS OF DOCTORS AND DENTISTS AND BY INTERVIEWS WITH ADMINISTRATORS OF HOSPITALS, NURSING HOMES AND PROFESSIONAL ORGANIZATIONS, INDICATED THAT (1) A 60-PERCENT INCREASE IN HEALTH MNAPOWER…
The Third National Health and Nutrition Examination Survey (NHANES III), 1988-94, was conducted on a nationwide probability sample of approximately 33,994 persons 2 months and over. The survey was designed to obtain nationally representative information on the health and nutritio...
Public Health Service (DHHS), Rockville, MD. Office of Disease Prevention and Health Promotion.
The survey reported in this document examined worksite health promotion and disease prevention activities in 1,507 private worksites in the United States. Specificlly, the survey assessed policies, practices, services, facilities, information, and activities sponsored by employers to improve the health of their employees, and assessed health…
Hendriksen, Ingrid J.M.; Snoijer, Mirjam; de Kok, Brenda P.H.; van Vilsteren, Jeroen; Hofstetter, Hedwig
Objective: Evaluation of the effectiveness of a workplace health promotion program on employees’ vitality, health, and work-related outcomes, and exploring the influence of organizational support and the supervisors’ role on these outcomes. Methods: The 5-month intervention included activities at management, team, and individual level targeting self-management to perform healthy behaviors: a kick-off session, vitality training sessions, workshops, individual coaching, and intervision. Outcome measures were collected using questionnaires, health checks, and sickness absence data at baseline, after the intervention and at 10 months follow-up. For analysis linear and generalized mixed models were used. Results: Vitality, work performance, sickness absence, and self-management significantly improved. Good organizational support and involved supervisors were significantly associated with lower sickness absence. Conclusions: Including all organizational levels and focusing on increasing self-management provided promising results for improving vitality, health, and work-related outcomes. PMID:27136605
Pinzon-Rondon, Angela Maria; Attaran, Amir; Botero, Juan Carlos; Ruiz-Sternberg, Angela Maria
Objectives To explore whether the rule of law is a foundational determinant of health that underlies other socioeconomic, political and cultural factors that have been associated with health outcomes. Setting Global project. Participants Data set of 96 countries, comprising 91% of the global population. Primary and secondary outcome measures The following health indicators, infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, were included to explore their association with the rule of law. We used a novel Rule of Law Index, gathered from survey sources, in a cross-sectional and ecological design. The Index is based on eight subindices: (1) Constraints on Government Powers; (2) Absence of Corruption; (3) Order and Security; (4) Fundamental Rights; (5) Open Government; (6) Regulatory Enforcement, (7) Civil Justice; and (8) Criminal Justice. Results The rule of law showed an independent association with infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, after adjusting for the countries’ level of per capita income, their expenditures in health, their level of political and civil freedom, their Gini measure of inequality and women's status (p<0.05). Rule of law remained significant in all the multivariate models, and the following adjustment for potential confounders remained robust for at least one or more of the health outcomes across all eight subindices of the rule of law. Findings show that the higher the country's level of adherence to the rule of law, the better the health of the population. Conclusions It is necessary to start considering the country's adherence to the rule of law as a foundational determinant of health. Health advocates should consider the improvement of rule of law as a tool to improve population health. Conversely, lack of progress in rule of law may constitute a structural barrier to health improvement
Behrman, Jere R; Xiong, Yanyan; Zhang, Junsen
Adult health outcomes and health behaviors are often associated with schooling. However, such associations do not necessarily imply that schooling has causal effects on health with the signs or magnitudes found in the cross-sectional associations. Schooling may be proxying for unobserved factors related to genetics and family background that directly affect both health and schooling. Recently several studies have used within-monozygotic (MZ) twins methods to control for unobserved factors shared by identical twins. Within-MZ estimates for developed countries are generally smaller than suggested by cross-sectional associations, consistent with positive correlations between unobserved factors that determine schooling and those that determine health. This study contributes new estimates of cross-sectional associations and within-MZ causal effects using the Chinese Adults Twins Survey, the first study of its type for developing countries. The cross-sectional estimates suggest that schooling is significantly associated with adult health-related behaviors (smoking, drinking, exercising) but not with own or spouse health outcomes (general health, mental health, overweight, chronic diseases). However, within-MZ-twins estimators change the estimates for approximately half of these health indicators, in one case declining in absolute magnitudes and becoming insignificant and in the other cases increasing in absolute magnitudes. Within-MZ estimates indicate significant pro-health effects for at least one of the indicators for own health (better mental health), own health-related behaviors (less smoking) and spouse health (less overweight). PMID:25464872
Scriven, A; Smith-Ferrier, S
Work has a synergistic relationship to health, and workplaces are increasingly the focus for both health promotion initiatives and health research. Electronic technologies are a common feature of many workplaces and as such are convenient low cost survey vehicles for the health researcher. The methods and the implications of employing Internet methods for health research are covered and a wide range of issues connected with online sampling and data collection are discussed. Because the workplace does not provide a neutral research environment, the security, anonymity and associated issues of using the two main forms of Internet surveys for workplace health research are examined and their advantages and disadvantages are debated. PMID:12852193
The 2014 survey includes degrees granted between September 1, 2013 and August 31, 2014. Enrollment information refers to the fall term 2014. Twenty-two academic programs were included in the survey universe, with all 22 programs providing data. Since 2009, data for two health physics programs located in engineering departments are also included in the nuclear engineering survey. The enrollments and degrees data includes students majoring in health physics or in an option program equivalent to a major.
The survey includes degrees granted between September 1, 2012 and August 31, 2013. Enrollment information refers to the fall term 2013. Twenty-two academic programs were included in the survey universe, with all 22 programs providing data. Since 2009, data for two health physics programs located in engineering departments are also included in the nuclear engineering survey. The enrollments and degrees data includes students majoring in health physics or in an option program equivalent to a major.taoi_na
Amoako Johnson, Fiifi; Padmadas, Sabu S; Smith, Peter W F
The HIV epidemic in sub-Saharan Africa has caused many children to become orphaned and vulnerable. Recent studies show that orphaned and vulnerable children (OVC) lack the basic necessities for survival and development. These children are particularly at high risk of poor health and poverty. Although the poor health outcomes of these children are well documented, the complexities of the factors that mediate their health outcomes have not been systematically studied. The aim of this paper is to examine how the complex relationships between and within the proximate and socio-economic determinants mediate the poor health outcomes of children through their OVC status. The analyses considered graphical chain modelling of morbidity data from a sample of 3745 children aged below five years from the 2005 Rwandan Demographic and Health Survey. The results show that OVC status influences the risk of childhood morbidity both directly and indirectly and also as a conduit through which other significant proximate factors and socio-economic factors operate. PMID:20390511
Johnson-Lawrence, Vicki; Griffith, Derek M.
Though gender, racial, and ethnic disparities in health in the United States are well documented, it is less clear how these factors intersect to produce patterns of mental health outcomes among men. This study examined the presence of father figures in the lives of African American, Caribbean black and non-Hispanic white American males until the age of 16; assessed the current socio-demographic factors of these men as adults; and explored whether these factors lead to variations in mental health outcomes. Regression models were used to examine the correlates of socio-demographic, psychosocial, and retrospective father figure measures for depressive symptoms and non-specific psychological distress among African American (n = 999), Caribbean black (n = 506), and non-Hispanic white men (n = 193) from the National Survey of American Life. Findings revealed racial and ethnic group differences by age, employment status, education, and household income on depressive symptoms (measured using the CES-D scale) and non-specific psychological distress (using the Kessler-6 scale). Findings suggested that being raised by a grandfather placed both African American and Caribbean black men at greater risk for depressive symptoms and non-specific psychological distress under certain socio-demographic conditions. This study is unique in that it considers the influence of father figures on the mental health outcomes of adult males across three racial and ethnic groups. We conclude with a discussion of the implications for future mental health research and practice with men of color. PMID:25057330
Dutta, M. J.; Bodie, G. D.
Increasingly, consumers are using the Internet to seek out health information. This increasing demand for health information on the Internet has been accompanied by an increase in the number of Websites delivering health information online. This rise in online health information search calls for a theoretical approach that explains consumer health information seeking on the Internet. Based on a review of the literature related to health information seeking, this chapter introduces an integrative model of online health information seeking, arguing that the motivation and ability to seek out health information are two key constructs in predicting health information seeking. Finally, the chapter highlights the implications of adopting the integrative model of online health information seeking in understanding the health outcomes associated with new communication technologies.
Turk, Dennis C; Dworkin, Robert H; Revicki, Dennis; Harding, Gale; Burke, Laurie B; Cella, David; Cleeland, Charles S; Cowan, Penney; Farrar, John T; Hertz, Sharon; Max, Mitchell B; Rappaport, Bob A
This two-phase study was conducted to identify relevant domains of patient-reported outcomes from the perspective of people who experience chronic pain. In Phase 1, focus groups were conducted to generate a pool of patient outcome-related domains and their components. The results of the focus groups identified 19 aspects of their lives that were significantly impacted by the presence of their symptoms and for which improvements were important criteria they would use in evaluating the effectiveness of any treatment. Phase 2 was conducted to examine the importance and relevance of domains identified from a much larger and diverse sample of people with chronic pain. A survey was developed and posted on the American Chronic Pain Association website. Participants were asked to rate the importance of each item or domain identified by the focus groups on a scale of 0 to10 (i.e., 0="not at all important" and 10="extremely important"). The survey was completed by 959 individuals. The results indicate that all 19 aspects of daily life derived from the focus groups were considered important with a majority of respondents indicating a score of 8 or greater. In addition to pain reduction, the most important aspects were enjoyment of life, emotional well-being, fatigue, weakness, and sleep-related problems. Chronic pain clearly impacts health-related quality of life. The results of the two phases of the study indicate that people with chronic pain consider functioning and well-being as important areas affected by the presence of symptoms and as appropriate targets of treatment. These multiple outcomes should be considered when evaluating the efficacy and effectiveness of chronic pain treatments. PMID:17937976
Schatz, Bruce R.
Abstract At the core of the healthcare crisis is fundamental lack of actionable data. Such data could stratify individuals within populations to predict which persons have which outcomes. If baselines existed for all variations of all conditions, then managing health could be improved by matching the measuring of individuals to their cohort in the population. The scale required for complete baselines involves effective National Surveys of Population Health (NSPH). Traditionally, these have been focused upon acute medicine, measuring people to contain the spread of epidemics. In recent decades, the focus has moved to chronic conditions as well, which require smaller measures over longer times. NSPH have long utilized quality of life questionnaires. Mobile Health Monitors, where computing technologies eliminate manual administration, provide richer data sets for health measurement. Older technologies of telephone interviews will be replaced by newer technologies of smartphone sensors to provide deeper individual measures at more frequent timings across larger-sized populations. Such continuous data can provide personal health records, supporting treatment guidelines specialized for population cohorts. Evidence-based medicine will become feasible by leveraging hundreds of millions of persons carrying mobile devices interacting with Internet-scale services for Big Data Analytics. PMID:26858915
Amaro, Hortensia; Reed, Elizabeth; Rowe, Erin; Picci, Jennifer; Mantella, Philomena; Prado, Guillermo
Objective: Evaluation of the Brief Alcohol Screen and Intervention in College Students (BASICS) in a university primary care setting. Participants/Methods: Undergraduates (N = 449) participated in BASICS and electronic surveys assessing frequency/quantity of alcohol and drug use, psychosocial and mental health outcomes, and demographic…
Systematic violations of expected utility theory (EU) have been reported in the context of both money and health outcomes. Rank-dependent utility theory (RDU) is currently the most popular and influential alternative theory of choice under circumstances of risk. This paper reports a test of the descriptive performance of RDU compared to EU in the context of health. When one of the options is certain, violations of EU that can be explained by RDU are found. When both options are risky, no evidence that RDU is a descriptive improvement over EU is found, though this finding may be due to the low power of the tests. PMID:14508870
Butler, Matthew J; Harootunian, Gevork; Johnson, William G
There are concerns that physicians serving low-income, Medicaid patients, in the United States are less likely to adopt electronic health records and, if so, that Medicaid patients will be denied the benefits from electronic health record use. This study seeks to determine whether physicians treating Medicaid patients were less likely to have adopted electronic health records. Physician surveys completed during physicians' license renewal process in Arizona were merged with the physician licensing data and Medicaid administrative claims data. Survey responses were received from 50.7 percent (6,780 out of 13,380) of all physicians practicing in Arizona. Physician survey responses were used to identify whether the physician used electronic health records and the degree to which the physician exchanged electronic health records with other health-care providers. Medicaid claims data were used to identify which physicians provided health care to Medicaid beneficiaries. The primary outcome of interest was whether Medicaid providers were more or less likely to have adopted electronic health records. Logistic regression analysis was used to estimate average marginal effects. In multivariate analysis, physicians with 20 or more Medicaid patients during the survey cycle were 4.1 percent more likely to use an electronic health record and 5.2 percent more likely to be able to transmit electronic health records to at least one health-care provider outside of their practice. These effects increase in magnitude when the analysis is restricted to solo practice physicians This is the first study to find a pro-Medicaid gap in electronic health record adoption suggesting that the low income patients served by Arizona's Health Care Cost Containment System are not at a disadvantage with regard to electronic health record access and that Arizona's model of promoting electronic health record adoption merits further study. PMID:23715209
Lee, Hyun Ou; Kim, Soyoon
Although research on health information has made significant progress in identifying the antecedents of individuals' information-seeking behavior in the context of the United States, the results have not been generalizable to the contexts of many other countries. Moreover, little is known about how one's information-seeking behavior is connected to actual behavioral outcomes relevant to the search action. The authors conducted an online survey with a stratified random sample of 1,004 mothers to examine the applicability of the comprehensive model of health information seeking in predicting the use of diverse childhood vaccination information sources in South Korea, and to investigate associations between the mothers' engagement with specific vaccine information sources and behavioral intention to immunize their children. Findings indicated that the hierarchical structure and the role of predictors within the comprehensive model of health information seeking provided a valid framework in the context of vaccine information seeking in Korea. In addition, the authors found negative associations between the use of certain types of information sources and mothers' intention to vaccinate. This suggests that the dissemination of critical health information through a variety of available sources does not automatically lead to prudent behavioral decisions when the specific characteristics of the different sources are not considered. PMID:25539018
Adams, Robert John
A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual's competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been
Pandey, Anamika; Dandona, Lalit
Abstract Several rounds of national health surveys have generated a vast amount of data in India since 1992. We describe and compare the key health information gathered, assess the availability of health data in the public domain, and review publications resulting from the National Family Health Survey (NFHS), the District Level Household Survey (DLHS) and the Annual Health Survey (AHS). We highlight issues that need attention to improve the usefulness of the surveys in monitoring changing trends in India’s disease burden: (i) inadequate coverage of noncommunicable diseases, injuries and some major communicable diseases; (ii) modest comparability between surveys on the key themes of child and maternal mortality and immunization to understand trends over time; (iii) short time intervals between the most recent survey rounds; and (iv) delays in making individual-level data available for analysis in the public domain. We identified 337 publications using NFHS data, in contrast only 48 and three publications were using data from the DLHS and AHS respectively. As national surveys are resource-intensive, it would be prudent to maximize their benefits. We suggest that India plan for a single major national health survey at five-year intervals in consultation with key stakeholders. This could cover additional major causes of the disease burden and their risk factors, as well as causes of death and adult mortality rate estimation. If done in a standardized manner, such a survey would provide useable and timely data to inform health interventions and facilitate assessment of their impact on population health. PMID:27034522
Boscarino, Joseph A; Hoffman, Stuart N; Kirchner, H Lester; Erlich, Porat M; Adams, Richard E; Figley, Charles R; Solhkhah, Ramon
On October 29, 2012, Hurricane Sandy made landfall in the most densely populated region in the US. In New Jersey, thousands of families were made homeless and entire communities were destroyed in the worst disaster in the history of the state. The economic impact of Sandy was huge, comparable to Hurricane Katrina. The areas that sustained the most damage were the small- to medium-sized beach communities along New Jersey's Atlantic coastline. Six months following the hurricane, we conducted a random telephone survey of 200 adults residing in 18 beach communities located in Monmouth County. We found that 14.5% (95% CI = 9.9-20.2) of these residents screened positive for PTSD and 6.0% (95% CI = 3.1-10.2) met criteria for major depression. Altogether 13.5% (95% CI = 9.1-19.0) received mental health counseling and 20.5% (95% CI = 15.1-26.8) sought some type of mental health support in person or online, rates similar to those reported in New York after the World Trade Center disaster In multivariate analyses, the best predictors of mental health status and service use were having high hurricane exposure levels, having physical health limitations, and having environmental health concerns. Research is needed to assess the mental health status and service use of Jersey Shore residents over time, to evaluate environmental health concerns, and to better understand the storm's impact among those with physical health limitations. PMID:24558743
Ito, Karen L.; So, Alvin
Data from the Asian American Field Survey of 1973 were examined to determine health problems, methods of seeking and paying for health services, health insurance coverage, and frequency of medical examinations among Japanese, Chinese, Filipino, Korean, and Samoan families in the United States. The analysis indicated that the Chinese reported the…
Lichtenstein, Gary; Thorme, Trisha; Cutforth, Nick; Tombari, Martin L.
With the goal of codifying student learning outcomes of community-based research (CBR), the authors created a conceptually valid and statistically reliable CBR Student Learning Outcomes Survey. The project began with individual interviews and focus groups with 70 undergraduates and faculty at six colleges and universities nationwide discussing…
Lee, Wang-Sheng; Polidano, Cain
The aim of this report is to examine the potential use of information from the Student Outcomes Survey, including the use of student course satisfaction information and post-study outcomes, as a means of determining markers of training quality. In an analysis of the student course satisfaction measures, the authors found there are very small…
Bumpass, J Brock; McDaneld, Patrick M; DePestel, Daryl D; Lamp, Kenneth C; Chung, Thomas J; McKinnon, Peggy S; Crompton, Monica G; Hermsen, Elizabeth D
We conducted a survey to compare antimicrobial stewardship outcomes considered to be most important with those used in practice as metrics. Respondent opinion of important outcomes compared with those collected as metrics were antimicrobial use (15% vs 73%), antimicrobial cost (10% vs 73%), appropriateness of antimicrobial use (56% vs 51%), infection-related mortality rate (34% vs 7%), and antibiotic-associated length of stay (22% vs 12%). Patient outcomes are important to many practitioners but are rarely used as metrics. PMID:25261537
Lordan, Grace; Frijters, Paul
This work considers whether planning matters with respect to the effect of a new sibling on another siblings' health. Objective health outcomes are observed before and after a new addition to the family. To date, the literature on family size has focused on a quality-quantity trade-off; the more children in a family, the less resources devoted to each child. We present a theoretical framework which highlights that the quantity-quality trade-off may only be relevant in the case of an unplanned sibling. We also suggest that a planned sibling may result in health gains for the other children. We use two waves of data for more than 1800 children from Peru from the Young Lives Project to test our hypothesis. The data relate to the children at 1 and 5 years. For health outcomes, height for age and weight for age Z are considered. The results highlight significant negative independent effects on height for age when an unplanned sibling is added to the household. In addition, we find positive sibling effects on height for age when a planned sibling arrives. We find only small planning effects for weight for age. We view our hypothesis as a pathway that can further explain the quantity-quality trade-off. PMID:22941673
Breysse, Jill; Jacobs, David E.; Weber, William; Dixon, Sherry; Kawecki, Carol; Aceti, Susan; Lopez, Jorge
Objective This study sought to determine whether renovating low-income housing using “green” and healthy principles improved resident health and building performance. Methods We investigated resident health and building performance outcomes at baseline and one year after the rehabilitation of low-income housing using Enterprise Green Communities green specifications, which improve ventilation; reduce moisture, mold, pests, and radon; and use sustainable building products and other healthy housing features. We assessed participant health via questionnaire, provided Healthy Homes training to all participants, and measured ventilation, carbon dioxide, and radon. Results Adults reported statistically significant improvements in overall health, asthma, and non-asthma respiratory problems. Adults also reported that their children's overall health improved, with significant improvements in non-asthma respiratory problems. Post-renovation building performance testing indicated that the building envelope was tightened and local exhaust fans performed well. New mechanical ventilation was installed (compared with no ventilation previously), with fresh air being supplied at 70% of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers standard. Radon was <2 picocuries per liter of air following mitigation, and the annual average indoor carbon dioxide level was 982 parts per million. Energy use was reduced by 45% over the one-year post-renovation period. Conclusions We found significant health improvements following low-income housing renovation that complied with green standards. All green building standards should include health requirements. Collaboration of housing, public health, and environmental health professionals through integrated design holds promise for improved health, quality of life, building operation, and energy conservation. PMID:21563714
Cuffe, Steven P.; Moore, Charity G.; McKeown, Robert
Objective: Describe the general health, comorbidities and health service use among U.S. children with ADHD. Method: The 2001 National Health Interview Survey (NHIS) contained the Strengths and Difficulties Questionnaire (SDQ; used to determine probable ADHD), data on medical problems, overall health, and health care utilization. Results: Asthma…
This 5-year project has been used for consumers to identify the best health care plans and services for their needs. The goals of the Consumer Assessment of Health Plans (CAHPS?) are to (1) develop and test questionnaires that assess health plans and services, (2) produce easily ...
Gordon, Jonathan; Ludlum, Joe; Hoey, J. Joseph
While there exist many examples of institutional use of the results of the National Survey of Student Engagement (NSSE), there is a relative paucity of research explicitly linking student outcomes to responses on the survey. A major Doctoral-Extensive institution in the Southeast recently conducted a large-scale implementation of the National…
Parker, Ben L.; Drummond-Reeves, Susan J.
Offers both the questionnaire and the subject calling card from the 1991 Boise State University (BSU) alumni outcomes assessment survey, as a general model for assessing communication alumni. Makes suggestions regarding the design of an effective survey instrument based on the BSU experience. (SR)
Mnich, E; Hofreuter-Gätgens, K; Salomon, T; Swart, E; von dem Knesebeck, O
The programme "active health promotion in old age" focuses on responsible self determination in old age (empowerment) and places special emphasis on physical activity and nutrition. The intervention, successfully conducted in an urban setting (Hamburg), was tested in a rural area (Kinzigtal, Baden-Wuerttemberg). In this paper we present the results of the outcome evaluation. The intervention group consisted of older people, without care need and without cognitive impairment who lived in their own home (N=468). For the evaluation of the results a pre-post comparison was conducted (2 measuring points within an interval of 12 months). 4 out of 5 participants reported changes in their behaviour after the intervention. However, the pre-post comparison shows significant changes only for nutrition behaviour, but not of physical activity. Health related quality of life (SF-36) did not change after 12 months. These findings indicate that health promotion in old age may lead to changes in nutrition behaviour. PMID:22615028
Anderson, G F; Poullier, J P
In 1997 the United States spent $3,925 per capita on health or 13.5 percent of gross domestic product (GDP), while the median Organization for Economic Cooperation and Development (OECD) country spent $1,728 or 7.5 percent. From 1990 to 1997 U.S. health spending per capita increased 4.3 percent per year, compared with the OECD median of 3.8 percent. The United States has the lowest percentage of the population with government-assured health insurance. It also has the fewest hospital days per capita, the highest hospital expenditures per day, and substantially higher physician incomes than the other OECD countries. On the available outcome measures, the United States is generally in the bottom half, and its relative ranking has been declining since 1960. PMID:10388215
Thach, Thuan-Quoc; Wong, Chit-Ming; Chan, King-Pan; Chau, Yuen-Kwan; Neil Thomas, G.; Ou, Chun-Quan; Yang, Lin; Peiris, Joseph S. M.; Lam, Tai-Hing; Hedley, Anthony J.
We assessed confounding of associations between short-term effects of air pollution and health outcomes by influenza using Hong Kong mortality and hospitalization data for 1996-2002. Three measures of influenza were defined: (i) intensity: weekly proportion of positive influenza viruses, (ii) epidemic: weekly number of positive influenza viruses ≥4% of the annual number for ≥2 consecutive weeks, and (iii) predominance: an epidemic period with co-circulation of respiratory syncytial virus <2% of the annual positive isolates for ≥2 consecutive weeks. We examined effects of influenza on associations between nitrogen dioxide (NO 2), sulfur dioxide (SO 2), particulate matter with aerodynamic diameter ≤10 μm (PM 10) and ozone (O 3) and health outcomes including all natural causes mortality, cardiorespiratory mortality and hospitalization. Generalized additive Poisson regression model with natural cubic splines was fitted to control for time-varying covariates to estimate air pollution health effects. Confounding with influenza was assessed using an absolute difference of >0.1% between unadjusted and adjusted excess risks (ER%). Without adjustment, pollutants were associated with positive ER% for all health outcomes except asthma and stroke hospitalization with SO 2 and stroke hospitalization with O 3. Following adjustment, changes in ER% for all pollutants were <0.1% for all natural causes mortality, but >0.1% for mortality from stroke with NO 2 and SO 2, cardiac or heart disease with NO 2, PM 10 and O 3, lower respiratory infections with NO 2 and O 3 and mortality from chronic obstructive pulmonary disease with all pollutants. Changes >0.1% were seen for acute respiratory disease hospitalization with NO 2, SO 2 and O 3 and acute lower respiratory infections hospitalization with PM 10. Generally, influenza does not confound the observed associations of air pollutants with all natural causes mortality and cardiovascular hospitalization, but for some pollutants
Lawrence, Herenia P; Cidro, Jaime; Isaac-Mann, Sonia; Peressini, Sabrina; Maar, Marion; Schroth, Robert J; Gordon, Janet N; Hoffman-Goetz, Laurie; Broughton, John R; Jamieson, Lisa
This study assessed links between racism and oral health outcomes among pregnant Canadian Aboriginal women. Baseline data were analyzed for 541 First Nations (94.6%) and Métis (5.4%) women in an early childhood caries preventive trial conducted in urban and on-reserve communities in Ontario and Manitoba. One-third of participants experienced racism in the past year determined by the Measure of Indigenous Racism Experience. In logistic regressions, outcomes significantly associated with incidents of racism included: wearing dentures, off-reserve dental care, asked to pay for dental services, perceived need for preventive care, flossing more than once daily, having fewer than 21 natural teeth, fear of going to dentist, never received orthodontic treatment and perceived impact of oral conditions on quality of life. In the context of dental care, racism experienced by Aboriginal women can be a barrier to accessing services. Programs and policies should address racism's insidious effects on both mothers' and children's oral health outcomes. PMID:26853210
Lodhi, Muhammad Kamran; Ansari, Rashid; Yao, Yingwei; Keenan, Gail M.; Wilkie, Diana J.; Khokhar, Ashfaq A.
Electronic health record (EHR) systems are used in healthcare industry to observe the progress of patients. With fast growth of the data, EHR data analysis has become a big data problem. Most EHRs are sparse and multi-dimensional datasets and mining them is a challenging task due to a number of reasons. In this paper, we have used a nursing EHR system to build predictive models to determine what factors impact death anxiety, a significant problem for the dying patients. Different existing modeling techniques have been used to develop coarse-grained as well as fine-grained models to predict patient outcomes. The coarse-grained models help in predicting the outcome at the end of each hospitalization, whereas fine-grained models help in predicting the outcome at the end of each shift, therefore providing a trajectory of predicted outcomes. Based on different modeling techniques, our results show significantly accurate predictions, due to relatively noise-free data. These models can help in determining effective treatments, lowering healthcare costs, and improving the quality of end-of-life (EOL) care.
Corso, Phaedra S.; Ingels, Justin B.; Taylor, Nathaniel; Desai, Samir
Introduction: Resources for public health (PH) are scarce and policymakers face tough decisions in determining their funding priorities. The difficulty of making these decisions is compounded by current PH accounting systems, which are ill-equipped to link fiscal resources to PH outcomes. This paper examines the types of revenues and expenditures, health services, and health outcomes that are being tracked at the local and state PH levels. The authors provide recommendations for strengthening the ability of local and state governments to link expenditures to PH outcomes, both within and across jurisdictions. Framework and Next Steps: The source of revenue data for most local jurisdictions is the accounting systems used for the budgeting and auditing of fiscal activities, and these are primarily linked to specific PH programs. In contrast, expenditure data are mostly generic and typically span multiple PH programs with no link to specific PH activities. Many challenges exist to then link PH activities to health outcomes data, which are often collected through separate reporting systems at the local, state, and national levels. Policy change at the state level and implementation strategies that are standardized across local health departments are required to assess the costs and health outcomes of PH activities. Conclusion: Information linking PH expenditures to health outcomes of PH services could greatly inform the decision-making process. This information will allow investments in PH to be better understood and will provide a strong foundation for the PH services and systems research community to understand variation and drive improvement. Ultimately, these data could be used to improve accountability at the local and state PH department levels. PMID:25848629
Allen, H M
Consumer surveys are at a pivotal moment in health care. With demand for consumer-supplied data escalating in every sector of the industry, current opportunities for consumer surveys to demonstrate unique value in the marketplace are unparalleled. These opportunities, however, carry considerable risks, particularly with respect to performance report cards for competing health plans and providers. As investigators multiply in an area notably lacking in standardization, the chances increase that surveys will arrive at conflicting assessments of plans and providers. To resolve these inconsistencies, users will need to sharpen their understanding of the role of consumer surveys, the business and operational needs they can address, and how their results can be affected by methodology. This article discusses each of these issues with an eye toward promoting intelligent use of consumer surveys in the health care marketplace. PMID:10151590
Weng, Hsin-Yi; Ankrom, Kimberly
Companion animals play an important role in our society. However, pregnant women and new mothers might have specific concerns about animal-associated health outcomes because of their altered immune function and posture as well as their newborn babies. The study was conducted to collect baseline data for developing an evidence-based intervention for pregnant women and new mothers to help them adopt certain behaviors to prevent adverse animal-associated health outcomes. A survey, using the Health Belief Model as the theoretical framework, was developed and administered to 326 women attending the Women, Infants, and Children programs in Illinois and Indiana in 2015. Prevalence of dog and cat ownership was estimated to be 39% (95% CI: 33–45%) and 26% (95% CI: 21–31%), respectively. Regardless of pet ownership, 74% of the respondents reported having some type of animal contact in the past month. Pregnancy or the birth of a child altered some animal contact practices among the study participants; particularly a discontinuation or decrease in cleaning cat litter boxes. Reports of diseases contracted from animals were low (4%) in this study. By contrast, animal-associated injuries were prevalent (42%), and the majority were caused by animals the respondents owned (56%). Overall, respondents indicated that they appreciated the benefits of a program addressing animal-associated health outcomes and did not indicate strong resistance to adopt certain behaviors. The majority recognized human health-care providers as a source of information about animal contact and associated health outcomes but less frequently identified veterinarians as a source for such information. In addition, although most of the respondents felt that health-care providers and veterinarians should initiate discussions about preventing animal-associated illness and injuries, only 41% among those who had visited doctors or prenatal care services reported that their health-care providers discussed these
Brumback, Babette A; Cai, Zhuangyu; He, Zhulin; Zheng, Hao W; Dailey, Amy B
In order to adjust individual-level covariate effects for confounding due to unmeasured neighborhood characteristics, we have recently developed conditional pseudolikelihood methods to estimate the parameters of a proportional odds model for clustered ordinal outcomes with complex survey data. The methods require sampling design joint probabilities for each within-neighborhood pair. In the present article, we develop a similar methodology for a baseline category logit model for clustered multinomial outcomes and for a loglinear model for clustered count outcomes. All of the estimators and asymptotic sampling distributions we present can be conveniently computed using standard logistic regression software for complex survey data, such as sas proc surveylogistic. We demonstrate validity of the methods theoretically and also empirically by using simulations. We apply the new method for clustered multinomial outcomes to data from the 2008 Florida Behavioral Risk Factor Surveillance System survey in order to investigate disparities in frequency of dental cleaning both unadjusted and adjusted for confounding by neighborhood. PMID:22976045
Applegate, Mary; Gee, Rebekah E; Martin, James N
Maternal and infant health is critical to our nation's health. Disparities remain unacceptably high, particularly in the areas of prematurity and infant mortality. In 2012, traditionally distant partners such as federal and state governments, Medicaid and commercial payers, patients, public health and private clinicians, and multiple advocacy groups collaborated to focus on improving birth outcomes. To catalyze the alignment, the Centers for Medicare and Medicaid Services convened an Expert Panel on Improving Maternal and Infant Health Outcomes in Medicaid and the Children's Health Insurance Program. Over a year's time, the Expert Panel assimilated the best available evidence in clinical science and policy from content leaders and patients. These recommendations culminated in the present report, which challenges us as a nation to implement strategies to help all children have the best chance to survive and thrive comparable to that of other westernized nations. PMID:24901270
Taber, Jennifer M.; Howell, Jennifer L.; Emanuel, Amber S.; Klein, William M. P.; Ferrer, Rebecca A.; Harris, Peter R.
Objective Self-affirming—such as by reflecting on one's strengths and values—reduces defensiveness to threatening information, reduces negative effects of stereotype threat, and promotes prosociality. These outcomes may promote physical health, highlighting a need to examine the role of self-affirmation in medical and health contexts. Design Data were collected as part of the nationally representative, cross-sectional, 2013 Health Information National Trends Survey. Items were completed by 2,731 respondents. Main Outcome Measures Respondents answered questions about spontaneous self-affirmation tendencies, perceptions of providers and health care, involvement in medical appointments, health information seeking, and engagement in medical research. Results Spontaneous self-affirmation was associated with more positive perceptions of communication with one's provider, better perceived quality of care, greater likelihood of asking questions in a medical appointment, greater information seeking for oneself, and multiple indices of surrogate information seeking (i.e., seeking information for others). Four of eight significant associations remained significant when controlling for optimism. The associations of self-affirmation with aspects of the patient-provider relationship were not modified by factors likely to be associated with stereotype threat (e.g., race or BMI). Conclusion Spontaneous self-affirmation was related to positive outcomes in health contexts. Experimental research is needed to further explore the causal nature of these associations. PMID:26315683
Jamil, Hikmet; Aldhalimi, Abir; Arnetz, Bengt B.
This study investigates employment and health outcomes in Iraqi refugees compared to Iraqi immigrants. We surveyed 148 Iraqi professional refugees and 111 Iraqi professional immigrants residing in the U.S. We hypothesized that Iraqi refugees would report lower employment and worse self-rated health as compared to Iraqi immigrants. Logistic Regression was used to test various models. Results showed that more immigrants were employed, as well as employed in their original profession as compared to refugees. Regardless of immigration status, participants' age and the way they rated their job played a larger role in health. The study is the first to demonstrate that, controlling for professional, ethnic and cultural background, there are unknown mechanisms resulting in lower employment and skilled employment in refugees as compared to matched immigrant controls. Furthermore, satisfaction with the new work appears more important than employment per se. PMID:24683383
René, A. A.; Daniels, D. E.; Martin, S. A.
A significant amount of evidence reveals a presence of environmental inequity. Although there is a disproportionate distribution of waste treatment, storage and disposal facilities, and chemical and manufacturing plants in minority and low-income communities in the United States, little research has been devoted to show any associations based on analytic epidemiological methods. To date, attempts to quantify health disparities have included demographic data, race, sex, income, other socioeconomic factors, and broad symptomatic survey instruments. To study this, we examined the latest epidemiological evidence documenting the existence of adverse health impacts resulting from environmental inequity. We observed that the overwhelming majority of studies were descriptive in nature and lacked comparison populations. As a result, we believe that further research based on analytic epidemiological methods would further contribute to the determination of the cause-effect relationship between environmental exposure and health outcome. PMID:10918762
Current evidence indicates that individuals exposed to short term elevations in ambient ozone may experience both upper and lower respiratory effects. Some respiratory symptoms and spirometric changes are mild and reversible in nature, while others involve more severe outcomes, including hospital admissions and emergency room visits. However, many questions remain about the effects of acute ozone exposure and the implications of this exposure for chronic disease outcomes. For example, the identification of sensitive subgroups, the delineation of the entire spectrum of health effects due to exposure to ozone, the potential synergy between viral infections and ozone exposure, and the nature of adaptation to ozone are not well characterized. In addition, studies that examine the association between acute responses to ozone and potential biological indicators of a chronic disease process would be desirable. This paper serves to provide an overview of the types of epidemiologic studies that may be appropriate and factors to consider in addressing these questions. 23 refs.
Braithwaite, Scott; Stine, Nicholas
Health system leaders sometimes adopt quality metrics without robust supporting evidence of improvements in quality and/or quantity of life, which may impair rather than facilitate improved health outcomes. In brief, there is now no easy way to measure how much "health" is conferred by a health system. However, we argue that this goal is achievable. Health-weighted composite quality metrics have the potential to measure "health" by synthesizing individual evidence-based quality metrics into a summary measure, utilizing relative weightings that reflect the relative amount of health benefit conferred by each constituent quality metric. Previously, it has been challenging to create health-weighted composite quality metrics because of methodological and data limitations. However, advances in health information technology and mathematical modeling of disease progression promise to help mitigate these challenges by making patient-level data (eg, from the electronic health record and mobile health (mHealth) more accessible and more actionable for use. Accordingly, it may now be possible to use health information technology to calculate and track a health-weighted composite quality metric for each patient that reflects the health benefit conferred to that patient by the health system. These health-weighted composite quality metrics can be employed for a multitude of important aims that improve health outcomes, including quality evaluation, population health maximization, health disparity attenuation, panel management, resource allocation, and personalization of care. We describe the necessary attributes, the possible uses, and the likely limitations and challenges of health-weighted composite quality metrics using patient-level health data. PMID:25848572
Quality of life is widely used as a measure of individual well-being in developed countries. Social quality (SQ), however, describes how favorable the socioenvironmental components are that impact the life chance of an individual. Despite the associations between SQ, including institutional capacity and citizen capacity, and other community indicators, the impact of SQ on community health status has not been fully examined. This study investigated the interrelationships among institutional capacity, citizen capacity, and their associations with community-level health indicators such as mortality and suicide among 230 local governments in South Korea. Under the principles of conceptual suitability, clarity, reliability, consistency, changeability, and comparability, a total of 81 SQ indicators were collected, and 19 indicators of the 81 indicators were selected. The 19 indicators were transformed by the imputation of missing values, standardization, and geographic information system transformation. It was found that the health outcome of local government was superior as social welfare, political participation, and education were higher. According to the result of the regression analysis based on the regional type, social welfare had the most influence on the health level of local government in both metropolises and small-/medium-sized cities. In addition, education and political participation had a positive effect on the health indicator of local metropolis government. However, SQ indicators did not have any meaningful influence at the county level. Therefore, small- and medium-sized cities need to promote the collective health of the local government through improving social welfare, and metropolises need to consider the complex relationship among other indicators while increasing the level of social welfare and education. Meanwhile, counties need to develop health indicators that reflect aged population characteristics and social environment of rural areas
To inform students of health risks (posed by behavior, environment, and genetics) and provide schools with collective risk appraisal information as a basis for planning/evaluating health and wellness initiatives, New Mexico administered the Teen Wellness Check in 1985 to 1,573 ninth-grade students from 7 New Mexico public schools. Subjects were…
The Association of State and Territorial Public Health Nutrition Directors (ASTPHND), with support from a cooperative agreement with the U.S. Department of Agriculture (USDA), conducted a census of the professional and paraprofessional public health nutrition workforce in the sta...
Work, Thierry M.; Coles, Steve L.; Rameyer, Robert
French Frigate Shoals consists of a large (31 nm) fringing reef partially enclosing a lagoon. A basalt pinnacle (La Perouse Pinnacle) arises approximately halfway between the two ends of the arcs of the fringing reefs. Tern Island is situated at the northern end of the lagoon and is surrounded by a dredged ship channel. The lagoon becomes progressively shallower from west to east and harbors a variety of marine life including corals, fish, marine mammals, and sea turtles (Amerson 1971). In 2000, an interagency survey of the northwestern Hawaiian Islands was done to document the fauna and flora in FFS (Maragos and Gulko, 2002). During that survey, 38 stations were examined, and 41 species of stony corals were documented, the most of any of the NW Hawaiian islands (Maragos and Gulko 2002). In some of these stations, corals with abnormalities were observed. The present study aimed to expand on the 2000 survey to evaluate the lesions in areas where they were documented.
Li, Kai; Armstrong, April W
Psoriasis, a chronic inflammatory skin condition, is a complex disease in terms of its significant comorbidities and impact on patients' quality of life. The objective of this article is to elucidate the health outcomes of the disease, including its economic and psychosocial burden on the patient. Current treatments options and the economic considerations of treatment costs are reviewed. Psoriasis is a multidimensional disease, so patients benefit from having a multidisciplinary team of dermatologists and other physicians for management of it and of associated comorbid conditions. PMID:22117868
Jonk, Yvonne; O'Connor, Heidi; Riise, Kirsten Sundgaard; Eisenberg, David M.; Kreitzer, Mary Jo
Background: Health coaching is a client-centric process to increase motivation and self-efficacy that supports sustainable lifestyle behavior changes and active management of health conditions. This study describes an intervention offered as a benefit to health plan members and examines health and behavioral outcomes of participants. Methods: High-risk health plan enrollees were invited to participate in a telephonic health coaching intervention addressing the whole person and focusing on motivating health behavior changes. Outcomes of self-reported lifestyle behaviors, perceived health, stress levels, quality of life, readiness to make changes, and patient activation levels were reported at baseline and upon program completion. Retrospectively, these data were extracted from administrative and health coaching records of participants during the first 2 full years of the program. Results: Less than 7% of the 114 615 potential candidates self-selected to actively participate in health coaching, those with the highest chronic disease load being the most likely to participate. Of 6940 active participants, 1082 fully completed health inventories, with 570 completing Patient Activation Measure (PAM). The conditions most often represented in the active participants were depression, congestive heart failure, diabetes, hyperlipidemia, hypertension, osteoporosis, asthma, and low back pain. In 6 months or less, 89% of participants met at least one goal. Significant improvements occurred in stress levels, healthy eating, exercise levels, and physical and emotional health, as well as in readiness to make change and PAM scores. Discussion: The types of client-selected goals most often met were physical activity, eating habits, stress management, emotional health, sleep, and pain management, resulting in improved overall quality of life regardless of condition. Positive shifts in activation levels and readiness to change suggest that health coaching is an intervention deserving
Attention-deficit/hyperactivity disorder (ADHD) is defined by extreme levels of inattention–disorganization and/or hyperactivity–impulsivity. In DSM-IV, the diagnostic criteria required impairment in social, academic, or occupational functioning. With DSM-5 publication imminent in 2013, further evaluation of impairment in ADHD is timely. This article reviews the current state of knowledge on health-related impairments of ADHD, including smoking, drug abuse, accidental injury, sleep, obesity, hypertension, diabetes, and suicidal behavior. It concludes by suggesting the need for new avenues of research on mechanisms of association and the potential for ADHD to be an early warning sign for secondary prevention of some poor health outcomes. PMID:23298633
O'Sullivan, Lucia F
New digital technologies are highly responsive to many of the developmental needs of adolescents, including their need for intimate connection and social identity. This chapter explores adolescents' use of web-based sexual information, texting and "sexting," online dating sites, role-playing games, and sexually explicit media, and presents new data comparing the interpersonal and intrapersonal health outcomes among youth who engage in online sexual activities to those who do not. Despite the media-stoked concerns surrounding adolescents' participation in online sexual activities, the ubiquity of online activities and close overlap between online and offline activities indicate that this type of behavior should not be pathologized or used as a metric of problem behavior. The chapter concludes with implications for parents, educators, researchers, counselors, and health care providers, a call to challenge our deep discomfort around adolescent sexuality and to harness these technologies in ways that help promote growth and positive development. PMID:24962361
Blackwell, Debra L.; Tonthat, Luong
This report presents statistics from the 1999 National Health Interview Survey (NHIS) on selected health measures for children under 18 years of age, classified by sex, age, race/ethnicity, family structure, parent education, family income, poverty status, health insurance coverage, place of residence, region, and current health status. The NHIS…
Ponce, Ninez A.; Lavarreda, Shana Alex; Yen, Wei; Brown, E. Richard; DiSogra, Charles; Satter, Delight E.
The cultural and linguistic diversity of the U.S. population presents challenges to the design and implementation of population-based surveys that serve to inform public policies. Information derived from such surveys may be less than representative if groups with limited or no English language skills are not included. The California Health Interview Survey (CHIS), first administered in 2001, is a population-based health survey of more than 55,000 California households. This article describes the process that the designers of CHIS 2001 underwent in culturally adapting the survey and translating it into an unprecedented number of languages: Spanish, Chinese, Vietnamese, Korean, and Khmer. The multiethnic and multilingual CHIS 2001 illustrates the importance of cultural and linguistic adaptation in raising the quality of population-based surveys, especially when the populations they intend to represent are as diverse as California's. PMID:15219795
The survey provides data on socioeconomic and demographic characteristics of mothers, prenatal care, pregnancy history, occupational background, health status of mother and infant, and types and sources of medical care received.
Bowden, V M
Twenty-eight health sciences library building projects are briefly described, including twelve new buildings and sixteen additions, remodelings, and renovations. The libraries range in size from 2,144 square feet to 190,000 gross square feet. Twelve libraries are described in detail. These include three hospital libraries, one information center sponsored by ten institutions, and eight academic health sciences libraries. Images PMID:10550027
The National Health and Nutrition Examination Survey (NHANES) is conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. Health Research Facilities: A survey of Doctorate-Granting Institutions.
Atelsek, Frank J.; Gomberg, Irene L.
The survey data cover three broad categories: (1) the status of existing health research facilities at doctorate-granting institutions (including their current value, adequacy, and condition); (2) the volume of new construction in progress; and (3) the additions to health research facilities anticipated during the next 5 years…
Illinois State Board of Education, Springfield.
A survey was conducted in Illinois to identify the risk of certain health problems among adolescents; to determine the health status of Illinois youth in relation to the Surgeon General's "Healthy People 2000 Objectives" and monitor progress toward national and state goals; and to help those working at national, state, and local levels develop…
Brack, Amy Badura; Kesitilwe, Kutlo; Ware, Mark E.
We conducted a random national survey of 100 doctoral, 100 comprehensive, and 100 baccalaureate institutions to determine the current state of the undergraduate health psychology course. We found clear evidence of a maturing course with much greater commonality in name (health psychology), theoretical foundation (the biopsychosocial model), and…
Lee, Jane A.; And Others
The study, conducted in 1971, assessed characteristics of licensed practical nurses (LPN's) who worked in occupational health nursing. The survey instrument, a questionnaire, was returned by 591 LPN's in occupational health and provided data related to: personal characteristics, work and setting, administrative and professional functioning,…
Yun, Katherine; Mohamad, Zeinab; Kiss, Ligia; Annamalai, Aniyizhai; Zimmerman, Cathy
Our goal was to describe the forms of persecution reported by adult refugees in the U.S. and the relationships between persecution and health status among this population. Data were derived from the 2003 New Immigrant Survey, a representative sample of new U.S. lawful permanent residents. Major depression, impairment in daily activities due to pain, poor self-reported health, and declining health were described for refugees who had and had not reported persecution prior to arrival in the U.S. Health status was also examined for refugees who reported different forms of persecution. Half of refugees (46.7 %) in this sample reported that they or an immediate family member had been persecuted. One in three persecuted refugees (31.8 %) reported both incarceration and physical punishment. Major depression, pain-related impairment, poor health, and declining health were twice as common among persecuted refugees than among non persecuted refugees. Notably, despite these adverse experiences, the majority of persecuted refugees did not report poor health outcomes. PMID:25740552
Currie, Janet; Stabile, Mark; Manivong, Phongsack; Roos, Leslie L.
Previous research has shown a strong connection between birth weight and future child outcomes. But this research has not asked how insults to child health after birth affect long-term outcomes, whether health at birth matters primarily because it predicts future health or through some other mechanism, or whether health insults matter more at some…
Ministry of Advanced Education and Labour Market Development, 2009
The BC Diploma, Associate Degree, and Certificate Student Outcomes (DACSO) Survey (formerly the BC College and Institute Student Outcomes Survey) collects and disseminates information about former students' post-secondary experiences and their subsequent labour market and further education experiences. The survey is administered annually to former…
Substance Abuse and Mental Health Services Administration, 2012
This report presents results pertaining to mental health from the 2010 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. This report presents national estimates of the prevalence of past year mental disorders and past year mental health…
Background Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables. Methods A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index. Results The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant. Conclusions Despite the adverse contextual conditions and the limitations imposed by the Colombian health
Gruszfeld, Dariusz; Socha, Piotr
Maternal diet, nutritional status during pregnancy, and the early diet of the offspring play an important role in later health. The short- and long-term outcomes of early nutrition have been extensively studied in recent decades. One of the most commonly investigated nutritional interventions is breastfeeding, which is associated with a number of positive short- and long-term outcomes. A short-term effect of breastfeeding is reduced morbidity and mortality in children from poor living conditions and in preterm infants. Breastfeeding is associated with better cognitive development and also has a long-term protective effect on obesity risk, prevalence of type 2 diabetes, and a lowering effect on blood pressure. Selected nutrients have undergone extensive investigation to show their role in disease prevention or improved development, e.g. protein intake in infancy seems to be associated with a later risk of obesity or docosahexaenoic acid supplementation has a positive impact on cognitive function. Another consideration is the fast catch-up growth in small for gestational age infants as an important factor associated with adult risk of cardiovascular problems. On the other hand, high protein and energy intake seems to be positively associated with some indicators of cognitive development. Most of the evidence comes from observational studies that cannot exclude potential confounders. Animal studies demonstrate causality but should not be directly extrapolated to humans. The number of randomized controlled studies is increasing but long-term follow-ups are necessary to obtain convincing results. The majority of these trials compare different infant formula compositions and macro- or micronutrient supplementation. One of the major questions is to define a critical (or opportunity) window and a mechanism of nutritional influence on several health outcomes. PMID:24029784
Lu, Shu-rong; Su, Jian; Xiang, Quan-yong; Zhang, Feng-yun; Wu, Ming
To investigate the prevalence of active transport (AT, defined as walking or bicycling for transport) and to explore the association between AT and health outcomes, we conducted a population-based cross-sectional study in Jiangsu, China, where walking and bicycling are still the main modes of transport. In this study, 8400 community residents aged 18 or above were interviewed following a multistage random sampling method (100% response rate). Face-to-face questionnaire survey data, anthropometric measurements, and biochemical data from blood tests were collected. Results show that 49.6% of the subjects, as part of daily transport, actively traveled on average 5.3 days per week, 53.5 minutes per day, and 300.3 minutes per week. There was an inverse correlation between AT and some health outcomes: AT respondents had a higher prevalence of cholesterol disorder; AT respondents who actively travelled every day had a higher risk of diabetes, whilst AT respondents with shorter daily or weekly duration had a lower risk of obesity, central obesity, and cholesterol disorder. Moreover, AT influences more health aspects among urban residents than among rural residents. Findings of this study do not support the notion that AT is beneficial to population health. Further research is needed in determining the negative side effects of AT. PMID:23690804
Fazel, Seena; Hayes, Adrian J; Bartellas, Katrina; Clerici, Massimo; Trestman, Robert
More than 10 million people are imprisoned worldwide, and the prevalence of all investigated mental disorders is higher in prisoners than in the general population. Although the extent to which prison increases the incidence of mental disorders is uncertain, considerable evidence suggests low rates of identification and treatment of psychiatric disorders. Prisoners are also at increased risk of all-cause mortality, suicide, self-harm, violence, and victimisation, and research has outlined some modifiable risk factors. Few high quality treatment trials have been done on psychiatric disorders in prisoners. Despite this lack of evidence, trial data have shown that opiate substitution treatments reduce substance misuse relapse and possibly reoffending. The mental health needs of women and older adults in prison are distinct, and national policies should be developed to meet these. In this Review, we present clinical, research, and policy recommendations to improve mental health care in prisons. National attempts to meet these recommendations should be annually surveyed. PMID:27426440
Background In low and middle income countries (LMICs), and other areas with low resources and unreliable access to the Internet, understanding the emerging best practices for the implementation of new mobile health (mHealth) technologies is needed for efficient and secure data management and for informing public health researchers. Innovations in mHealth technology can improve on previous methods, and dissemination of project development details and lessons learned during implementation are needed to provide lessons learned to stakeholders in both the United States and LMIC settings. Objective The aims of this paper are to share implementation strategies and lessons learned from the development and implementation stages of two survey research projects using offline mobile technology, and to inform and prepare public health researchers and practitioners to implement new mobile technologies in survey research projects in LMICs. Methods In 2015, two survey research projects were developed and piloted in Puerto Rico and pre-tested in Costa Rica to collect face-to-face data, get formative evaluation feedback, and to test the feasibility of an offline mobile data collection process. Fieldwork in each setting involved survey development, back translation with cultural tailoring, ethical review and approvals, data collector training, and piloting survey implementation on mobile tablets. Results Critical processes and workflows for survey research projects in low resource settings were identified and implemented. This included developing a secure mobile data platform tailored to each survey, establishing user accessibility, and training and eliciting feedback from data collectors and on-site LMIC project partners. Conclusions Formative and process evaluation strategies are necessary and useful for the development and implementation of survey research projects using emerging mHealth technologies in LMICs and other low resource settings. Lessons learned include: (1) plan
Pignone, Michael; Scott, Tracy L; Schild, Laura A; Lewis, Carmen; Vázquez, Raquel; Glanz, Karen
Screening can reduce incidence and mortality from colorectal cancer but has been underutilized. Efforts to increase screening depend on accurate data about screening status. We sought to evaluate the independent and combined yield of claims and direct survey for identifying colorectal cancer screening among average-risk health plan beneficiaries. Participants were Aetna members ages between 52 and 80 years from 32 primary care practices in Florida and Georgia participating in the Communicating Health Options through Information and Cancer Education study. Main outcomes were the proportion of average-risk patients who were up-to-date with colorectal cancer screening based on claims data and the estimated additional yield of survey data for patients with no evidence of screening in their claims history. Of 4,020 average-risk members identified, claims data indicated that 1,066 (27%) had recent colorectal cancer screening. Among the 1,269 average-risk members with no evidence of screening by claims data who returned surveys, 498 (39%) reported being up-to-date with screening. Combining claims data and survey data and accounting for survey nonresponse, we estimate that 47% to 59% of member patients were actually up-to-date with screening, an additional yield of 20 to 32 percentage points. We conclude that, among health plan members, the combination of claims data and survey information had substantially higher yield than claims data alone for identifying colorectal cancer screening. PMID:19273480
The National Health Survey undertaken in 1935 and 1936 was the largest morbidity survey until that time. It was also the first national survey to focus on chronic disease and disability. The decision to conduct a survey of this magnitude was part of the larger strategy to reform health care in the United States. The focus on morbidity allowed reformers to argue that the health status of Americans was poor, despite falling mortality rates that suggested the opposite. The focus on chronic disease morbidity proved to be an especially effective way of demonstrating the poor health of the population and the strong links between poverty and illness. The survey, undertaken by a small group of reform-minded epidemiologists led by Edgar Sydenstricker, was made possible by the close interaction during the Depression of agencies and actors in the public health and social welfare sectors, a collaboration which produced new ways of thinking about disease burdens. PMID:21233434
Luo, Wei; Nguyen, Thin; Nichols, Melanie; Tran, Truyen; Rana, Santu; Gupta, Sunil; Phung, Dinh; Venkatesh, Svetha; Allender, Steve
For years, we have relied on population surveys to keep track of regional public health statistics, including the prevalence of non-communicable diseases. Because of the cost and limitations of such surveys, we often do not have the up-to-date data on health outcomes of a region. In this paper, we examined the feasibility of inferring regional health outcomes from socio-demographic data that are widely available and timely updated through national censuses and community surveys. Using data for 50 American states (excluding Washington DC) from 2007 to 2012, we constructed a machine-learning model to predict the prevalence of six non-communicable disease (NCD) outcomes (four NCDs and two major clinical risk factors), based on population socio-demographic characteristics from the American Community Survey. We found that regional prevalence estimates for non-communicable diseases can be reasonably predicted. The predictions were highly correlated with the observed data, in both the states included in the derivation model (median correlation 0.88) and those excluded from the development for use as a completely separated validation sample (median correlation 0.85), demonstrating that the model had sufficient external validity to make good predictions, based on demographics alone, for areas not included in the model development. This highlights both the utility of this sophisticated approach to model development, and the vital importance of simple socio-demographic characteristics as both indicators and determinants of chronic disease. PMID:25938675
Geltman, Paul L; Grant-Knight, Wanda; Ellis, Heidi; Landgraf, Jeanne M
To assess whether mental health counseling and other health services were associated with functional health outcomes of unaccompanied Sudanese refugee minors in the U.S., this study was a descriptive survey of 304 Sudanese refugee minors in foster care through the U.S. Unaccompanied Refugee Minors Program (URMP). Functional health outcomes included scores of Child Health Questionnaire (CHQ) scales and questions regarding care for symptoms or problems associated with behavioral disorders, i.e. somatization. Posttraumatic stress disorder (PTSD) was assessed using the Harvard Trauma Questionnaire (HTQ). Health services questions derived from the National Health Interview Survey. Minors reported high rates of counseling (45%); however no differences were noted in counseling use by those with PTSD compared with others. Counseling was not associated with health outcomes. The majority (76%) reported seeking medical care for symptoms or problems often associated with behavioral and emotional problems; however such care-seeking was more common among those with PTSD (OR = 2.5, 95% CI = 1.004-6.26). Through the efforts of the URMP, the Sudanese unaccompanied minors received high levels of psychosocial support despite the absence of their biological parents. Those with worse functional health were no more likely than others to have received mental health counseling while being more likely to seek care from any health professional. This was also the case for those with PTSD compared to those without it. In linear regression analyses, reported receipt of mental health counseling did not impact either positively or negatively on the score of any CHQ scale. PMID:18071901
Brown, Tyson H.; O’Rand, Angela M.; Adkins, Daniel E.
Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories. PMID:22940814
Saha, S.; Kermode, M.; Annear, P.L.
Objectives Women's participation in microfinance-based self-help groups (SHGs) and the resultant social capital may provide a basis to address the gap in health attainment for poor women and their children. We investigated the effect of combining a health program designed to improve health behaviours and outcomes with a microfinance-based SHG program. Design A mixed method study was conducted among 34 villages selected from three blocks or district subdivisions of India; one in Gujarat, two in Karnataka. Methods A set of 17 villages representing new health program areas were pair-matched with 17 comparison villages. Two rounds of surveys were conducted with a total of 472 respondents, followed by 17 key informant interviews and 17 focus group discussions. Results Compared to a matched comparison group, women in SHGs that received the health program had higher odds of delivering their babies in an institution (OR: 5.08, 95% CI 1.21–21.35), feeding colostrum to their newborn (OR: 2.83, 95% CI 1.02–5.57), and having a toilet at home (OR: 1.53, 95% CI 0.76–3.09). However, while the change was in the expected direction, there was no statistically significant reduction in diarrhoea among children in the intervention community (OR: 0.86, 95% CI 0.42–1.76), and the hypothesis that the health program would result in decreased out-pocket expenditures on treatment was not supported. Conclusion Our study found evidence that health programs implemented with microfinance-based SHGs is associated with improved health behaviours. With broad population coverage of SHGs and the social capital produced by their activities, microfinance-based SHGs may provide an avenue for addressing the health needs of poor women. PMID:26304181
Runkle, Jennifer; Flocks, Joan; Economos, Jeannie; Tovar-Aguilar, J. Antonio; McCauley, Linda
The agricultural industry has some of the highest incidence rates and numbers of occupational injuries and illnesses in the United States. Injuries and illnesses in agriculture result from accidents, falls, excessive heat, repetitive motion and adverse pesticide exposure. Women working in agriculture are exposed to the same hazards and risks as their male counterparts, but can face additional adverse impacts on their reproductive health. Yet, few occupational risk assessment studies have considered the reproductive health of female farmworkers. The objective of this community-based participatory research study was to conduct a retrospective, cross-sectional survey to collect information on workplace conditions and behaviors and maternal, pregnancy and infant health outcomes among a sample of female nursery and fernery farmworkers in Central Florida. Survey results showed that nursery workers were more likely to report health symptoms during their pregnancy than fernery workers. We also observed a self-reported increased risk of respiratory illness in the first year of life for infants whose mothers worked in ferneries. Our findings confirm that agricultural work presents potential reproductive hazards for women of childbearing age. PMID:25101767
Thompson, Melissa; Henshall, Chris; Garrison, Louis P; Griffin, Adrian D; Coyle, Doug; Long, Stephen; Khayat, Zayna A; Anger, Dana L; Yu, Rebecca
Objectives To address the uncertainty associated with procuring pharmaceutical products, product listing agreements (PLAs) are increasingly being used to support responsible funding decisions in Canada and elsewhere. These agreements typically involve financial-based rebating initiatives or, less frequently, outcome-based contracts. A qualitative survey was conducted to improve the understanding of outcome-based and more innovative PLAs (IPLAs) based on input from Canadian and international key opinion leaders in the areas of drug manufacturing and reimbursement. Methods Results from a structured literature review were used to inform survey development. Potential participants were invited via email to partake in the survey, which was conducted over phone or in person. Responses were compiled anonymously for review and reporting. Results Twenty-one individuals participated in the survey, including health technology assessment (HTA) key opinion leaders (38%), pharmaceutical industry chief executive officers/vice presidents (29%), ex-payers (19%), and current payers/drug plan managers/HTA (14%). The participants suggested that ~80%–95% of Canadian PLAs are financial-based rather than outcomes-based. They indicated that IPLAs offer important benefits to patients, payers, and manufacturers; however, several challenges limit their use (eg, administrative burden, lack of agreed-upon endpoint). They noted that IPLAs are useful in rapidly evolving therapeutic areas and those associated with high unmet need, a quantifiable endpoint, and/or robust data systems. The Canadian Agency for Drugs and Technologies in Health, the pan-Canadian Pharmaceutical Alliance, and other arms-length organizations could play important roles in identifying uncertainty and endpoints and brokering pan-Canadian PLAs. Industry should work collaboratively with payers to identify uncertainty and develop innovative mechanisms to address it. Conclusion The survey results indicated that while
Beyer, Kirsten M. M.; Kaltenbach, Andrea; Szabo, Aniko; Bogar, Sandra; Nieto, F. Javier; Malecki, Kristen M.
Green space is now widely viewed as a health-promoting characteristic of residential environments, and has been linked to mental health benefits such as recovery from mental fatigue and reduced stress, particularly through experimental work in environmental psychology. Few population level studies have examined the relationships between green space and mental health. Further, few studies have considered the role of green space in non-urban settings. This study contributes a population-level perspective from the United States to examine the relationship between environmental green space and mental health outcomes in a study area that includes a spectrum of urban to rural environments. Multivariate survey regression analyses examine the association between green space and mental health using the unique, population-based Survey of the Health of Wisconsin database. Analyses were adjusted for length of residence in the neighborhood to reduce the impact of neighborhood selection bias. Higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety and stress, after controlling for a wide range of confounding factors. Results suggest that “greening” could be a potential population mental health improvement strategy in the United States. PMID:24662966
Adams, Ted D.; Pendleton, Robert C.; Strong, Michael B.; Kolotkin, Ronette L.; Walker, James M.; Litwin, Sheldon E.; Berjaoui, Wael K.; LaMonte, Michael J.; Cloward, Tom V.; Avelar, Erick; Owan, Theophilus E.; Nuttall, Robert T.; Gress, Richard E.; Crosby, Ross D.; Hopkins, Paul N.; Brinton, Eliot A.; Rosamond, Wayne D.; Wiebke, Gail A.; Yanowitz, Frank G.; Farney, Robert J.; Halverson, R. Chad; Simper, Steven C.; Smith, Sherman C.; Hunt, Steven C.
Favorable health outcomes at 2 years postbariatric surgery have been reported. With exception of the Swedish Obesity Subjects (SOS) study, these studies have been surgical case series, comparison of surgery types, or surgery patients compared to subjects enrolled in planned nonsurgical intervention. This study measured gastric bypass effectiveness when compared to two separate severely obese groups not participating in designed weight-loss intervention. Three groups of severely obese subjects (N = 1,156, BMI ≥ 35 kg/m2) were studied: gastric bypass subjects (n = 420), subjects seeking gastric bypass but did not have surgery (n = 415), and population-based subjects not seeking surgery (n = 321). Participants were studied at baseline and 2 years. Quantitative outcome measures as well as prevalence, incidence, and resolution rates of categorical health outcome variables were determined. All quantitative variables (BMI, blood pressure, lipids, diabetes-related variables, resting metabolic rate (RMR), sleep apnea, and health-related quality of life) improved significantly in the gastric bypass group compared with each comparative group (all P < 0.0001, except for diastolic blood pressure and the short form (SF-36) health survey mental component score at P < 0.01). Diabetes, dyslipidemia, and hypertension resolved much more frequently in the gastric bypass group than in the comparative groups (all P < 0.001). In the surgical group, beneficial changes of almost all quantitative variables correlated significantly with the decrease in BMI. We conclude that Roux-en-Y gastric bypass surgery when compared to severely obese groups not enrolled in planned weight-loss intervention was highly effective for weight loss, improved health-related quality of life, and resolution of major obesity-associated complications measured at 2 years. PMID:19498344
de Rezende, Leandro Fornias Machado; Rodrigues Lopes, Maurício; Rey-López, Juan Pablo; Matsudo, Victor Keihan Rodrigues; Luiz, Olinda do Carmo
Objective 1) To synthesize the current observational evidence for the association between sedentary behavior and health outcomes using information from systematic reviews. 2) To assess the methodological quality of the systematic reviews found. Methodology/Principal Findings Medline; Excerpta Medica (Embase); PsycINFO; and Web of Science were searched for reviews published up to September 2013. Additional publications were provided by Sedentary Behaviour Research Network members. The methodological quality of the systematic reviews was evaluated using recommended standard criteria from AMSTAR. For each review, improper use of causal language in the description of their main results/conclusion was evaluated. Altogether, 1,044 review titles were identified, 144 were read in their entirety, and 27 were included. Based on the systematic reviews with the best methodological quality, we found in children and adolescents, strong evidence of a relationship between time spent in sedentary behavior and obesity. Moreover, moderate evidence was observed for blood pressure and total cholesterol, self-esteem, social behavior problems, physical fitness and academic achievement. In adults, we found strong evidence of a relationship between sedentary behavior and all-cause mortality, fatal and non-fatal cardiovascular disease, type 2 diabetes and metabolic syndrome. In addition, there is moderate evidence for incidence rates of ovarian, colon and endometrial cancers. Conclusions This overview based on the best available systematics reviews, shows that sedentary behavior may be an important determinant of health, independently of physical activity. However, the relationship is complex because it depends on the type of sedentary behavior and the age group studied. The relationship between sedentary behavior and many health outcomes remains uncertain; thus, further studies are warranted. PMID:25144686
Fabricant, S J; Harpham, T
Data from interview surveys of households or health facilities are used to assess community parameters such as health status and factors related to the ability and willingness of individuals to pay for health services. Although the effect of sample size on confidence intervals is generally well understood by the survey designers and policy-makers who use the results, the typical survey is also subject to non-sampling errors whose magnitude may exceed that of the sampling errors. The non-sampling errors associated with surveys are only rarely assessed and reported, even though they may have a major effect on the interpretation of findings. The present study reports the non-sampling errors associated with a household survey in Sierra Leone by comparing the results of reinterviews with the responses given during the original interviews. Certain types of questions were subject to greater non-sampling errors than others. The findings should be of use to designers of similar surveys and to those who rely on such surveys for making policy decisions. PMID:8324853
Becker, Kimberly D.; Brandt, Nicole Evangelista; Stephan, Sharon H.; Chorpita, Bruce F.
We examined the measurement of educational outcomes related to children's mental health treatments. A total of 85 papers describing 88 randomized controlled trials that included at least one educational outcome and one mental health outcome were included in these analyses. Forty-five different measures were identified as the primary educational…
Abel, Thomas; Hofmann, Karen; Ackermann, Sabine; Bucher, Sabine; Sakarya, Sibel
Health literacy (HL) is context-specific. In public health and health promotion, HL in the private realm refers to individuals' knowledge and skills to prevent disease and to promote health in everyday life. However, there is a scarcity of measurement tools explicitly geared to private realm contexts. Our aim was to develop and test a short survey tool that captures different dimensions of HL in the context of family and friends. We used cross-sectional data from the Swiss Federal Surveys of Adolescents from 2010 to 2011, comprising 7983 males and 366 females between 18 and 25 years. HL was assessed through a set of eight items (self-reports). We used principal component analysis to explore the underlying factor structure among these items in the male sample and confirmatory factor analysis to verify the factor structure in the female sample. The results showed that the tested item set represented dimensions of functional, interactive and critical HL. Two sub-dimensions, understanding versus finding health-relevant information, denoted functional HL. Interactive and critical HL were each represented with two items. A sum score based on all eight items (Cronbach's α: 0.64) showed expected positive associations with own and parental education among males and females (p < 0.05). The short item set appears to be a feasible measurement tool to assess HL in the private realm. Its broader application in survey studies may help to improve our understanding of how this form of HL is distributed in the general population. PMID:24482542
Whitehurst, David G. T.; Engel, Lidia; Bryan, Stirling
Context ‘Short Form’ health surveys – such as the SF-36 and SF-12 – are widely used in medical research. Spinal cord injury (SCI) is no exception, despite oft-cited concerns regarding measurement properties for populations with physical impairment. Objective To provide a comprehensive overview of the use of Short Form health surveys and their variants within the SCI literature. Methods Papers published between database inception and September 2012 were identified from 11 electronic databases; a supplementary reference list search was also conducted. Data extraction focused on details regarding the range of different Short Form surveys and variants used in SCI research, the respective frequency of use, the nature of reporting (complete versus partial reporting) and the method of survey administration. Results One hundred seventy-four papers were identified. Thirty-six-item Short Form health surveys were frequently administered as complete instruments (n = 82); in 69 of these 82 studies (84%), it was not clearly stated which 36-item version had been used (e.g. SF-36v1, SF-36v2, RAND-36). Data for individual items and domains were often reported (29% of identified studies), indicating significant partial use of standardized measures. Modified variants of standardized health surveys were administered in 12 studies. Conclusion Although standardized Short Form health surveys are common within SCI research, attempts to add, delete, or modify items have resulted in a number of variants, often with minimal supportive psychometric evidence. Using established, generic outcome measures is appealing for a number of reasons. However, validity is paramount and requires further explicit consideration within the SCI research community. PMID:24559417
Grodstein, Francine; Stampfer, Meir J.; Willett, Walter C.; Hu, Frank B.; Manson, JoAnn E.
Objectives. To review the contribution of the Nurses’ Health Study (NHS) to our understanding of the complex relationship between exogenous hormones and health outcomes in women. Methods. We performed a narrative review of the publications of the NHS and NHS II from 1976 to 2016. Results. Oral contraceptive and postmenopausal hormone use were studied in relation to major health outcomes, including cardiovascular disease and cancer. Current or recent oral contraceptive use is associated with a higher risk of cardiovascular disease (mainly among smokers), melanoma, and breast cancer, and a lower risk of colorectal and ovarian cancer. Although hormone therapy is not indicated primarily for chronic disease prevention, findings from the NHS and a recent analysis of the Women’s Health Initiative indicate that younger women who are closer to menopause onset have a more favorable risk–benefit profile than do older women from use of hormone therapy for relief of vasomotor symptoms. Conclusions. With updated information on hormone use, lifestyle factors, and other variables, the NHS and NHS II continue to contribute to our understanding of the complex relationship between exogenous hormones and health outcomes in women. PMID:27459451
Ungar, Wendy J; Ariely, Rinat
SUMMARY Ensuring optimal access to medications has received increasing attention as health care systems struggle with increasing costs. Although this has been studied extensively in adults, there has been little investigation in pediatric populations, which have different health care needs. A literature review was conducted to examine the evidence regarding the relationship between insurance-mediated access to prescription medicines and outcomes in children. Twelve studies were classified according to i) uninsured versus insured, ii) type of insurance provider and iii), impact of family income. The studies demonstrated that insurance coverage and low cost-sharing are both essential to facilitate access to medications. Increased access was consistently observed for insured compared to uninsured children. Access to prescription drugs frequently differed by type of health provider organization. Adequate family income was an important determinant of access to and receipt of prescriptions. Moreover, income-indexed insurance coverage may increase unmet need. Compared to the literature on access to prescription medicines and health outcomes in adults, there have been few studies in children. Further research relating pharmaceutical policies to pediatric health outcomes is needed to strengthen the quality of policy decision-making regarding access to prescription medicines for children. PMID:19807576
Hurwitz, Elizabeth J Himelfarb; Gupta, Jhumka; Liu, Rosalyn; Silverman, Jay G; Raj, Anita
To assess the associations between Intimate Partner Violence (IPV) victimization and health outcomes of South Asian women in Greater Boston. To explore the nature of the health experiences of victimized women in this population. Cross-sectional surveys with a community-based sample of women in relationships with males (n = 208) assessed demographics, IPV history, and health. In-depth interviews were conducted with a separate sample of women with a history of IPV (n = 23). Quantitative data were assessed by logistic regression, qualitative data by a grounded theory approach. Twenty-one percent of the quantitative sample reported IPV in the current relationship. Abused women were significantly more likely than those with no history of IPV in their current relationship to report poor physical health (95% CI = 1.3-12.0), depression (95% CI = 1.8-9.3), anxiety (95% CI = 1.3-6.4), and suicidal ideation (95% CI = 1.9-25.1). Qualitative subjects described how victimization resulted in injury and chronic health concerns and how IPV-induced depression and anxiety affected their sleep, appetite, energy, and wellbeing. Experiences of IPV are related to increased poor health among South Asian women. This elevated risk demands intervention. Healthcare providers should be trained to screen and refer South Asian patients for partner violence. PMID:16791535
Aggarwal, Neelum T; Everson-Rose, Susan A; Evans, Denis A
The broad spectrum of economic and cultural diversity in the U.S. population correlates with and affects the study of behavioral aspects of health. The purpose of this article is to provide a selective overview of research findings from the Chicago Health and Aging Project (CHAP), which covers a socio-demographically diverse population in Chicago, with a focus on role-related psychosocial factors and observed racial/ethnic differences in aging outcomes. CHAP is a longitudinal, epidemiological study of common chronic conditions of aging with an emphasis on medical, psychosocial, and environmental risk factors for the decline in cognitive function across the older adult lifespan. We briefly summarize the study design and methods used in the CHAP study and characterize the study population and describe the psychosocial data, noting black-white associations as they relate to three common brain health outcomes: cognitive function and Alzheimer's Disease, stroke, and subclinical vascular disease as noted on neuroimaging. PMID:26239039
Guerrero, Erick G; Aarons, Gregory A; Grella, Christine E; Garner, Bryan R; Cook, Benjamin; Vega, William A
We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed. PMID:25450596
Bischoff-Ferrari, Heike A
Recent evidence suggests that vitamin D deficiency has harmful effects on health and that recent vitamin D intake recommendations may be associated with better health outcomes. In this chapter, evidence is summarized from different studies that evaluate threshold levels for serum 25(OH)D levels in relation to bone mineral density (BMD), lower extremity function, dental health, risk of falls, fractures, cancer prevention, incident hypertension and mortality. For all endpoints, levels in the deficient range (< 50 nmol/l; < 20 ng/ml) are associated with no benefit or adverse effects, while the most advantageous serum levels for 25(OH)D appeared to be close to 75 nmol/l (30 ng/ml). An intake of 800 IU (20 microg) of vitamin D3 (cholecalciferol) per day for all adults may bring 97% of the population to level of at least 50 nmol/l and about 50% up to 75 nmol/l. Thus, higher doses of vitamin D than currently recommended are needed to bring most individuals to75 nmol/l. While estimates suggest that 1600 to 2000 IU vitamin D3 per day may successfully and safely achieve this goal, the implications of higher doses for the total adult population need to be addressed in future studies. PMID:25207384
Johnson, Owen A; Hall, Peter S; Hulme, Claire
Many healthcare organizations are now making good use of electronic health record (EHR) systems to record clinical information about their patients and the details of their healthcare. Electronic data in EHRs is generated by people engaged in complex processes within complex environments, and their human input, albeit shaped by computer systems, is compromised by many human factors. These data are potentially valuable to health economists and outcomes researchers but are sufficiently large and complex enough to be considered part of the new frontier of 'big data'. This paper describes emerging methods that draw together data mining, process modelling, activity-based costing and dynamic simulation models. Our research infrastructure includes safe links to Leeds hospital's EHRs with 3 million secondary and tertiary care patients. We created a multidisciplinary team of health economists, clinical specialists, and data and computer scientists, and developed a dynamic simulation tool called NETIMIS (Network Tools for Intervention Modelling with Intelligent Simulation; http://www.netimis.com ) suitable for visualization of both human-designed and data-mined processes which can then be used for 'what-if' analysis by stakeholders interested in costing, designing and evaluating healthcare interventions. We present two examples of model development to illustrate how dynamic simulation can be informed by big data from an EHR. We found the tool provided a focal point for multidisciplinary team work to help them iteratively and collaboratively 'deep dive' into big data. PMID:26879667
Larson, Charles P
It is estimated that nearly 100,000 children are born into poverty each year in Canada. During pregnancy, their mothers are likely to face multiple stressful life events, including lone-mother and teenage pregnancies, unemployment, more crowded or polluted physical environments, and far fewer resources to deal with these exposures. The early child health consequences of poverty and pregnancy are multiple, and often set a newborn child on a life-long course of disparities in health outcomes. Included are greatly increased risks for preterm birth, intrauterine growth restriction, and neonatal or infant death. Poverty has consistently been found to be a powerful determinant of delayed cognitive development and poor school performance. Behaviour problems among young children and adolescents are strongly associated with maternal poverty. Sound evidence in support of policies and programs to reduce these disparities among the poor, including the role of health practitioners, is difficult to find. This is partly because many interventions and programs targeting the poor are not properly evaluated or critically appraised. PMID:19030445
DeJoy, David M; Dyal, Mari-Amanda; Padilla, Heather M; Wilson, Mark G
This commentary reviews findings from the four previous national surveys of workplace health promotion activities (1985, 1992, 1999, and 2004, respectively) and offers recommendations for future surveys mandated under the Affordable Care Act of 2010. Future surveys should place greater emphasis on assessing program quality, reach, and effectiveness. Both employer and employee input should be sought. In addition, sampling plans should differentiate worksites from employers, and results should include public as well as private sector organizations. Ideas are offered for addressing these limitations and for creating a sustainable survey process and multifunctional database of results. PMID:24380423
Salt Lake City School District, UT.
A study examined the views, outcomes, and recommendations of members of the graduating classes of 1986-87, 1989-90, and 1990-91 of Salt Lake City School District's high schools. Of the 3,990 survey instruments mailed to potential respondents, 1,010 were undeliverable and 1,292 surveys were returned for an overall district response rate of 43.36%.…
Cooper, S. A.; Morrison, J.; Melville, C.; Finlayson, J.; Allan, L.; Martin, G.; Robinson, N.
Background: People with intellectual disabilities (IDs) have a higher level of health needs, a higher level of which is unmet, compared with the general population. Health screening can detect unmet health needs, but it is unknown whether it effects beneficial health outcomes in the longer term. People with IDs are reliant on health management by…
Jones, V B; Taylor, L C
The question of the degree of technical versus managerial competence to be found in future graduates from health administration programs is not easily resolved. In the HIMSS 1988 survey of CIOs the attributes needed for success are listed in descending rank order as follows: leadership ability, vision/imagination, knowledge of hospital systems, business acumen, decisiveness, and technical competence. CIOs ranked technical competence as less important than other attributes associated with general management success. The expectations for attitudes, knowledge, and skills presented in this article support the greater importance of management abilities relative to pure technical competence. However, it is vital that an appropriate level of technical knowledge and skill be maintained to enable future alumni of health administration programs to function effectively as administrators. Depending on their role in a health care organization, greater or lesser technical knowledge may be needed. Those pursuing a career path toward CIO must, of necessity, have greater technical knowledge and skill. We have discussed necessary and expected attitudes, knowledge, and skills that will be needed by the generalist health administration graduate in the future. It will be important to develop and maintain an attitude that MIS is a strategic tool, that health care technology is a corporate asset, and that information is power. Graduates must recognize the necessity of maintaining and enhancing their knowledge and skills through continuing education. The knowledge base of MIS education should focus on determining information needs to support strategic goals, understanding of general systems theory, principles of systems analysis, design, implementation and maintenance, awareness and exposure to standard application software, and an awareness of external sources of data.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10106375
Centers for Disease Control and Prevention, 2011
The national Youth Risk Behavior Survey (YRBS) monitors priority health risk behaviors that contribute to the leading causes of death, disability, and social problems among youth and adults in the United States. The national YRBS is conducted every two years during the spring semester and provides data representative of 9th through 12th grade…
Noor, Abdisalan Mohamed
National health systems performance (HSP) assessments and benchmarking are critical to understanding how well the delivery of healthcare meets the needs of citizens. Benchmarking HSP has often been done between countries to inform the global public health space. However, its impact is likely to be far greater when implemented sub-nationally to inform actual decisions on resource allocations and performance improvements, especially in high disease burden, low-income countries, where the resource envelope available for health is inadequate. In their study, Roberts and colleagues assemble, analyse and map a minimum set of health intervention and outcome indicators from 1990-2011 to assess and benchmark HSP across the 11 regions of Uganda. This is the first empirical sub-national HSP benchmarking study in the country and the results have potentially important health system policy implications. Please see related research: http://www.biomedcentral.com/1741-7015/13/285. PMID:26654445
Bradley, Elizabeth H; Canavan, Maureen; Rogan, Erika; Talbert-Slagle, Kristina; Ndumele, Chima; Taylor, Lauren; Curry, Leslie A
Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000-09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health-not only in health care but also in social services and public health-is warranted. PMID:27140980
Fitzgibbon, M. L.; Stolley, M. R.; Schiffer, L.; Kong, A.; Braunschweig, C. L.; Gomez-Perez, S. L.; Odoms-Young, A.; Van Horn, L.; Christoffel, K. Kaufer; Dyer, A. R.
This pilot study tested the feasibility of Family-Based Hip-Hop to Health, a school-based obesity prevention intervention for 3–5 year old Latino children and their parents, and estimated its effectiveness in producing smaller average changes in body mass index at one year follow-up. Four Head Start preschools administered through the Chicago Public Schools were randomly assigned to receive a Family-Based Intervention (FBI) or a General Health intervention (GHI). Parents signed consent forms for 147 of the 157 children enrolled. Both the school-based and family-based components of the intervention were feasible, but attendance for the parent intervention sessions was low. Contrary to expectations, a downtrend in BMI Z score was observed in both the intervention and control groups. While the data reflect a downward trend in obesity among these young Hispanic children, obesity rates remained higher at one-year follow-up (15%) than those reported by the National Health and Nutrition Examination Survey (2009–2010) for 2–5 year old children (12.1%). Developing evidence-based strategies for obesity prevention among Hispanic families remains a challenge. PMID:23532990
Winkler, Mirko S.; Divall, Mark J.; Krieger, Gary R.; Schmidlin, Sandro; Magassouba, Mohamed L.; Knoblauch, Astrid M.; Singer, Burton H.; Utzinger, Juerg
The quantitative assessment of health impacts has been identified as a crucial feature for realising the full potential of health impact assessment (HIA). In settings where demographic and health data are notoriously scarce, but there is a broad range of ascertainable ecological, environmental, epidemiological and socioeconomic information, a diverse toolkit of data collection strategies becomes relevant for the mainly small-area impacts of interest. We present a modular, cross-sectional baseline health survey study design, which has been developed for HIA of industrial development projects in the humid tropics. The modular nature of our toolkit allows our methodology to be readily adapted to the prevailing eco-epidemiological characteristics of a given project setting. Central to our design is a broad set of key performance indicators, covering a multiplicity of health outcomes and determinants at different levels and scales. We present experience and key findings from our modular baseline health survey methodology employed in 14 selected sentinel sites within an iron ore mining project in the Republic of Guinea. We argue that our methodology is a generic example of rapid evidence assembly in difficult-to-reach localities, where improvement of the predictive validity of the assessment and establishment of a benchmark for longitudinal monitoring of project impacts and mitigation efforts is needed.
Miller, Elizabeth M
There is a strong link between maternal knowledge and child well-being in many populations worldwide. Fewer studies have investigated the links between indigenous systems of medical knowledge and infant outcomes in non-Western societies, such as the Ariaal people of northern Kenya. This study has four goals. First, it defines culture-specific domains of health knowledge in Ariaal mothers using the cultural consensus method, a statistical model that measures knowledge shared by a set of informants. Second, it identifies factors that predict maternal health knowledge. Third, it investigates associations between maternal health knowledge and treatment-seeking behaviors. Finally, it associates health knowledge with biomarkers of infant health. Data collection took place in two separate periods. The first data collection period (October-November 2007) enrolled 41 women to participate in an open-ended interview or true-false consensus questionnaire. The second data collection period (November 2008-January 2009) used information from the cultural consensus analysis to assess how health knowledge impacted infant health outcomes and treatment. Women and infants in this data collection period (n = 251 pairs) underwent anthropometric measurement and participated in a questionnaire that included traditional medicine consensus questions. Data were analyzed using the cultural consensus capabilities in ANTHROPAC 4.98; univariate and multivariate statistics were performed in SAS 9.2. This study found consensus in the domains of infant illness, traditional medicine, Western medicine, and treatment decision-making. Proximity to a medical dispensary and use of public health infrastructure significantly predicted higher levels of maternal health knowledge. Mothers' knowledge of traditional medicine was positively associated with treating infants at a dispensary versus at home. Finally, women with greater knowledge of traditional medicine had infants who were significantly less likely
Fekete, Katalin; Berti, Cristiana; Cetin, Irene; Hermoso, Maria; Koletzko, Berthold V; Decsi, Tamás
The importance of physiological supply of folate is well recognized in human health; the crucial roles of folate in one-carbon metabolism for physiological DNA synthesis and cell division, as well as in the conversion of homocysteine (Hcy) to methionine, and subsequently, to S-adenosylmethionine, have been convincingly demonstrated. Improved folate status may reduce the risk of macrocytic anaemia, cardiovascular diseases, neuropsychiatric disorders and adverse pregnancy outcomes. Inadequate folate status results in a decrease in the methylation cycle and in increased blood levels of the neurotoxic Hcy. The aim of this review is to provide insight into the influence of folate status on pregnancy health outcomes, and to consider increasing evidence of a link between the extent of genome/epigenome damage and elevated risk for adverse obstetrical endpoints. Pregnant women are at risk for folate insufficiency because of the increased need for folate for rapid fetal growth, placental development and enlargement of the uterus. Inadequate folate status may cause fetal malformations, impaired fetal growth, pre-term delivery and maternal anaemia. Even some diseases of the placenta may arise from folate deficiencies. Fetal growth seems to be vulnerable to maternal folate status during the periconception period, because it has the potential to affect both the closure of the neural tube and several epigenetic mechanisms within the placenta and the fetus. Mainly on the basis of the well recognized link between maternal folate status and fetal neural tube defects, women are advised to receive folic acid supplement during the periconceptional period. Because an adequate folate supply seems to play an important role in the implantation and development of the placenta and in improving endothelial function, folic acid supplementation in the late first trimester or early second trimester might also be beneficial. PMID:22296249
Suh, Kangho; Gabriel, Susan; Adams, Michelle A; Arcona, Steve
The guidelines for health economics and outcomes research (HEOR) fellowship training programs devised by the American College of Clinical Pharmacy (ACCP) and the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) suggest that continuous improvements are made to ensure that postgraduate training through didactic and professional experiences prepare fellows for HEOR research careers. The HEOR Fellowship Program at Novartis Pharmaceuticals Corporation was standardized to enhance the fellows' HEOR research understanding and align professional skill sets with the ACCP-ISPOR Fellowship Program Guidelines. Based on feedback from an internal task force comprised of HEOR employees and current and former fellows, the HEOR Fellowship Program was normatively and qualitatively assessed to evaluate the current curricular program. Fellowship program activities were instituted to ensure that the suggested minimum level requirements established by the guidelines were being met. Research opportunities enabling fellows to work hand-in-hand with other fellows and HEOR professionals were emphasized. Curricular enhancements in research methodology and professional training and development, and materials for a structured journal club focusing on specific methodological and HEOR research topics were developed. A seminar series (e.g., creating SMART Goals, StrengthsFinder 2.0) and professional courses (e.g., ISPOR short courses, statistics.com) were included to enhance the fellows' short- and long-term professional experience. Additional program attributes include an online reference library developed to enrich the current research facilities and a Statistical Analysis Software training program. Continuously assessing and updating HEOR fellowship programs keeps programs up-to-date in the latest HEOR concepts and approaches used to evaluate health care, both professionally and educationally. PMID:25178521
Thompson, J S; Dixon, R A
A survey of the environment, life-style, and health status, knowledge, attitudes and practices in the village of Sina Mala was carried out prior to the introduction of a village health post by a church-run rural health programme. In addition to the perceived needs of the villagers for a school, easier access to medicine and external assistance with well drilling, the study identified the need to train traditional midwives in hygienic delivery, to make local health workers more aware of onchocerciasis and to educate the community on sanitation and hygiene, including the harmful effects of the guinea corn beer. PMID:7839910
Verret, Catherine; Jutand, Mathe-Aline; De Vigan, Catherine; Bégassat, Marion; Bensefa-Colas, Lynda; Brochard, Patrick; Salamon, Roger
Background Since 1993, many studies on the health of Persian Gulf War veterans (PGWVs) have been undertaken. Some authors have concluded that an association exists between Gulf War service and reported infertility or miscarriage, but that effects on PGWV's children were limited. The present study's objective was to describe the reproductive outcome and health of offspring of French Gulf War veterans. Methods The French Study on the Persian Gulf War (PGW) and its Health Consequences is an exhaustive cross-sectional study on all French PGWVs conducted from 2002 to 2004. Data were collected by postal self-administered questionnaire. A case-control study nested in this cohort was conducted to evaluate the link between PGW-related exposures and fathering a child with a birth defect. Results In the present study, 9% of the 5,666 Gulf veterans who participated reported fertility disorders, and 12% of male veterans reported at least one miscarriage among their partners after the PGW. Overall, 4.2% of fathers reported at least one child with a birth defect conceived after the mission. No PGW-related exposure was associated with any birth defect in children fathered after the PGW mission. Concerning the reported health of children born after the PGW, 1.0% of children presented a pre-term delivery and 2.7% a birth defect. The main birth defects reported were musculoskeletal malformations (0.5%) and urinary system malformations (0.3%). Birth defect incidence in PGWV children conceived after the mission was similar to birth defect incidence described by the Paris Registry of Congenital Malformations, except for Down syndrome (PGWV children incidence was lower than Registry incidence). Conclusion This study did not highlight a high frequency of fertility disorders or miscarriage among French PGW veterans. We found no evidence for a link between paternal exposure during the Gulf War and increased risk of birth defects among French PGWV children. PMID:18442369
Richman, Judith A.; Cloninger, Lea; Rospenda, Kathleen M.
Objectives. We examined the extent to which the stress paradigm linking psychosocial stressors to mental health status has focused disproportionate attention on microlevel social stressors to the detriment of macrolevel stressors. Also, we assessed the effects of the terrorist attacks of September 11, 2001, on subsequent mental health among participants in a Midwestern cohort study. Methods. Respondents in a 6-wave longitudinal mail survey completed questionnaires before September 11, 2001, and again in 2003 and 2005. Regression analyses focused on measures of negative terrorism-related beliefs and fears, as well as psychological distress and deleterious alcohol use outcomes measured both before and after September 11. Results. Negative terrorism-related beliefs and fears assessed in 2003 predicted distress and drinking outcomes in 2005 after control for sociodemographic characteristics and pre–September 11 distress and drinking. Conclusions. The events of September 11 continue to negatively affect the mental health of the American population. Our results support the utility of according greater attention to the effects of such macrolevel social stressors in population studies embracing the stress paradigm. PMID:18687593
Richman, Judith A.; Cloninger, Lea; Rospenda, Kathleen M.
Objectives. We examined the extent to which the stress paradigm linking psychosocial stressors to mental health status has focused disproportionate attention on microlevel social stressors to the detriment of macrolevel stressors. Also, we assessed the effects of the terrorist attacks of September 11, 2001, on subsequent mental health among participants in a Midwestern cohort study. Methods. Respondents in a 6-wave longitudinal mail survey completed questionnaires before September 11, 2001, and again in 2003 and 2005. Regression analyses focused on measures of negative terrorism-related beliefs and fears, as well as psychological distress and deleterious alcohol use outcomes measured both before and after September 11. Results. Negative terrorism-related beliefs and fears assessed in 2003 predicted distress and drinking outcomes in 2005 after control for sociodemographic characteristics and pre–September 11 distress and drinking. Conclusions. The events of September 11 continue to negatively affect the mental health of the American population. Our results support the utility of according greater attention to the effects of such macrolevel social stressors in population studies embracing the stress paradigm. PMID:18172139
The learning outcome was to understand the important contribution of lean beef to total nutrient intake in diets of American adults and to determine dietary intake differences between lean beef consumers and non-consumers. The National Health and Nutritional Examination Survey, 1999-2004, 24-hour di...
Introduction Prevailing sociopolitical and economic obstacles have been implicated in the inadequate utilization and delivery of the Armenian health care system. Methods A random survey of 1,000 local residents, from all administrative regions of Armenia, concerned with health care services cost and satisfaction was conducted. Participation in the survey was voluntary and the information was collected using anonymous telephone interviews. Results The utilization of health care services was low, particularly in rural areas. This under-utilization of services correlated with low income of the population surveyed. The state funded health care services are inadequate to ensure availability of free-of-charge services even to economically disadvantaged groups. Continued reliance on direct out-of pocket and illicit payments, for medical services, are serious issues which plague healthcare, pharmaceutical and medical technology sectors of Armenia. Conclusions Restructuring of the health care system to implement a cost-effective approach to the prevention and treatment of diseases, especially disproportionately affect the poor, should be undertaken. Public payments, increasing the amount of subsidies for poor and lower income groups through a compulsory health insurance system should be evaluated and included as appropriate in this health system redesign. Current medical services reimbursement practices undermine the principle of equity in financing and access. Measures designed to improve healthcare access and affordability for poor and disadvantaged households should be enacted. PMID:22695079
Geochemical surveys in relation to health may be classified as having one, two or three dimensions. One-dimensional surveys examine relations between concentrations of elements such as Pb in soils and other media and burdens of the same elements in humans, at a given time. The spatial distributions of element concentrations are not investigated. The primary objective of two-dimensional surveys is to map the distributions of element concentrations, commonly according to stratified random sampling designs based on either conceptual landscape units or artificial sampling strata, but systematic sampling intervals have also been used. Political units have defined sample areas that coincide with the units used to accumulate epidemiological data. Element concentrations affected by point sources have also been mapped. Background values, location of natural or technological anomalies and the geographic scale of variation for several elements often are determined. Three-dimensional surveys result when two-dimensional surveys are repeated to detect environmental changes. -Author
Langston, Anne C.; Sarriot, Eric G.
ABSTRACT We believe that global health practice and evaluation operate with misleading assumptions about lack of reliability of small population-based health surveys (district level and below), leading managers and decision-makers to under-use this valuable information and programmatic tool and to rely on health information from large national surveys when neither timing nor available data meet their needs. This paper uses a unique opportunity for comparison between a knowledge, practice, and coverage (KPC) household survey and Rwanda Demographic and Health Survey (RDHS) carried out in overlapping timeframes to disprove these enduring suspicions. Our analysis shows that the KPC provides coverage estimates consistent with the RDHS estimates for the same geographic areas. We discuss cases of divergence between estimates. Application of the Lives Saved Tool to the KPC results also yields child mortality estimates comparable with DHS-measured mortality. We draw three main lessons from the study and conclude with recommendations for challenging unfounded assumptions against the value of small household coverage surveys, which can be a key resource in the arsenal of local health programmers. PMID:25995729
Langston, Anne C; Prosnitz, Debra M; Sarriot, Eric G
We believe that global health practice and evaluation operate with misleading assumptions about lack of reliability of small population-based health surveys (district level and below), leading managers and decision-makers to under-use this valuable information and programmatic tool and to rely on health information from large national surveys when neither timing nor available data meet their needs. This paper uses a unique opportunity for comparison between a knowledge, practice, and coverage (KPC) household survey and Rwanda Demographic and Health Survey (RDHS) carried out in overlapping timeframes to disprove these enduring suspicions. Our analysis shows that the KPC provides coverage estimates consistent with the RDHS estimates for the same geographic areas. We discuss cases of divergence between estimates. Application of the Lives Saved Tool to the KPC results also yields child mortality estimates comparable with DHS-measured mortality. We draw three main lessons from the study and conclude with recommendations for challenging unfounded assumptions against the value of small household coverage surveys, which can be a key resource in the arsenal of local health programmers. PMID:25995729
Sanetti, Lisa M. Hagermoser; DiGennaro Reed, Florence D.
Treatment integrity data are essential to drawing valid conclusions in treatment outcome studies. Such data, however, are not always included in peer-reviewed research articles in school psychology or related fields. To gain a better understanding of why treatment integrity data are lacking in the school psychology research, we surveyed the…
Bohlscheid, Jeffri; Clark, Stephanie
Fifty-eight recent graduates (1998-2008) from the joint Washington State University (WSU) and University of Idaho (UI) BiState School of Food Science program and 27 of their employers participated in a survey assessing learning outcomes based on the 2001 Institute of Food Technologists (IFT) core competencies for undergraduate food science…
Stuckey, Heather L.; Taylor, Edward W.; Cranton, Patricia
The purpose of this research was to develop an inclusive evaluation of "transformative learning theory" that encompassed varied perspectives of transformative learning. We constructed a validated quantitative survey to assess the potential outcomes and processes of how transformative learning may be experienced by college-educated…
State Univ. of New York, Saratoga Springs. Empire State Coll.
This report on student educational outcomes is based on 1982/83 surveys of 1978 through 1982 graduates of programs at the Genesee Valley Regional Center (n=135) and the Metropolitan Regional Center of the Empire State College (ESC) (n=144) of New York. The report reflects information concerning graduates' current employment circumstances, graduate…
Eaves, Ronald C.; Rabren, Karen; Hall, George
This study investigated the validity of the "Post-School Outcomes Transition Survey" (PSOTS). The PSOTS was designed to ascertain whether individuals who received special education services in secondary school have obtained postschool employment or have enrolled in postsecondary education or training within 1 to 2 years of exiting high school. The…
Meyer, Katrina A.; Murrell, Vicki S.
This article presents the results of a national study of 39 higher education institutions that collected information about their evaluation procedures and outcome measures for faculty development for online teaching conducted during 2011-2012. The survey results found that over 90% of institutions used measures of the faculty person's…
Misko, Josie; Priest, Suellen
This booklet provides details on the codes used to classify the verbatim suggestions for improvement made by students in their responses to the Student Outcomes Survey as well as the codes for various types of demographic information, and responses to questions about how students evaluate their training. These verbatim suggestions represent a…
Oshio, Takashi; Sano, Shinpei; Kobayashi, Miki
We attempt to examine the extent to which poverty in childhood adversely affects success in adulthood, using micro data from nationwide surveys in Japan and taking into account the recursive structure of life outcomes. We use retrospective assessments of income class at the age of 15, because longitudinal data on household income are not…
Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi
Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…
Edington, Marilyn; Karjalainen, Terry; Hirschland, David; Edington, Dee W
1. The success of the LifeSteps program may rest in the UAW and GM leadership's vision to use a high level joint steering committee, a day to day working committee, third party program providers, support of confidentiality throughout the entire program, and a comprehensive data driven decision making system. 2. The program design is a multiplatform method of program delivery to a diverse and nationwide population of the active and retired employees and dependents (more than 1 million individuals older than age 18). They receive an annual health risk appraisal, telephone access to a registered nurse 24 hours a day. LifeSteps website, a quarterly health information newsletter and a health care book sent to each of the households, and access to a telephonic audiotape library. 3. A pilot program has a more intense design of low risk maintenance and high risk reduction programs specifically for all active employees who work in the pilot locations. A telephonic program for behavior change is available only to high risk individuals in the total pilot population of active and retired employees and dependents. 4. The major success criterion for the LifeSteps program is helping workers, former employees, and their families maintain or achieve low risk status. The increased number of employees at low risk status (4% gain the second year and a 2% gain from the second to the third year) documents the improved health status of the population. Moreover, of surveyed participants and nonparticipants, 85% supported program continuation and 74% said they had an improved opinion of the UAW and GM due to the program. PMID:11842778
Tsakos, Georgios; Sheiham, Aubrey; Marmot, Michael G; Kawachi, Ichiro; Watt, Richard G
Objective To compare oral health in the US and England and to assess levels of educational and income related oral health inequalities between both countries. Design Cross sectional analysis of US and English national surveys. Setting Non-institutionalised adults living in their own homes. Participants Oral health measures and socioeconomic indicators were assessed in nationally representative samples: the Adult Dental Health Survey 2009 for England, and the US National Health and Nutrition Examination Survey 2005-08. Adults aged ≥25 years were included in analyses with samples of 8719 (England) and 9786 (US) for analyses by education, and 7184 (England) and 9094 (US) for analyses by income. Main outcome measures Number of missing teeth, self rated oral health, and oral impacts on daily life were outcomes. Educational attainment and household income were used as socioeconomic indicators. Age standardised estimates of oral health were compared between countries and across educational and income groups. Regression models were fitted, and relative and absolute inequalities were measured using the relative index of inequality (RII) and the slope index of inequality (SII). Results The mean number of missing teeth was significantly higher in the US (7.31 (standard error 0.15)) than in England (6.97 (0.09)), while oral impacts were higher in England. There was evidence of significant social gradients in oral health in both countries, although differences in oral health by socioeconomic position varied according to the oral health measure used. Consistently higher RII and SII values were found in the US than in England, particularly for self rated oral health. RII estimates for self rated oral health by education were 3.67 (95% confidence interval 3.23 to 4.17) in the US and 1.83 (1.59 to 2.11) in England. In turn, SII values were 42.55 (38.14 to 46.96) in the US and 18.43 (14.01 to 22.85) in England. Conclusions The oral health of US citizens is not better than
Dagher, Rada K; Chen, Jie; Thomas, Stephen B
We examined gender differences in mental health outcomes during and post-recession versus pre-recession. We utilized 2005-2006, 2008-2009, and 2010-2011 data from the Medical Expenditure Panel Survey. Females had lower odds of depression diagnoses during and post-recession and better mental health during the recession, but higher odds of anxiety diagnoses post-recession. Males had lower odds of depression diagnoses and better mental health during and post-recession and lower Kessler 6 scores post-recession. We conducted stratified analyses, which confirmed that the aforementioned findings were consistent across the four different regions of the U.S., by employment status, income and health care utilization. Importantly, we found that the higher odds of anxiety diagnoses among females after the recession were mainly prominent among specific subgroups of females: those who lived in the Northeast or the Midwest, the unemployed, and those with low household income. Gender differences in mental health in association with the economic recession highlight the importance of policymakers taking these differences into consideration when designing economic and social policies to address economic downturns. Future research should examine the reasons behind the decreased depression diagnoses among both genders, and whether they signify decreased mental healthcare utilization or increased social support and more time for exercise and leisure activities. PMID:25970634
Dagher, Rada K.; Chen, Jie; Thomas, Stephen B.
We examined gender differences in mental health outcomes during and post-recession versus pre-recession. We utilized 2005-2006, 2008-2009, and 2010-2011 data from the Medical Expenditure Panel Survey. Females had lower odds of depression diagnoses during and post-recession and better mental health during the recession, but higher odds of anxiety diagnoses post-recession. Males had lower odds of depression diagnoses and better mental health during and post-recession and lower Kessler 6 scores post-recession. We conducted stratified analyses, which confirmed that the aforementioned findings were consistent across the four different regions of the U.S., by employment status, income and health care utilization. Importantly, we found that the higher odds of anxiety diagnoses among females after the recession were mainly prominent among specific subgroups of females: those who lived in the Northeast or the Midwest, the unemployed, and those with low household income. Gender differences in mental health in association with the economic recession highlight the importance of policymakers taking these differences into consideration when designing economic and social policies to address economic downturns. Future research should examine the reasons behind the decreased depression diagnoses among both genders, and whether they signify decreased mental healthcare utilization or increased social support and more time for exercise and leisure activities. PMID:25970634
Gray, Kathleen; Martin-Sanchez, Fernando; Lopez-Campos, Guillermo
Background Patient-reported outcomes (PROs) from social media use in chronic disease management continue to emerge. While many published articles suggest the potential for social media is positive, there is a lack of robust examination into mediating mechanisms that might help explain social media’s therapeutic value. This study presents findings from a global online survey of people with chronic pain (PWCP) to better understand how they use social media as part of self-management. Objective Our aim is to improve understanding of the various health outcomes reported by PWCP by paying close attention to therapeutic affordances of social media. We wish to examine if demographics of participants underpin health outcomes and whether the concept of therapeutic affordances explains links between social media use and PROs. The goal is for this to help tailor future recommendations for use of social media to meet individuals’ health needs and improve clinical practice of social media use. Methods A total of 231 PWCP took part in a global online survey investigating PROs from social media use. Recruited through various chronic disease entities and social networks, participants provided information on demographics, health/pain status, social media use, therapeutic affordances, and PROs from use. Quantitative analysis was performed on the data using descriptive statistics, cross-tabulation, and cluster analysis. Results The total dataset represented 218 completed surveys. The majority of participants were university educated (67.0%, 146/218) and female (83.9%, 183/218). More than half (58.7%, 128/218) were married/partnered and not working for pay (75.9%, 88/116 of these due to ill health). Fibromyalgia (46.6%, 55/118) and arthritis (27.1%, 32/118) were the most commonly reported conditions causing pain. Participants showed a clear affinity for social network site use (90.0%, 189/210), followed by discussion forums and blogs. PROs were consistent, suggesting that social
Barnett, E; Sienkiewicz, M; Roholt, S
A statewide project was implemented in 1993 to increase breastfeeding among low-income women in North Carolina through improved institutional policies and practices and professional lactation-management skills. A survey designed to ascertain professional beliefs about breastfeeding was mailed to 31 hospitals and 25 public health agencies. A total of 2209 health professionals completed the survey and met the study selection criteria. Nutritionists and pediatricians were most likely to have positive beliefs about breastfeeding, whereas hospital nurses were most likely to have negative beliefs. Personal breastfeeding experience contributed to positive beliefs. Professionals were least convinced of the emotional benefits of breastfeeding. Those with negative beliefs were most likely to advocate complete infant weaning from the breast before nine months of age. Although most health professionals had positive beliefs about breastfeeding, differences by profession, work environment, and personal breastfeeding experience indicate the need for comprehensive training in lactation management, and improvements in hospital and public health clinic environments. PMID:7741946
Barger, Laura K.; Rajaratnam, Shantha M.W.; Wang, Wei; O'Brien, Conor S.; Sullivan, Jason P.; Qadri, Salim; Lockley, Steven W.; Czeisler, Charles A.
Study Objectives: Heart attacks and motor vehicle crashes are the leading causes of death in US firefighters. Given that sleep disorders are an independent risk factor for both of these, we examined the prevalence of common sleep disorders in a national sample of firefighters and their association with adverse health and safety outcomes. Methods: Firefighters (n = 6,933) from 66 US fire departments were assessed for common sleep disorders using validated screening tools, as available. Firefighters were also surveyed about health and safety, and documentation was collected for reported motor vehicle crashes. Results: A total of 37.2% of firefighters screened positive for any sleep disorder including obstructive sleep apnea (OSA), 28.4%; insomnia, 6.0%; shift work disorder, 9.1%; and restless legs syndrome, 3.4%. Compared with those who did not screen positive, firefighters who screened positive for a sleep disorder were more likely to report a motor vehicle crash (adjusted odds ratio 2.00, 95% CI 1.29–3.12, p = 0.0021) and were more likely to self-report falling asleep while driving (2.41, 2.06–2.82, p < 0.0001). Firefighters who screened positive for a sleep disorder were more likely to report having cardiovascular disease (2.37, 1.54–3.66, p < 0.0001), diabetes (1.91, 1.31–2.81, p = 0.0009), depression (3.10, 2.49–3.85, p < 0.0001), and anxiety (3.81, 2.87–5.05, p < 0.0001), and to report poorer health status (p < 0.0001) than those who did not screen positive. Adverse health and safety associations persisted when OSA and non-OSA sleep disorders were examined separately. Conclusions: Sleep disorders are prevalent in firefighters and are associated with increased risk of adverse health and safety outcomes. Future research is needed to assess the efficacy of occupational sleep disorders prevention, screening, and treatment programs in fire departments to reduce these safety and health risks. Citation: Barger LK, Rajaratnam SM, Wang W, O'Brien CS
Optimizing Population Health and Economic Outcomes: Innovative Treatment for Benign Prostatic Hyperplasia (BPH) Transcribed and adapted for publication by Janice L. Clarke, RN, BBA Editorial: David B. Nash, MD, MBA S-2 Introduction S-2 Benign Prostatic Hyperplasia (BPH) S-3 • Overview S-3• Current BPH Treatment Paradigm S-4• BPH Continuum of Care: Bladder Health S-5 New Treatment Option for BPH S-5 • The UroLift® System S-6• Positioning of UroLift® in BPH Treatment Paradigm S-7 New Value Proposition S-8 • Addressing Bladder Health: Breaking the Cycle S-8• Cost Benefit Analysis: The Big Picture S-8 Patient and Family Engagement S-10 Summary S-11 PMID:22823180
This study uses data from the Organisation for Economic Co-operation and Development countries over the 2008-2010 period to construct indicators of "pro-primary" and "pro-secondary" distributions. The former is concerned with the original distribution of income through the market, whereas the latter is concerned with the redistribution efforts of the government. The study ranks these countries along these dimensions to create a distributional orientation map for such countries. It finds that the Scandinavian countries occupy the top rankings in terms of equity in pro-primary distribution, followed by countries with a Bismarckian welfare state regime. The Scandinavian countries also rank very high on equity in pro-secondary distribution, along with some of the top-ranking Bismarckian countries. More significantly, the study finds that the countries' health outcomes are associated more strongly with the pro-primary distributional stance than with the pro-secondary distributional stance. A key policy implication is that to achieve better and more equitable health, it is more effective to design a level playing field for market participants in the first place, than to try to mend inequities after the fact through remedial social policy. PMID:26159174
Rootman, Irving; Warren, Reg; Catlin, Gary
This commentary describes the contribution of the 1985 Canadian National Health Promotion Survey to the development of public health research and policy-making in Canada and argues that on the basis of that contribution, it should be considered to be a public health research milestone. In terms of research, among its contributions which subsequently have been adopted in other survey studies were: going beyond risk factors to operationalize concepts implicit in the Ottawa Charter for Health Promotion; empowering users to participate in knowledge translation, sharing and transfer; ensuring sufficient sample sizes for each jurisdiction to be able to confidently generalize to its population; establishing a model as well as questions for subsequent health surveys; encouraging widespread use of data through making them available early; and developing and using an explicit social marketing strategy to reach target audiences, including the general public. With regard to policy-making, among its contributions which have been adopted were: using survey data to develop and enhance healthy public policy initiatives; encouraging researchers to work with policy-makers in developing policies; using survey data to contribute to the evaluation of public health initiatives; engaging policy-makers in the development of surveys; and encouraging the use of survey data for advocacy. PMID:21370775
Broderick, Andrew; Haque, Farshid
Patient-centered technologies have emerged as a way to actively engage patients in care. The reach and potential of cell phones to engage diverse patient populations is great. Evidence of their effectiveness in improving health-related outcomes is limited. Researchers conducted an online survey of community health centers and clinics to assess if and how health care providers in the safety net use cell phones to support patient engagement. The findings indicate that the use of cell phones in patient care is at an early stage of deployment across the safety net. Organizations identify chronic disease management as an area where cell phones offer considerable potential to effectively engage patients. To promote widespread adoption and use, technical assistance to support the implementation and management of interventions, evidence-based or best practice models that highlight successful implementation strategies in care delivery, and the introduction of new payment or reimbursement policies will be essential. PMID:26040018
Stahre, Mandy; VanEenwyk, Juliet; Siegel, Paul; Njai, Rashid
Few studies of associations between housing and health have focused on housing insecurity and health risk behaviors and outcomes. We measured the association between housing insecurity and selected health risk behaviors and outcomes, adjusted for socioeconomic measures, among 8,415 respondents to the 2011 Washington State Behavioral Risk Factor Surveillance System. Housing insecure respondents were about twice as likely as those who were not housing insecure to report poor or fair health status or delay doctor visits because of costs. This analysis supports a call to action among public health practitioners who address disparities to focus on social determinants of health risk behaviors and outcomes. PMID:26160295
Background Evidence-based public health requires the existence of reliable information systems for priority setting and evaluation of interventions. Existing data systems in the United States are either too crude (e.g., vital statistics), rely on administrative data (e.g., Medicare) or, because of their national scope (e.g., NHANES), lack the discriminatory power to assess specific needs and to evaluate community health activities at the state and local level. This manuscript describes the rationale and methods of the Survey of the Health of Wisconsin (SHOW), a novel infrastructure for population health research. Methods/Design The program consists of a series of independent annual surveys gathering health-related data on representative samples of state residents and communities. Two-stage cluster sampling is used to select households and recruit approximately 800-1,000 adult participants (21-74 years old) each year. Recruitment and initial interviews are done at the household; additional interviews and physical exams are conducted at permanent or mobile examination centers. Individual survey data include physical, mental, and oral health history, health literacy, demographics, behavioral, lifestyle, occupational, and household characteristics as well as health care access and utilization. The physical exam includes blood pressure, anthropometry, bioimpedance, spirometry, urine collection and blood draws. Serum, plasma, and buffy coats (for DNA extraction) are stored in a biorepository for future studies. Every household is geocoded for linkage with existing contextual data including community level measures of the social and physical environment; local neighborhood characteristics are also recorded using an audit tool. Participants are re-contacted bi-annually by phone for health history updates. Discussion SHOW generates data to assess health disparities across state communities as well as trends on prevalence of health outcomes and determinants. SHOW also serves
... AFFAIRS Proposed Information Collection (Veterans Health Benefits Handbook Satisfaction Survey) Activity... forms of information technology. Title: Veterans Health Benefits Handbook Satisfaction Survey, VA Form... benefits information contained in Veterans Health Benefits handbook. DATES: Written comments...
Umland, Elena; Collins, Lauren; Baronner, Ashley; Lim, Edwin; Giordano, Carolyn
The need to evaluate the impact of interprofessional education (IPE) on learner outcomes is clear, but assessment of IPE's impact on patient health and well-being is lacking. This mixed-methods study evaluated perspectives of community volunteers, health mentors (HMs) who have at least one chronic condition, who participated in an IPE curriculum. In May 2014, 93 HMs concluding the Health Mentors Program completed a survey evaluating their student teams according to the Interprofessional Education Collaborative core competencies' four domains and program impact on health/wellbeing using a 4-point Likert scale (1=strongly disagree; 4=strongly agree). The average response to statements regarding the four domains of values/ethics, roles/responsibilities, communication, and teamwork statements were all >3.0. HMs rated program satisfaction on a 10-point scale (1=least satisfied, 10=most satisfied) and answered open-ended outcome questions. The average program satisfaction score was 9.13±1.43; increased motivation to make and maintain healthy behaviors was reported. In a follow-up focus group with 10 mentors, high satisfaction levels from working with interprofessional student teams were reported, and substantial improvements in managing health conditions and improving overall health status were relayed. Further studies will determine if the patient-reported outcomes of the mentors correlate with objective health measures. PMID:27585619
Ghio, Lucio; Respino, Matteo; Belvederi Murri, Martino; Cocchi, Angelo; Meneghelli, Anna; Amore, Mario; Natta, Werner
Early intervention (EI) is an effective strategy to improve outcomes of psychiatric disorders, but there is little evidence on mental health professionals' opinions on this approach. Hence, during conferences on this topic, we surveyed participants on the benefits, aims, and barriers to implementation of EI. Participants reported that the most important outcomes of EI were decreasing the risk of long-term social consequences, of severe psychopathological conditions, and chronicization. EI would primarily need to be implemented in the care of psychotic, eating, and mood disorders, whereas the main barriers to EI implementation were the lack of funding and of a prevention-oriented culture. Although these results might be biased by a generic attitude favoring EI, participants showed a very positive attitude towards EI and stated the need of a culture shift towards a more prevention-oriented model in a mental health setting. PMID:26340134
Andrade, Flávia Reis de; Narvai, Paulo Capel
The article briefly systematizes health care models, emphasizes the role of population surveys as a management tool and analyzes the specific case of the Brazilian Oral Health Survey (SBBrasil 2010) and its contribution to the consolidation process of health care models consistent with the principles of the Sistema Único de Saúde (SUS, Public Health Care System). While in legal terms SUS corresponds to a health care model, in actual practice the public policy planning and health action, the system gives rise to a care model which is not the result of legal texts or theoretical formulations, but rather the praxis of the personnel involved. Bearing in mind that the management of day-to-day health affairs is a privileged space for the production and consolidation of health care models, it is necessary to stimulate and support the development of technical and operational skills which are different from those required for the management of care related to individual demands. PMID:24626592
Choudhary, Ekta; Coben, Jeffrey; Bossarte, Robert M
In the United States, an estimated three million men are victims of sexual violence each year, yet the majority of existing studies have evaluated the consequences and characteristics of victimization among women alone. The result has been a gap in the existing literature examining the physical and psychological consequences of sexual assault among men. The main objective of this study was to identify health outcomes, risk behaviors, and perpetrator/victim relationship characteristics among men who have experienced an attempted or completed sexual assault using data from the sexual violence module of the Behavioral Risk Factor Surveillance System survey. A total of 59,511 male respondents participated in the sexual violence module, and the majority of participants were White (73.7%), between the ages of 35 to 44 years (19.8%), married (69.0%), graduated from college (34.6%), and had an annual household income of more than US$50,000 (49.9%). Stratified multivariate logistic regression models were conducted to test the associations between victimization and health outcomes and risk behaviors controlling for age, marital status, race/ethnicity, income, education, and other potential confounders. Results of these analyses suggest important associations between health and sexual violence victimization. Specifically, men who reported unwanted attempted intercourse and attempted and completed intercourse were more likely to report poor mental health, poor life satisfaction, activity limitations, and lower emotional and social support. The current study extends knowledge of consequences of male sexual violence by considering characteristics of sexual assault and by identifying associations between victimization and a broad range of health indicators. PMID:19940163
Wong, Kam Cheong; Wang, Zhiqiang
Background Traditionally, postal surveys or face to face interviews are the main approaches for health researchers to obtain essential research data. However, with the prevalence of information technology and Internet, Web-based surveys are gaining popularity in health research. Objective This study aims to report the process and outcomes of recruiting Chinese migrants through social network sites in Australia and to examine the sample characteristics of online recruitment by comparing the sample which was recruited by an online survey to a sample of Australian Chinese migrants collected by a postal survey. Methods Descriptive analyses were performed to describe and compare the process and outcomes of online recruitment with postal survey questionnaires. Chi square tests and t tests were performed to assess the differences between the two samples for categorical and continuous variables respectively. Results In total, 473 Chinese migrants completed the online health survey from July to October 2013. Out of 426 participants recruited through the three Chinese social network sites in Australia, over 86.6% (369/426) were recruited within six weeks. Participants of the Web-based survey were younger, with a higher education level or had resided in Australia for less time compared to those recruited via a postal survey. However, there was no significant difference in gender, marital status, and professional occupation. Conclusions The recruitment of Chinese migrants through social network sites in our online survey was feasible. Compared to a postal survey of Chinese migrants, the online survey attracted different group of Chinese migrants who may have diverse health needs and concerns. Our findings provided insightful information for researchers who are considering employing a Web-based approach to recruit migrants and ethnic minority participants. PMID:25917837
The second National Health and Nutrition Examination Survey, NHANES II, is a nationwide probability sample of 27,801 persons from 6 months 74 years of age. From this sample, 25,286 people were interviewed and 20,322 people were examined, resulting in an overall response rate of 7...
The First National Health and Nutrition Examination Survey (NHANES I) was conducted on a nationwide probability sample of approximately 32,000 persons 1-74 years of age. The NHANES I sample was selected so that certain population groups thought to be at high risk of malnutrition ...
Garfield, Charles A.; And Others
Summarizes a national survey of the hospice community. Results indicated that the hospice community is attempting to meet the mental health training needs of its paid staff members and volunteers. However, more than half expressed a need for further training and a more systematic and comprehensive curriculum. (Author)
Calkins, Beverly; Williams, Phyllis M.
Health education was an important part of the screening phase of a large epidemiological survey of school children's blood pressure. After children's height, weight, and blood pressure were measured, they were directed to displays of educational materials which explained the cardiovascular system and stressed the importance of blood pressure…
Objective: A survey was conducted of health sciences libraries to obtain information about newer buildings, additions, remodeling, and renovations. Method: An online survey was developed, and announcements of survey availability posted to three major email discussion lists: Medical Library Association (MLA), Association of Academic Health Sciences Libraries (AAHSL), and MEDLIB-L. Previous discussions of library building projects on email discussion lists, a literature review, personal communications, and the author's consulting experiences identified additional projects. Results: Seventy-eight health sciences library building projects at seventy-three institutions are reported. Twenty-two are newer facilities built within the last ten years; two are space expansions; forty-five are renovation projects; and nine are combinations of new and renovated space. Six institutions report multiple or ongoing renovation projects during the last ten years. Conclusions: The survey results confirm a continuing migration from print-based to digitally based collections and reveal trends in library space design. Some health sciences libraries report loss of space as they move toward creating space for “community” building. Libraries are becoming more proactive in using or retooling space for concentration, collaboration, contemplation, communication, and socialization. All are moving toward a clearer operational vision of the library as the institution's information nexus and not merely as a physical location with print collections. PMID:20428277
The survey purpose, methods, and statistical methods are presented. Results are discussed according to: area differences in background variables, area differences in health variables, area differences in annoyance reactions, and comparison of symptom frequencies with age, smoking, and drinking. Included in appendices are tables of data, enumeration forms, the questionnaire, interviewer cards, and interviewer instructions. (MHR)
Abdel-Aal, R E; Mangoud, A M
The use of modern abductive machine learning techniques is described for modeling and predicting outcome parameters in terms of input parameters in medical survey data. The AIM (Abductory Induction Mechanism) abductive network machine-learning tool is used to model the educational score in a health survey of 2,720 Albanian primary school children. Data included the child's age, gender, vision, nourishment, parasite infection, family size, parents' education, and educational score. Models synthesized by training on just 100 cases predict the educational score output for the remaining 2,620 cases with 100% accuracy. Simple models represented as analytical functions highlight global relationships and trends in the survey population. Models generated are quite robust, with no change in the basic model structure for a 10-fold increase in the size of the training set. Compared to other statistical and neural network approaches, AIM provides faster and highly automated model synthesis, requiring little or no user intervention. PMID:8952313
Liemburg, Edith J; Castelein, Stynke; van Es, Frank; Scholte-Stalenhoef, Anne Neeltje; van de Willige, Gerard; Smid, Henderikus; Visser, Ellen; Knegtering, Henderikus; Bruggeman, Richard
Psychotic disorders are among the most complex medical conditions. Longitudinal cohort studies may offer further insight into determinants of functional outcome after a psychotic episode. This paper describes the Psychosis Recent Onset in GRoningen Survey (PROGR-S) that currently contains data on 1076 early-episode patients with psychosis, including symptoms, personality, cognition, life events and other outcome determinants. Our goal in this report is to give an overview of PROGR-S, as a point of reference for future publications on the effect of cognition, personality and psychosocial functioning on outcomes. PROGR-S contains an extensive, diagnostic battery including anamnesis, biography, socio-demographic characteristics, clinical status, drug use, neuropsychological assessment, personality questionnaires, and physical status tests. Extensive follow-up data is available on psychopathology, physical condition, medication use, and care consumption. Sample characteristics were determined and related to existing literature. PROGR-S (period 1997-2009, n = 718) included the majority of the expected referrals in the catchment area. The average age was 27 (SD = 8.6) and two-thirds were male. The average IQ was lower than that in the healthy control group. The majority had been diagnosed with a psychotic spectrum disorder. A substantial number of the patients had depressive symptoms (479/718, 78%) and current cannabis or alcohol use (465/718, 75%). The level of community functioning was moderate, i.e. most patients were not in a relationship and were unemployed. The PROGR-S database contains a valuable cohort to study a range of aspects related to symptomatic and functional outcomes of recent onset psychosis, which may play a role in the treatment of this complex and disabling disorder. Results reported here show interesting starting points for future research. Thus, we aim to investigate long-term outcomes on the basis of cognition, personality, negative symptoms and
Johnson, Kiersten B; Jacob, Anila; Brown, Molly E
Healthy forests provide human communities with a host of important ecosystem services, including the provision of food, clean water, fuel, and natural medicines. Yet globally, about 13 million hectares of forests are lost every year, with the biggest losses in Africa and South America. As biodiversity loss and ecosystem degradation due to deforestation continue at unprecedented rates, with concomitant loss of ecosystem services, impacts on human health remain poorly understood. Here, we use data from the 2010 Malawi Demographic and Health Survey, linked with satellite remote sensing data on forest cover, to explore and better understand this relationship. Our analysis finds that forest cover is associated with improved health and nutrition outcomes among children in Malawi. Children living in areas with net forest cover loss between 2000 and 2010 were 19% less likely to have a diverse diet and 29% less likely to consume vitamin A-rich foods than children living in areas with no net change in forest cover. Conversely, children living in communities with higher percentages of forest cover were more likely to consume vitamin A-rich foods and less likely to experience diarrhea. Net gain in forest cover over the 10-year period was associated with a 34% decrease in the odds of children experiencing diarrhea (P = .002). Given that our analysis relied on observational data and that there were potential unknown factors for which we could not account, these preliminary findings demonstrate only associations, not causal relationships, between forest cover and child health and nutrition outcomes. However, the findings raise concerns about the potential short- and long-term impacts of ongoing deforestation and ecosystem degradation on community health in Malawi, and they suggest that preventing forest loss and maintaining the ecosystem services of forests are important factors in improving human health and nutrition outcomes. PMID:25276536
Johnson, Kiersten B.; Jacob, Anila; Brown, Molly Elizabeth
Healthy forests provide human communities with a host of important ecosystem services, including the provision of food, clean water, fuel, and natural medicines. Yet globally, about 13 million hectares of forests are lost every year, with the biggest losses in Africa and South America. As biodiversity loss and ecosystem degradation due to deforestation continue at unprecedented rates, with concomitant loss of ecosystem services, impacts on human health remain poorly understood. Here, we use data from the 2010 Malawi Demographic and Health Survey, linked with satellite remote sensing data on forest cover, to explore and better understand this relationship. Our analysis finds that forest cover is associated with improved health and nutrition outcomes among children in Malawi. Children living in areas with net forest cover loss between 2000 and 2010 were 19% less likely to have a diverse diet and 29% less likely to consume vitamin A-rich foods than children living in areas with no net change in forest cover. Conversely, children living in communities with higher percentages of forest cover were more likely to consume vitamin A-rich foods and less likely to experience diarrhea. Net gain in forest cover over the 10-year period was associated with a 34% decrease in the odds of children experiencing diarrhea (P5.002). Given that our analysis relied on observational data and that there were potential unknown factors for which we could not account, these preliminary findings demonstrate only associations, not causal relationships, between forest cover and child health and nutrition outcomes. However, the findings raise concerns about the potential short- and long-term impacts of ongoing deforestation and ecosystem degradation on community health in Malawi, and they suggest that preventing forest loss and maintaining the ecosystems services of forests are important factors in improving human health and nutrition outcomes.
McCaughey, Deirdre; McGhan, Gwen; Kim, Jungyoon; Brannon, Diane; Leroy, Hannes; Jablonski, Rita
Purpose of study: The direct care workforce continues to rank as one of the most frequently injured employee groups in North America. Occupational health and safety studies have shown that workplace injuries translate into negative outcomes for workers and their employers. The National Institute for Occupational Safety and Health (NIOSH)…
Selhub, Jacob; Rosenberg, Irwin H
The recent increase in the intake of folic acid by the general public through fortified foods and supplements, has raised safety concern based on early reports of adverse health outcome in elderly with low B12 status who took high doses of folic acid. These safety concerns are contrary to the 2015 WHO statement that "high folic acid intake has not reliably been shown to be associated with negative healeffects". In the folic acid post-fortification era, we have shown that in elderly participants in NHANES 1999-2002, high plasma folate level is associated with exacerbation of both clinical (anemia and cognitive impairment) and biochemical (high MMA and high Hcy plasma levels) signs of vitamin B12 deficiency. Adverse clinical outcomes in association with high folate intake were also seen among elderly with low plasma B12 levels from the Framingham Original Cohort and in a study from Australia which combined three elderly cohorts. Relation between high folate and adverse biochemical outcomes were also seen in the Sacramento Area Latino Study on Aging (High Hcy, high MMA and lower TC2) and at an outpatient clinic at Yale University where high folate is associated with higher MMA in the elderly but not in the young. Potential detrimental effects of high folic acid intake may not be limited to the elderly nor to those with B12 deficiency. A study from India linked maternal high RBC folate to increased insulin resistance in offspring. Our study suggested that excessive folic acid intake is associated with lower natural killer cells activity in elderly women. In a recent study we found that the risk for unilateral retinoblastoma in offspring is 4 fold higher in women that are homozygotes for the 19 bp deletion in the DHFR gene and took folic acid supplement during pregnancy. In the elderly this polymorphism is associated with lower memory and executive scores, both being significantly worse in those with high plasma folate. These and other data strongly imply that
Isham, George J; Zimmerman, Donna J; Kindig, David A; Hornseth, Gary W
Clinical care contributes only 20 percent to overall health outcomes, according to a population health model developed at the University of Wisconsin. Factors contributing to the remainder include lifestyle behaviors, the physical environment, and social and economic forces--all generally considered outside the realm of care. In 2010 Minnesota-based HealthPartners decided to target nonclinical community health factors as a formal part of its strategic business plan to improve public health in the Twin Cities area. The strategy included creating partnerships with businesses and institutions that are generally unaccustomed to working together or considering how their actions could help improve community health. This article describes efforts to promote healthy eating in schools, reduce the stigma of mental illness, improve end-of-life decision making, and strengthen an inner-city neighborhood. Although still in their early stages, the partnerships can serve as encouragement for organizations inside and outside health care that are considering undertaking similar efforts in their markets. PMID:23918490
Molinari, NoelleAngelique M; Wolter, Kirk M; Skalland, Benjamin; Montgomery, Robert; Khare, Meena; Smith, Philip J; Barron, Martin L; Copeland, Kennon; Santos, Kathleen; Singleton, James A
Random-digit-dial telephone surveys are experiencing both declining response rates and increasing under-coverage due to the prevalence of households that substitute a wireless telephone for their residential landline telephone. These changes increase the potential for bias in survey estimates and heighten the need for survey researchers to evaluate the sources and magnitudes of potential bias. We apply a Monte Carlo simulation-based approach to assess bias in the NIS, a land-line telephone survey of 19-35 month-old children used to obtain national vaccination coverage estimates. We develop a model describing the survey stages at which component nonsampling error may be introduced due to nonresponse and under-coverage. We use that model and components of error estimated in special studies to quantify the extent to which noncoverage and nonresponse may bias the vaccination coverage estimates obtained from the NIS and present a distribution of the total survey error. Results indicated that the total error followed a normal distribution with mean of 1.72 per cent(95 per cent CI: 1.71, 1.74 per cent) and final adjusted survey weights corrected for this error. Although small, the largest contributor to error in terms of magnitude was nonresponse of immunization providers. The total error was most sensitive to declines in coverage due to cell phone only households. These results indicate that, while response rates and coverage may be declining, total survey error is quite small. Since response rates have historically been used to proxy for total survey error, the finding that these rates do not accurately reflect bias is important for evaluation of survey data. Published in 2011 by John Wiley & Sons, Ltd. PMID:21294147
Linnan, Laura; Bowling, Mike; Childress, Jennifer; Lindsay, Garry; Blakey, Carter; Pronk, Stephanie; Wieker, Sharon; Royall, Penelope
Objectives. We examined worksite health promotion programs, policies, and services to monitor the achievement of the Healthy People 2010 worksite-related goal of 75% of worksites offering a comprehensive worksite health promotion program. Methods. We conducted a nationally representative, cross-sectional telephone survey of worksite health promotion programs stratified by worksite size and industry type. Techniques appropriate for analyzing complex surveys were used to compute point estimates, confidence intervals, and multivariate statistics. Results. Worksites with more than 750 employees consistently offered more programs, policies, and services than did smaller worksites. Only 6.9% of responding worksites offered a comprehensive worksite health promotion program. Sites with a staff person dedicated to and responsible for health promotion were significantly more likely to offer a comprehensive program, and sites in the agriculture and mining or financial services sector were significantly less likely than those in other industry sectors to offer such a program. Conclusions. Increasing the number, quality, and types of health promotion programs at worksites, especially smaller worksites, remains an important public health goal. PMID:18048790
Quantifiable indicators will measure the progress of local and national PM reduction strategies in lowering population exposure to PM and positively impacting public health. These environmental health outcome indicators will ultimately serve to inform and evaluate environmen...
Ivankovich, Megan B.; Leichliter, Jami S.; Douglas, John M.
Objectives To identify opportunities within nationally representative surveys and surveillance systems to measure indicators of sexual health, we reviewed and inventoried existing data systems that include variables relevant to sexual health. Methods We searched for U.S. nationally representative surveys and surveillance systems that provided individual-level sexual health data. We assessed the methods of each data system and catalogued them by their measurement of the following domains of sexual health: knowledge, communication, attitudes, service access and utilization, sexual behaviors, relationships, and adverse health outcomes. Results We identified 18 U.S.-focused, nationally representative data systems: six assessing the general population, seven focused on special populations, and five addressing health outcomes. While these data systems provide a rich repository of information from which to assess national measures of sexual health, they present several limitations. Most importantly, apart from data on service utilization, routinely gathered, national data are currently focused primarily on negative aspects of sexual health (e.g., risk behaviors and adverse health outcomes) rather than more positive attributes (e.g., healthy communication and attitudes, and relationship quality). Conclusion Nationally representative data systems provide opportunities to measure a broad array of domains of sexual health. However, current measurement gaps indicate the need to modify existing surveys, where feasible and appropriate, and develop new tools to include additional indicators that address positive domains of sexual health of the U.S. population across the life span. Such data can inform the development of effective policy actions, services, prevention programs, and resource allocation to advance sexual health. PMID:23450886
Foutz, Julia D.; Cohen, Steven A.; Cook, Sarah K.
Background From 1970 to 2010, the Alaskan population increased from 302,583 to 698,473. During that time, the growth rate of Alaskan seniors (65+) was 4 times higher than their national counterparts. Ageing in Alaska requires confronting unique environmental, sociodemographic and infrastructural challenges, including an extreme climate, geographical isolation and less developed health care infrastructure compared to the continental US. Objective The objective of this analysis is to compare the health needs of Alaskan seniors to those in the continental US. Design We abstracted 315,161 records of individuals age 65+ from the 2013 and 2014 Behavioral Risk Factor Surveillance System, of which 1,852 were residents of Alaska. To compare residents of Alaska to residents of the 48 contiguous states we used generalized linear models which allowed us to adjust for demographic differences and survey weighting procedures. We examined 3 primary outcomes – general health status, health care coverage status and length of time since last routine check-up. Results Alaskan seniors were 59% less likely to have had a routine check-up in the past year and 12% less likely to report excellent health status than comparable seniors in the contiguous US. Conclusions Given the growth rate of Alaskan seniors and inherent health care challenges this vulnerable population faces, future research should examine the specific pathways through which these disparities occur and inform policies to ensure that all US seniors, regardless of geographical location, have access to high-quality health services. PMID:27056177
Veras, Mirella; Pottie, Kevin; Welch, Vivian; Labonte, Ron; Eslava-Schmalbach, Javier; Borkhoff, Cornelia M.; Kristjansson, Elizabeth A.; Tugwell, Peter
Objective: Health professionals are paying increased attention to issues of global health. However, there are no current competency assessment tools appropriate for evaluating their competency in global health. This study aims to assess the validity and reliability of a global health competency survey for different health disciplines. Methods: A total of 429 students participated in the Global Health Competency Survey, drawn from family medicine residency, nursing, physiotherapy and occupational therapy programs of five universities in Ontario, Canada. The surveys were evaluated for face and content validity and reliability. Results: Factor analysis was used to identify the main factors to be included in the reliability analysis. Content validity was supported with one floor effect in the “racial/ethnic disparities” variable (36.1%), and few ceiling effects. Seven of the twenty-two variables performed the best (between 34% and 59.6%). For the overall rating score, no participants had floor or ceiling effects. Five factors were identified which accounted for 95% of the variance. Cronbach’s alpha was >0.8 indicating that the survey items had good internal consistency and represent a homogeneous construct. Conclusion: The Global Health Competency Survey demonstrated good internal consistency and validity. PMID:23283032
King, Nicholas B; Harper, Sam; Young, Meredith E
Reduction of health inequalities within and between countries is a global health priority, but little is known about the determinants of popular support for this goal. We used data from the World Health Survey to assess individual preferences for prioritizing reductions in health and health care inequalities. We used descriptive tables and regression analysis to study the determinants of preferences for reducing health inequalities as the primary health system goal. Determinants included individual socio-demographic characteristics (age, sex, urban residence, education, marital status, household income, self-rated health, health care use, satisfaction with health care system) and country-level characteristics [gross domestic product (GDP) per capita, disability-free life expectancy, equality in child mortality, income inequality, health and public health expenditures]. We used logistic regression to assess the likelihood that individuals ranked minimizing inequalities first, and rank-ordered logistic regression to compare the ranking of other priorities against minimizing health inequalities. Individuals tended to prioritize health system goals related to overall improvement (improving population health and health care responsiveness) over those related to equality and fairness (minimizing inequalities in health and responsiveness, and promoting fairness of financial contribution). Individuals in countries with higher GDP per capita, life expectancy, and equality in child mortality were more likely to prioritize minimizing health inequalities. PMID:23059735
Objectives. I investigated whether the introduction of health and health care provisions in US state constitutions can make health systems more equitable and improve health outcomes by urging state policymakers and administrative agencies to uphold their human rights obligations at state level. Methods. I constructed a panel of infant mortality rates from 50 US states over the period 1929 through 2000 to examine their association with the timing and details of introducing a constitutional right to health and health care provisions. Results. The introduction of a stronger constitutional commitment that obligates state legislature to provide health care was associated with a subsequent reduction in the infant mortality rate of approximately 7.8%. The introduction of provisions explicitly targeting the poor was also associated with a reduction in the infant mortality rate of 6.5%. These health benefits are primarily evident in non-White populations. Conclusions. This empirical result supports Elizabeth Leonard’s view that although state constitutional rights have been poorly enforced through the judiciary, a constitutional expression of health care duties has fueled the political and social process, ultimately allowing states to identify the best way to address citizens’ health inequality concerns. PMID:25905857
Beard, Leslie; Wilson, Kumanan; Morra, Dante
Background Increasingly, governments, health care agencies, companies, and private groups have chosen Second Life as part of their Web 2.0 communication strategies. Second Life offers unique design features for disseminating health information, training health professionals, and enabling patient education for both academic and commercial health behavior research. Objectives This study aimed to survey and categorize the range of health-related activities on Second Life; to examine the design attributes of the most innovative and popular sites; and to assess the potential utility of Second Life for the dissemination of health information and for health behavior change. Methods We used three separate search strategies to identify health-related sites on Second Life. The first used the application’s search engine, entering both generic and select illness-specific keywords, to seek out sites. The second identified sites through a comprehensive review of print, blog, and media sources discussing health activities on Second Life. We then visited each site and used a snowball method to identify other health sites until we reached saturation (no new health sites were identified). The content, user experience, and chief purpose of each site were tabulated as well as basic site information, including user traffic data and site size. Results We found a wide range of health-related activities on Second Life, and a diverse group of users, including organizations, groups, and individuals. For many users, Second Life activities are a part of their Web 2.0 communication strategy. The most common type of health-related site in our sample (n = 68) were those whose principle aim was patient education or to increase awareness about health issues. The second most common type of site were support sites, followed by training sites, and marketing sites. Finally, a few sites were purpose-built to conduct research in SL or to recruit participants for real-life research. Conclusions Studies
Friedel, Jonathan E.; DeHart, William B.; Frye, Charles C. J.; Rung, Jillian M.; Odum, Amy L.
In delay discounting, temporally remote outcomes have less value. Cigarette smoking is associated with steeper discounting of money and consumable outcomes. It is presently unclear whether smokers discount health outcomes more than non-smokers. We sought to establish the generality of steep discounting for different types of health outcomes in cigarette smokers. Seventy participants (38 smokers and 32 non-smokers) completed four hypothetical outcome delay-discounting tasks: a gain of $500, a loss of $500, a temporary boost in health, and temporary cure from a debilitating disease. Participants reported the duration of each health outcome that would be equivalent to $500; these durations were then used in the respective discounting tasks. Delays ranged from 1 week to 25 years. Smokers’ indifference points for monetary gains, boosts in health, and temporary cures were lower than indifference points from non-smokers. Indifference points of one outcome were correlated with indifference points of other outcomes. Smokers demonstrate steeper discounting across a range of delayed outcomes. How a person discounts one outcome predicts how they will discount other outcomes. These two findings support our assertion that delay discounting is in part a trait. PMID:26691848
Wang, Lin; Kuntz-Melcavage, Kara; Forrest, Christopher B.; Lu, Yanyan; Piet, Leslie; Evans, Kathy; Uriyo, Maria; Sherry, Melissa; Richardson, Regina; Hawkins, Michelle; Neale, Donna
Purpose: To develop and apply an outcomes assessment framework (OAF) for care management programs in health care delivery settings. Background: Care management (CM) refers to a regimen of organized activities that are designed to promote health in a population with particular chronic conditions or risk profiles, with focus on the triple aim for populations: improving the quality of care, advancing health outcomes, and lowering health care costs. CM has become an integral part of a care continuum for population-based health care management. To sustain a CM program, it is essential to assure and improve CM effectiveness through rigorous outcomes assessment. To this end, we constructed the OAF as the foundation of a systematic approach to CM outcomes assessment. Innovations: To construct the OAF, we first systematically analyzed the operation process of a CM program; then, based on the operation analysis, we identified causal relationships between interventions and outcomes at various implementation stages of the program. This set of causal relationships established a roadmap for the rest of the outcomes assessment. Built upon knowledge from multiple disciplines, we (1) formalized a systematic approach to CM outcomes assessment, and (2) integrated proven analytics methodologies and industrial best practices into operation-oriented CM outcomes assessment. Conclusion: This systematic approach to OAF for assessing the outcomes of CM programs offers an opportunity to advance evidence-based care management. In addition, formalized CM outcomes assessment methodologies will enable us to compare CM effectiveness across health delivery settings. PMID:25992387
Alvarez-Galvez, Javier; Salvador-Carulla, Luis
Introduction Studies have shown that perceived discrimination has an impact on our physical and mental health. A relevant part of literature has highlighted the influence of discrimination based on race or ethnicity on mental and physical health outcomes. However, the influence of other types of discrimination on health has been understudied. This study is aimed to explore how different types of discrimination are related to our subjective state of health, and so to compare the intensity of these relationships in the European context. Methods We have performed a multilevel ordered analysis on the fifth wave of the European Social Survey (ESS 2010). This dataset has 52,458 units at individual level that are grouped in 26 European countries. In this study, the dependent variable is self-rated health (SRH) that is analyzed in relationship to ten explanatory variables of perceived discrimination: color or race, nationality, religion, language, ethnic group, age, gender, sexuality, disability and others. Results The model identifies statistically significant differences in the effect that diverse types of perceived discrimination can generate on the self-rated health of Europeans. Specifically, this study identifies three well-defined types of perceived discrimination that can be related to poor health outcomes: (1) age discrimination; (2) disability discrimination; and (3) sexuality discrimination. In this sense, the effect on self-rated health of perceived discrimination related to aging and disabilities seems to be more relevant than other types of discrimination in the European context with a longer tradition in literature (e.g. ethnic and/or race-based). Conclusion The present study shows that the relationship between perceived discrimination and health inequities in Europe are not random, but systematically distributed depending on factors such as age, sexuality and disabilities. Therefore the future orientation of EU social policies should aim to reduce the
Ershoff, D H; Aaronson, N K; Danaher, B G; Wasserman, F W
This report presents the results of an evaluation of a prenatal health education program conducted within a health maintenance organization (HMO) setting. Specifically, the behavioral, birth, and treatment-cost outcomes for 57 women in an experimental group who received individual nutrition counseling and a home-correspondence smoking cessation program were evaluated against the outcomes for 72 women in a control group who received standard prenatal care. In comparison with the controls, a greater percentage of women in the experimental group quit smoking during pregnancy (49.1 percent versus 37.5 percent). Of those who smoked throughout their pregnancy, women in the experimental group had a greater reduction in their mean rate of daily smoking. A significantly greater percentage of experimental group women adjusted their diets during the prenatal period (91 percent versus 68 percent), and particular success was achieved in increased consumption of dairy products and vegetables, decreased consumption of coffee, and adequate weight gain during pregnancy. Analysis of birth outcome data revealed that infants born to the experimental group had a significantly higher mean birth weight than infants born to the controls (121.34 oz versus 113.64 oz). The experimental group also had fewer low birth weight infants (7.0 percent versus 9.7 percent for controls). Hospital treatment cost savings associated with the reduced incidence of low birth weight infants among experimental group women yielded an overall benefit-cost ratio for the prenatal program of approximately 2:1. PMID:6419268
Burt, Vicki L.; Harris, Tamara
Describes third National Health and Nutrition Examination Survey (NHANES III), noting that upper age limit was removed and that older black, Mexican American, and white populations were oversampled. Sees NHANES III component for older adults providing multidimensional overview of physical and functional health status (osteoporosis; arthritis;…
Cohen, Alison; Lopez, Andrea; Malloy, Nile; Morello-Frosch, Rachel
This study presents a health survey conducted by a community-based participatory research partnership between academic researchers and community organizers to consider environmental health and environmental justice issues in four neighborhoods of Richmond, California, a low-income community of color living along the fence line of a major oil…
Mock, C. N.; Abantanga, F.; Cummings, P.; Koepsell, T. D.
Injury is an increasingly significant health problem in most low-income countries. However, strategies for preventing injury have not been well addressed. The present study was carried out to measure the incidence and outcome of various mechanisms of injury in Ghana in order to provide data for use in developing priorities for injury prevention efforts. For this purpose, using two-stage cluster sampling and household interviews, we surveyed 21,105 persons living in 431 urban and rural sites. During the preceding year, 1609 injuries resulting in one or more days of loss of normal activity were reported. Injury-related mortality was slightly higher in the urban (83 per 100,000) than in the rural area (53 per 100,000). However, the burden of disability from nonfatal injuries, as assessed by disability days, was higher in the rural (4697 disability days per 1000 person-years) than in the urban area (2671 days per 1000 person-years). Based on incidence rates and disability times, the major types of injury in the urban area were transport-related injury and falls. In the rural area, agricultural injuries predominated, followed by falls and transport-related injury. In rural and urban areas combined, 73% of motor vehicle-related injuries involved commercial vehicles. In this and other similar developing-country settings, injury prevention efforts should focus on falls and on transport safety in both urban and rural areas, with special attention being paid to commercial vehicles. In rural areas, agricultural injuries contributed the largest burden of morbidity, and should be a priority for prevention efforts. PMID:10680242
Simpson, R.; Albert, W.; Wilson, D. M. C.; Ciliska, D.; Evans, C. E.
In the Region of Halton, a health promotion data base was developed to assist with planning for local services and programs. Three data sources were used: preventable mortality, preventable morbidity, and the prevalence of modifiable risk among community members. Existing information was used for the first two sources, and the community was surveyed for the last. A survey version of the FANTASTIC Lifestyle Checklist was mailed to a random sample of 1,200 households. FANTASTIC showed itself to be a reliable lifestyle construct with two major factors: a group of psychosocial behaviors, and a set of “bad habits”.
Wade, Roy; Cronholm, Peter F; Fein, Joel A; Forke, Christine M; Davis, Martha B; Harkins-Schwarz, Mary; Pachter, Lee M; Bair-Merritt, Megan H
Adverse Childhood Experiences (ACEs), which include family dysfunction and community-level stressors, negatively impact the health and well being of children throughout the life course. While several studies have examined the impact of these childhood exposures amongst racially and socially diverse populations, the contribution of ACEs in the persistence of socioeconomic disparities in health is poorly understood. To determine the association between ACEs and health outcomes amongst a sample of adults living in Philadelphia and examine the moderating effect of Socioeconomic Status (SES) on this association, we conducted a cross-sectional survey of 1,784 Philadelphia adults, ages 18 and older, using random digit dialing methodology to assess Conventional ACEs (experiences related to family dysfunction), Expanded ACEs (community-level stressors), and health outcomes. Using weighted, multivariable logistic regression analyses along with SES stratified models, we examined the relationship between ACEs and health outcomes as well as the modifying effect of current SES. High Conventional ACE scores were significantly associated with health risk behaviors, physical and mental illness, while elevated Expanded ACE scores were associated only with substance abuse history and sexually transmitted infections. ACEs did have some differential impacts on health outcomes based on SES. Given the robust impact of Conventional ACEs on health, our results support prior research highlighting the primacy of family relationships on a child's life course trajectory and the importance of interventions designed to support families. Our findings related to the modifying effect of SES may provide additional insight into the complex relationship between poverty and childhood adversity. PMID:26726759
Vietri, Jeffrey; Otsubo, Tempei; Montgomery, William; Tsuji, Toshinaga; Harada, Eiji
Background Depression is often associated with painful physical symptoms. Previous research has seldom assessed the relationship between the severity of physical symptoms and the severity of mental and emotional symptoms of depression or other health outcomes, and no such studies have been conducted previously among individuals with depression in Japan. The aim of this study was to assess the relationship between the severity of physical pain and depression and other outcomes among individuals in Japan diagnosed with depression. Methods Data for individuals aged 18 and older in Japan who reported being diagnosed with depression and also reported physical pain were obtained from the Japan National Health and Wellness Survey. These respondents were characterized on sociodemographics and health characteristics, and the relationship between ratings of severity on pain in the last week and health outcomes were assessed using bivariate correlations and generalized linear models. Measures included the Patient Health Questionnaire for depression severity, Medical Outcomes Study 12-Item Short Form Survey Instrument for health-related quality of life, the Work Productivity and Activity Impairment for work and activity impairment, and 6-month report of health care use. Results More severe physical pain in the past week was correlated with more severe depression, worse health-related quality of life, lower health utility, greater impairment at work, and more health care provider visits. These relationships remained significant after incorporating sociodemographics and health characteristics in the statistical models. Conclusion Individuals whose depression is accompanied by more severe physical pain have a higher burden of illness than those whose depression includes less severe pain, suggesting that even partially ameliorating painful physical symptoms may significantly benefit patients with depression. Clinicians should take the presence and severity of physical pain into
Ueda, Kimiko; Yonemoto, Naohiro; Bailey, Donald B
According to a revision of Japan's Basic Law for Persons with Disabilities in 2011, Article 17 stipulated the government's obligation to provide early intervention to children with disabilities. However, the concept of family outcomes in early intervention has not really been considered in Japan yet. This article describes the development and validation of the Japanese version of the Family Outcomes Survey Revised (FOS-R). Our goal was to determine whether this survey for assessing how families of children with disabilities are affected by early intervention would be appropriate for use in early intervention in Japan. Both the Japanese version of the FOS-R and an anonymous, self-administered questionnaire about background factors were given to 394 mothers of children who were either currently using or had in the past year used early intervention at an early intervention facility or medical institution. Survey responses were obtained from 335 mothers (response rate of 85.0%). The total number of subjects in the analysis was 301 mothers who answered the Japanese version of the FOS-R completely. To assess content validity, another survey was given to 115 experts involved in supporting children with disabilities and their families. The family outcomes indicator items as well as the helpfulness indicators items showed good psychometric properties. Although the components of the FOS-R worked better as individual subscales than as a single scale, we confirmed that a total score was also psychometrically valid. We also confirmed both content validity and external validity. The Japanese version of the FOS-R appears to be a valid tool for assessing the benefits experienced by families as a result of services received, but further research is needed to determine the nature of practices most likely to lead to positive family outcomes. PMID:25668211
Quintal, Carlota; Lopes, José
Equity in health care financing is recognised as a main goal in health policy. It implies that payments should be linked to capacity to pay and that households should be protected against catastrophic health expenditure (CHE). The risk of CHE is inversely related to the share of out-of-pocket payments (OOP) in total health expenditure. In Portugal, OOP represented 26% of total health expenditure in 2010 [one of the highest among Organisation for Economic Co-operation and Development (OECD) countries]. This study aims to identify the proportion of households with CHE in Portugal and the household factors associated with this outcome. Additionally, progressivity indices are calculated for OOP and private health insurance. Data were taken from the Portuguese Household Budget Survey 2010/2011. The prevalence of CHE is 2.1%, which is high for a developed country with a universal National Health Service. The main factor associated with CHE is the presence of at least one elderly person in households (when the risk quadruples). Payments are particularly regressive for medicines. Regarding the results by regions, the Kakwani index for total OOP is larger (negative) for the Centre and lower, not significant, for the Azores. Payments for voluntary health insurance are progressive. PMID:26573411
Bjørngaard, Johan Håkon; Rustad, Åse-Bente; Kjelsberg, Ellen
Background There is evidence for higher morbidity among prison inmates than in the general population. Despite this, patient satisfaction with the prison health services is scarcely investigated. The aim of the present study was to investigate patient satisfaction with prison health services in Norway and to analyze possible patient and service effects. Methods The survey took part in 29 prisons in the southern and central part of Norway, representing 62% of the total prison capacity in Norway. A total of 1,150 prison inmates with prison health services experiences completed a satisfaction questionnaire (90% response rate). The patients' satisfaction was measured on a 12-item index. Multilevel analyses were used to analyze both patient and service characteristics as predictors of satisfaction. Results The study revealed high levels of dissatisfaction with prison health services. There were substantial differences between services, with between-service-variance accounting for 9% of the total variance. Satisfaction was significantly associated with a senior staff member's evaluation of the health services possessing adequate resources and the quality of drug abuse treatment. At the patient level, satisfaction was significantly associated with older age, frequent consultations and better self-perceived health. Conclusion Prison inmates' satisfaction with the health services provided are low compared with patient satisfaction measured in other health areas. The substantial differences observed between services - even when adjusting for several known factors associated with patient satisfaction - indicate a potential for quality improvement. PMID:19785736
Aim Education is one of the strongest social determinants of health, yet previous literature has focused on primary education. We examined whether there are additional benefits to completing upper secondary compared to lower secondary education in a middle-income country. Methods We performed a longitudinal analysis of the Cape Area Panel Study, a survey of adolescents living in South Africa. We undertook causal modeling using structural marginal models to examine the association between level of education and various health outcomes, using inverse probability weighting to control for sex, age, ethnicity, home language, income, whether employed in past year, region of birth, maternal educational status, marital status, whether currently pregnant and cognitive ability. Educational attainment was defined as primary (grades 1–7), lower secondary (grades 8–9) or upper secondary (grades 10–12). Results Of 3,432 participants, 165 (4.8%) had completed primary education, 646 (18.8%) lower secondary and 2,621 (76.3%) upper secondary. Compared to those completing lower secondary, males completing upper secondary education were less likely to have a health problem (OR 0.49; 95%CI 0.27–0.88; p = 0.02); describe their health as poor (0.52; 0.29–0.95; p = 0.03) or report that health interferes with daily life (0.54; 0.29–0.99; p = 0.047). Females were less likely to have been pregnant (0.45; 0.33–0.61; p<0.001) or pregnant under 18 (0.32; 0.22–0.46; p<0.001); and having had sex under 16 was also less likely (males 0.63; 0.44–0.91; p = 0.01; females 0.39; 0.26–0.58; p<0.001). Cigarette smoking was less likely (males 0.52; 0.38–0.70; p = <0.001; females 0.56; 0.41–0.76; p<0.001), as was taking illicit drugs in males (0.6; 0.38–0.96; p = 0.03). No associations were found between education and alcohol use, psychological distress, obesity, increased waist circumference or hypertension. Conclusion Completing upper secondary education was associated with
Khaskheli, Meharun-nissa; Baloch, Shahla; Sheeba, Aneela
Objective: To observe acute maternal morbidity and mortality due to iatrogenic factors and outcomes. Methods: This observational cross sectional study was conducted at intensive care unit of Liaquat University of Medical and Health sciences Jamshoro from 1-January-2011 to 31-December-2012. In this study all the delivered or undelivered women who needed intensive care unit (ICU) admission due to management related life threatening complication referred from periphery or within this hospital were included, while those women who had pregnancy complicated by medical conditions were excluded. These women were registered on the predesigned proforma containing variables like Demographic characteristics, various iatrogenic risk factors, complications and management out comes. The data was collected and analyzed on SPSS version 20. Results: During these study period 51 women needed ICU care for different complications due to adverse effects of medical treatments. Majority of these women were between 20-40 years of age 41(80.39%), multiparous 29(56.86%), unbooked 38(74.50%), referred from periphery 39(76.47%), common iatrogenic factors were misuse of oxytocin 16(31.37%), fluid overload/cardiac failure 8(15.68%), blood reaction 7(13.72%), anesthesia related problems were delayed recovery 3(5.88%), cardiac arrest 2(3.92%), spinal shock 2(3.92%), surgical problems were bladder injury 5(9.8%), post operative internal haemorrhage 3(5.88%), 37(72.54%) women recovered and 14(27.45%) expired. Conclusion: The maternal morbidity and mortality rate with iatrogenic factors was high and majority of these factors were avoidable. PMID:24639842
This document presents the results of the Bolivia Demographic and Health Survey (DHS), or Encuesta Nacional de Demografia y Salud 1998, conducted by the Instituto Nacional de Estadistica, La Paz, Bolivia, within the framework of the DHS Program of Macro International. Data were collected from 12,109 households and complete interviews were conducted with 11,187 women aged 15-49. A male survey was also conducted, which collected data from 3780 men aged 15-64. The information collected include the following: 1) general characteristics of the population, 2) fertility, 3) fertility preferences, 4) current contraceptive use, 5) contraception, 6) marital and contraceptive status, 7) postpartum variables, 8) infant mortality, 9) health: disease prevention and treatment, and 10) nutritional status: anthropometric measures. PMID:11020937
Ross, Alyson; Friedmann, Erika; Bevans, Margaret; Thomas, Sue
Background. Yoga shows promise as a therapeutic intervention, but relationships between yoga practice and health are underexplored. Purpose. To examine the relationship between yoga practice and health (subjective well-being, diet, BMI, smoking, alcohol/caffeine consumption, sleep, fatigue, social support, mindfulness, and physical activity). Methods. Cross-sectional, anonymous internet surveys distributed to 4307 randomly selected from 18,160 individuals at 15 US Iyengar yoga studios; 1045 (24.3%) surveys completed. Results. Mean age 51.7 (± 11.7) years; 84.2% female. Frequency of home practice favorably predicted (P < .001): mindfulness, subjective well-being, BMI, fruit and vegetable consumption, vegetarian status, sleep, and fatigue. Each component of yoga practice (different categories of physical poses, breath work, meditation, philosophy study) predicted at least 1 health outcome (P < .05). Conclusions. Home practice of yoga predicted health better than years of practice or class frequency. Different physical poses and yoga techniques may have unique health benefits. PMID:22927885
Sharma, Rabi N; Goel, Sudha
Long-term impacts of drinking chlorinated water on the incidence of cancers and other adverse health outcomes were assessed in a population-based cross-sectional study. The study was conducted by comparing a group exposed to chlorinated drinking water for more than thirty years with control groups with less or no exposure to chlorine. A house-to-house survey was completed to gather information on residential history, age, education, income, source and extent of treatment of water and health characteristics. All residents below thirty years of age were excluded from the database used for analyses to ensure that the groups were comparable. Fourteen cancer cases were found in the long-term exposed groups of 1085 persons and 9 cancer cases in the two control populations of 725 persons. The odds ratio for cancers (OR) was 1.05 (95% CI = 0.43-2.65) and is not statistically significant. Reciprocal or inverse odds [corrected] ratios for gastrointestinal disorders, kidney problems and skin infections were statistically significant ranging from 2.06 (95% CI = 1.01-4.17) to 2.2 (95% CI = 1.45-3.33). These OR values indicate that there is no significant association between the incidence of cancer and exposure to chlorinated water while chlorinating drinking water significantly reduced the incidence of non-carcinogenic adverse health effects like gastrointestinal diseases, skin infections, and kidney diseases. PMID:18476370
Walldius, Åke; Olve, Nils-Göran; Aminoff, Hedvig
As costs for healthcare are rising in society, information systems are often seen as enablers of new cost-saving healthcare processes. But an on-going deployment of a wide range of new kinds of systems requires close attention to interoperability between new and legacy systems. Another challenge is to assure that the healthcare professions are given realistic opportunities to play an active part in designing the new ways of working that the new, integrated systems are designed to support. We argue that a feasible way to approach such a user participation in design of work processes and systems is to extend well known user-survey and strategy-mapping methods with the new value-based healthcare approach which invites health professionals to participate in strategic assessments of health outcome and costs along the care chain in which they work. We also argue that such a combination of practical research methods resonates well with Techno-Anthropology's foregrounding of ethical considerations to inform the interdisciplinary cross-fertilization of interactional competencies in health informatics research. PMID:26249201
Franks, P; Clancy, C M; Gold, M R; Nutting, P A
OBJECTIVES. The relationship between health insurance and subjective health status was investigated. It was hypothesized that persons without health insurance would have lower levels of subjective health status than those with health insurance and that this relationship would hold for both poor and nonpoor persons. METHODS. Data from the 1987 National Medical Expenditure Survey were analyzed to examine the relationship between health insurance and self-reported health status. The analysis controlled for sociodemographic and attitudinal variables and medical conditions. RESULTS. Persons without health insurance had significantly lower levels of subjective health status than did persons with insurance. This adverse effect persisted after adjustments were made for the effects of age, sex, race, income, attitude toward the value of medical care and health insurance, and medical conditions. The detrimental effect of lacking health insurance on subjective health status was present for persons at all income levels and was greater than the effect on subjective health status found for 2 of the 11 reported medical conditions. CONCLUSIONS. Lacking health insurance is associated with clinically significant lower levels of subjective health status in both poor and non-poor persons. PMID:8363006
Cheng, Lingguo; Liu, Hong; Zhang, Ye; Shen, Ke; Zeng, Yi
This paper investigates the effects of China’s New Cooperative Medical Scheme (NCMS) on health outcomes and health care expenditure of the elderly in rural China, using panel data from the 2005 and 2008 waves of the Chinese Longitudinal Healthy Longevity Survey. We employ a strategy that combines propensity score matching with a difference-in-differences approach to address selection bias. Results show that the NCMS has significantly improved the elderly enrollees’ activities of daily living and cognitive function, but has not led to better self-assessed general health status. We find no significant effect of NCMS on mortality for the previously uninsured elderly in NCMS counties, although there is moderate evidence that it is associated with reduced mortality for the elderly enrollees. We also find that the elderly participants are more likely to get adequate medical services when sick, which provides a good explanation for the beneficial health effects of NCMS. However, there is no evidence that the NCMS has reduced their out-of-pocket spending. Furthermore, we also find that low-income seniors benefit more from NCMS participation in terms of health outcomes and perceived access to health care, suggesting that the NCMS helps reduce health inequalities among the rural elderly. PMID:24777657
Moran, Valerie; Jacobs, Rowena
Evidence on provider payment systems that incorporate patient outcomes is limited for mental health care. In England, funding for mental health care services is changing to a prospective payment system with a future objective of linking some part of provider payment to outcomes. This research examines performance of mental health providers offering hospital and community services, in order to investigate if some are delivering better outcomes. Outcomes are measured using the Health of the Nation Outcome Scales (HoNOS) - a clinician-rated routine outcome measure (CROM) mandated for national use. We use data from the Mental Health Minimum Data Set (MHMDS) - a dataset on specialist mental health care with national coverage - for the years 2011/12 and 2012/13 with a final estimation sample of 305,960 observations with follow-up HoNOS scores. A hierarchical ordered probit model is used and outcomes are risk adjusted with independent variables reflecting demographic, need, severity and social indicators. A hierarchical linear model is also estimated with the follow-up total HoNOS score as the dependent variable and the baseline total HoNOS score included as a risk-adjuster. Provider performance is captured by a random effect that is quantified using Empirical Bayes methods. We find that worse outcomes are associated with severity and better outcomes with older age and social support. After adjusting outcomes for various risk factors, variations in performance are still evident across providers. This suggests that if the intention to link some element of provider payment to outcomes becomes a reality, some providers may gain financially whilst others may lose. The paper contributes to the limited literature on risk adjustment of outcomes and performance assessment of providers in mental health in the context of prospective activity-based payment systems. PMID:26218853
Archambeau, Olga G.; Frueh, B. Christopher; Deliramich, Aimee N.; Elhai, Jon D.; Grubaugh, Anouk L.; Herman, Steve; Kim, Bryan S. K.
In a cross-sectional survey of college students (N = 614) we studied interpersonal violence victimization, perpetration, and mental health outcomes in an ethnoracially diverse rural-based sample of Asian Americans (27%), and Native Hawaiian/Other Pacific Islanders (25%), two groups vastly underrepresented in trauma research. High rates of interpersonal violence (34%), violence perpetration (13%), and probable psychiatric diagnoses (77%), including posttraumatic stress disorder, were found. Exposure to physical violence, sexual violence, and life stress all were predictive of psychopathology. Female participants were associated with higher likelihood of sexual violence victimization compared to male participants, and Asian American status (especially among males) was associated with lower likelihood of physical and sexual violence compared with European Americans. These data enhance our understanding of interpersonal violence and mental health outcomes among previously understudied minority groups. PMID:21297936
Magana, Sandra; Smith, Matthew J.
The impact of caring for a child with a developmental disability on the physical and mental health of Latina and Black American women was examined. We used the National Health Interview Survey to compare the health of older mothers who were co-residing with a child who had a developmental disability to the health of same age mothers without…
Friis, Karina; Lasgaard, Mathias; Osborne, Richard H; Maindal, Helle T
Objectives To (1) quantify levels of subjective health literacy in people with long-term health conditions (diabetes, cardiovascular disease, chronic obstructive pulmonary disease, musculoskeletal disorders, cancer and mental disorders) and compare these to levels in the general population and (2) examine the association between health literacy, socioeconomic characteristics and comorbidity in each long-term condition group. Design Population-based survey in the Central Denmark Region (n=29 473). Main outcome measures Health literacy was measured using two scales from the Health Literacy Questionnaire (HLQ): (1) Ability to understand health information and (2) Ability to actively engage with healthcare providers. Results People with long-term conditions reported more difficulties than the general population in understanding health information and actively engaging with healthcare providers. Wide variation was found between disease groups, with people with cancer having fewer difficulties and people with mental health disorders having more difficulties in actively engaging with healthcare providers than other long-term condition groups. Having more than one long-term condition was associated with more difficulty in engaging with healthcare providers and understanding health information. People with low levels of education had lower health literacy than people with high levels of education. Conclusions Compared with the general population, people with long-term conditions report more difficulties in understanding health information and engaging with healthcare providers. These two dimensions are critical to the provision of patient-centred healthcare and for optimising health outcomes. More effort should be made to respond to the health literacy needs among individuals with long-term conditions, multiple comorbidities and low education levels, to improve health outcomes and to reduce social inequality in health. PMID:26769783
Background To examine the association between rurality and health in Scotland, after adjusting for differences in individual and practice characteristics. Methods Design: Mortality and hospital record data linked to two cross sectional health surveys. Setting: Respondents in the community-based 1995 and 1998 Scottish Health Survey who consented to record-linkage follow-up. Main outcome measures: Hypertension, all-cause premature mortality, total hospital stays and admissions due to coronary heart disease (CHD). Results Older age and lower social class were strongly associated with an increased risk of each of the four health outcomes measured. After adjustment for individual and practice characteristics, no consistent pattern of better or poorer health in people living in rural areas was found, compared to primary cities. However, individuals living in remote small towns had a lower risk of a hospital admission for CHD and those in very remote rural had lower mortality, both compared with those living in primary cities. Conclusion This study has shown how linked data can be used to explore the possible influence of area of residence on health. We were unable to find a consistent pattern that people living in rural areas have materially different health to that of those living in primary cities. Instead, we found stronger relationships between compositional determinants (age, gender and socio-economic status) and health than contextual factors (including rurality). PMID:22340710
Background Recent studies show several health-related behaviors to cluster in adolescents. This has important implications for public health. Interrelated behaviors have been shown to be most effectively targeted by multimodal interventions addressing wider-ranging improvements in lifestyle instead of via separate interventions targeting individual behaviors. However, few previous studies have taken into account a broad, multi-disciplinary range of health-related behaviors and connected these behavioral patterns to health-related outcomes. This paper presents an analysis of the clustering of a broad range of health-related behaviors with relevant demographic factors and several health-related outcomes in adolescents. Methods Self-report questionnaire data were collected from a sample of 2,690 Dutch high school adolescents. Behavioral patterns were deducted via Principal Components Analysis. Subsequently a Two-Step Cluster Analysis was used to identify groups of adolescents with similar behavioral patterns and health-related outcomes. Results Four distinct behavioral patterns describe the analyzed individual behaviors: 1- risk-prone behavior, 2- bully behavior, 3- problematic screen time use, and 4- sedentary behavior. Subsequent cluster analysis identified four clusters of adolescents. Multi-problem behavior was associated with problematic physical and psychosocial health outcomes, as opposed to those exerting relatively few unhealthy behaviors. These associations were relatively independent of demographics such as ethnicity, gender and socio-economic status. Conclusions The results show that health-related behaviors tend to cluster, indicating that specific behavioral patterns underlie individual health behaviors. In addition, specific patterns of health-related behaviors were associated with specific health outcomes and demographic factors. In general, unhealthy behavior on account of multiple health-related behaviors was associated with both poor psychosocial
Jovaag, Amanda; Catlin, Bridget B.; Rodock, Matthew; Park, Hyojun
Introduction The objective of this observational study was to examine the key contributors to health outcomes and to better understand the health disparities between Delta and non-Delta counties in 8 states in the Mississippi River Delta Region. We hypothesized that a unique set of contributors to health outcomes in the Delta counties could explain the disparities between Delta and non-Delta counties. Methods Data were from the 2014 County Health Rankings for counties in 8 states (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee). We used the Delta Regional Authority definition to identify the 252 Delta counties and 468 non-Delta counties or county equivalents. Information on health factors (eg, health behaviors, clinical care) and outcomes (eg, mortality) were derived from 38 measures from the 2014 County Health Rankings. The contributions of health factors to health outcomes in Delta and non-Delta counties were examined using path analysis. Results We found similarities between Delta counties and non-Delta counties in the health factors (eg, tobacco use, diet and exercise) that significantly predicted the health outcomes of self-rated health and low birthweight. The most variation was seen in predictors of mortality; however, Delta counties shared 2 of the 3 significant predictors (ie, community safety and income) of mortality with non-Delta counties. On average across all measures, values in the Delta were 16% worse than in the non-Delta and 22% worse than in the rest of the United States. Conclusion The health status of Delta counties is poorer than that of non-Delta counties because the health factors that contribute to health outcomes in the entire region are worse in the Delta counties, not because of a unique set of health predictors. PMID:26940300
Pelikan, Jürgen M.; Röthlin, Florian; Ganahl, Kristin; Slonska, Zofia; Doyle, Gerardine; Fullam, James; Kondilis, Barbara; Agrafiotis, Demosthenes; Uiters, Ellen; Falcon, Maria; Mensing, Monika; Tchamov, Kancho; van den Broucke, Stephan; Brand, Helmut
Background: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations. Methods: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews. Results: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29–62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model. Discussion: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe. PMID:25843827
Gindi, Renee; Cohen, Robin A.
Objectives Using linked administrative data, to validate Medicare coverage estimates among adults aged 65 or older from the National Health Interview Survey (NHIS), and to assess the impact of a recently added Medicare probe question on the validity of these estimates. Data sources Linked 2005 NHIS and Master Beneficiary Record and Payment History Update System files from the Social Security Administration (SSA). Study design We compared Medicare coverage reported on NHIS with “benchmark” benefit records from SSA. Principal findings With the addition of the probe question, more reports of coverage were captured, and the agreement between the NHIS-reported coverage and SSA records increased from 88% to 95%. Few additional overreports were observed. Conclusions Increased accuracy of the Medicare coverage status of NHIS participants was achieved with the Medicare probe question. Though some misclassification remains, data users interested in Medicare coverage as an outcome or correlate can use this survey measure with confidence. PMID:24800138
McCall, M. A.; Sorbie, J.
OBJECTIVE: To identify which women's health issues are taught in the 2-year core curriculum of Canadian family medicine residency programs and whether educators think their current teaching of women's health is adequate. DESIGN: Mailed survey using a questionnaire. PARTICIPANTS: All program and unit directors of the 16 Canadian family medicine residency training programs were surveyed. Replies were received from 63% (10 of 16) of program directors and 79% (55 of 70) of unit directors. MAIN OUTCOME MEASURES: Percentage of programs teaching specific women's health topics from a list of 21 possible topics; percentage offering educational opportunities with sexual assault teams and women's shelters; participants' assessment of the adequacy of current teaching in each training program; plans to increase women's health education. RESULTS: Topics such as violence against women and medical conditions more common among women were taught in more than 80% of programs, but poverty and the health care concerns of Native and immigrant women were included in fewer than 40% of programs. Half of the program directors indicated that residents were given educational opportunities with sexual assault teams or women's shelters. Unit directors gave a lower estimate. Most (90%) program directors thought their current teaching of women's health issues was inadequate and had plans to increase it, as did 64% of unit directors. CONCLUSION: Violence against women and the traditional medical topics of osteoporosis, weight disorders, and reproductive and breast cancer are frequently taught in family medicine training programs. However, the social and cultural aspects of health are addressed less often. It is encouraging that many family medicine programs plan to increase their teaching of women's health. PMID:8038635
Coyne, Joseph S; McLaughlin, Eric; Cantoni, Lorenzo
The development of an international graduate program requires thorough analysis, awareness of the risks involved, and the constraints unique to a particular institution. An assessment of three critical questions must be answered. First, what are the host university investment requirements? Second, what is the degree of enhancement of educational outcomes for the host university? Third, what is the contribution to the international reputations of the host university? This paper presents the result of a survey about these three questions of international educators attending the Third International Conference on Healthcare Systems meeting in Charleston, West Virginia. The results of this survey suggest that there is much to be gained in the educational outcomes and international reputation for both the host campus and the international campus yet the investment is significant. Perhaps of greatest importance is funding, and if possible, external funding is advised. This will attract both high quality students and faculty to participate and/or enroll, thus strengthening the program. There appears to be no optimal strategy or single model that can maximize the educational outcomes and international reputation while minimizing the degree of investment simultaneously. Further research is needed on what is successful and what is not, in terms of investment of time and effort. Hopefully, such research will contribute to higher quality international health management graduate programs that achieve the stated business and educational goals of all parties to reduce the risk of investing both time and money in a new educational venture. PMID:18214077
Boswell, James F; Constantino, Michael J; Kraus, David R; Bugatti, Matteo; Oswald, Jennifer M
Evidence shows that routine outcome monitoring (ROM) and feedback using standardized measurement tools enhances the outcomes of individual patients. When outcome data from a large number of patients and clinicians are collected, patterns can be tracked and comparisons can be made at multiple levels. Variability in skills and outcomes among clinicians and service settings has been documented, and the relevance of ROM for decision making is rapidly expanding alongside the transforming health care landscape. In this article, we highlight several developing core implications of ROM for mental health care, and frame points of future work and discussion. PMID:25861984
Yang, Zhou; Gilleskie, Donna B.; Norton, Edward C.
Prescription drug coverage creates a change in medical care consumption, beyond standard moral hazard, arising both from the differential cost-sharing and the relative effectiveness of different types of care. We model the dynamic supplemental health insurance decisions of Medicare beneficiaries, their medical care demand, and subsequent health…
Rogers, Bonnie; Kono, Keiko; Marziale, Maria Helena Palucci; Peurala, Marjatta; Radford, Jennifer; Staun, Julie
Access to occupational health services for primary prevention and control of work-related injuries and illnesses by the global workforce is limited (World Health Organization [WHO], 2013). From the WHO survey of 121 (61%) participating countries, only one-third of the responding countries provided occupational health services to more than 30% of their workers (2013). How services are provided in these countries is dependent on legal requirements and regulations, population, workforce characteristics, and culture, as well as an understanding of the impact of workplace hazards and worker health needs. Around the world, many occupational health services are provided by occupational health nurses independently or in collaboration with other disciplines' professionals. These services may be health protection, health promotion, or both, and are designed to reduce health risks, support productivity, improve workers' quality of life, and be cost-effective. Rantanen (2004) stated that basic occupational health services must increase rather than decline, especially as work becomes more complex; workforces become more dynamic and mobile, creating new models of work-places; and jobs become more precarious and temporary. To better understand occupational health services provided by occupational health nurses globally and how decisions are made to provide these services, this study examined the scope of services provided by a sample of participating occupational health nurses from various countries. PMID:25000546
Qayumi, Karim; Pachev, George; Zheng, Bin; Ziv, Amitai; Koval, Valentyna; Badiei, Sadia; Cheng, Adam
Simulation is rapidly penetrating the terrain of health care education and has gained growing acceptance as an educational method and patient safety tool. Despite this, the state of simulation in health care education has not yet been evaluated on a global scale. In this project, we studied the global status of simulation in health care education by determining the degree of financial support, infrastructure, manpower, information technology capabilities, engagement of groups of learners, and research and scholarly activities, as well as the barriers, strengths, opportunities for growth, and other aspects of simulation in health care education. We utilized a two-stage process, including an online survey and a site visit that included interviews and debriefings. Forty-two simulation centers worldwide participated in this study, the results of which show that despite enormous interest and enthusiasm in the health care community, use of simulation in health care education is limited to specific areas and is not a budgeted item in many institutions. Absence of a sustainable business model, as well as sufficient financial support in terms of budget, infrastructure, manpower, research, and scholarly activities, slows down the movement of simulation. Specific recommendations are made based on current findings to support simulation in the next developmental stages. PMID:25489254
Sharma, P; Busby, M; Chapple, L; Matthews, R; Chapple, I
.Conclusion The current study has demonstrated that patient reported general health and risk factors were negatively associated with an overall composite oral health score outcome in a large population of over 37,000 patients examined by 493 dentists. While the clinical significance of some of the reported associations is unknown, the data lend support to the growing body of evidence linking the oral and systemic health of individuals. Therefore, GDPs may be in a unique position to influence the lifestyle and general health of patients as part of their specific remit to attain and maintain optimal oral health. PMID:27444597
Kaspin, Lisa C; Gorman, Kathleen M; Miller, Ross M
This review determines the characteristics and health-related and economic outcomes of employer-sponsored wellness programs and identifies possible reasons for their success. PubMed, ABI/Inform, and Business Source Premier databases, and Corporate Wellness Magazine were searched. English-language articles published from 2005 to 2011 that reported characteristics of employer-sponsored wellness programs and their impact on health-related and economic outcomes among US employees were accepted. Data were abstracted, synthesized, and interpreted. Twenty references were accepted. Wellness interventions were classified into health assessments, lifestyle management, and behavioral health. Improved economic outcomes were reported (health care costs, return on investment, absenteeism, productivity, workers' compensation, utilization) as well as decreased health risks. Programs associated with favorable outcomes had several characteristics in common. First, the corporate culture encouraged wellness to improve employees' lives, not only to reduce costs. Second, employees and leadership were strongly motivated to support the wellness programs and to improve their health in general. Third, employees were motivated by a participation-friendly corporate policy and physical environment. Fourth, successful programs adapted to the changing needs of the employees. Fifth, community health organizations provided support, education, and treatment. Sixth, successful wellness programs utilized technology to facilitate health risk assessments and wellness education. Improved health-related and economic outcomes were associated with employer-sponsored wellness programs. Companies with successful programs tended to include wellness as part of their corporate culture and supported employee participation in several key ways. PMID:23113636
Nagy, Stephen; Adcock, Anthony
The Alabama Adolescent Health Survey was a comprehensive survey of the knowledge and behaviors of eighth- and tenth-grade students in the public schools. The sample consisted of 3,803 students from school systems that were rural, metropolitan, and mixed. The survey measured student attitudes toward, and knowledge of: (1) mental health; (2)…
Brown, Molly E; Grace, Kathryn; Shively, Gerald; Johnson, Kiersten B; Carroll, Mark
Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vectorborne diseases, such as malaria and yellow fever, to undermining nutrition through deleterious impacts on food production and concomitant increases in food prices. This paper uses case studies to describe methods that make use of satellite remote sensing and Demographic and Health Survey data to better understand individual-level human health and nutrition outcomes. By bringing these diverse datasets together, the connection between environmental change and human health outcomes can be described through new research and analysis. PMID:25132700
Brown, Molly E.; Grace, Kathryn; Shively, Gerald; Johnson, Kiersten B.; Carroll, Mark
Climate change and degradation of ecosystem services functioning may threaten the ability of current agricultural systems to keep up with demand for adequate and inexpensive food and for clean water, waste disposal and other broader ecosystem services. Human health is likely to be affected by changes occurring across multiple geographic and time scales. Impacts range from increasing transmissibility and the range of vector-borne diseases, such as malaria and yellow fever, to undermining nutrition through deleterious impacts on food production and concomitant increases in food prices. This paper uses case studies to describe methods that make use of satellite remote sensing and Demographic and Health Survey data to better understand individual-level human health and nutrition outcomes. By bringing these diverse datasets together, the connection between environmental change and human health outcomes can be described through new research and analysis.
Poon, Kenneth K; Ooi, Nona; Bull, Rebecca; Bailey, Donald B
This study sought to examine the construct validity of the Family Outcomes Survey-Revised (FOS-R) in Singapore, describe the extent to which family outcomes of early childhood intervention (ECI) are attained, and obtain caregivers' perception on the extent to which ECI has served their needs. The FOS-R was translated into Chinese (simplified) and Malay for use in Singapore. Bilingual (i.e., English-Chinese and English-Malay) versions of the instrument were distributed to caregivers of young children with disabilities receiving ECI in four centers in Singapore. A total of 291 surveys were available for analyses (response rate of 43.1%). Confirmatory factor analyses indicated that there was a fit between the current data set and the FOS-R structure proposed by the developers. Overall, the participants reported moderately high attainment of family outcomes. They also reported that the ECI programs were mostly helpful. Other aspects of the cross-cultural application of instruments were considered and implications for local service provision as well as directions for future research were discussed. PMID:24763378
Background Australia’s National Mental Health Strategy has emphasised the quality, effectiveness and efficiency of services, and has promoted the collection of outcomes and casemix data as a means of monitoring these. All public sector mental health services across Australia now routinely report outcomes and casemix data. Since late-2003, the Australian Mental Health Outcomes and Classification Network (AMHOCN) has received, processed, analysed and reported on outcome data at a national level, and played a training and service development role. This paper documents the history of AMHOCN’s activities and achievements, with a view to providing lessons for others embarking on similar exercises. Method We conducted a desktop review of relevant documents to summarise the history of AMHOCN. Results AMHOCN has operated within a framework that has provided an overarching structure to guide its activities but has been flexible enough to allow it to respond to changing priorities. With no precedents to draw upon, it has undertaken activities in an iterative fashion with an element of ‘trial and error’. It has taken a multi-pronged approach to ensuring that data are of high quality: developing innovative technical solutions; fostering ‘information literacy’; maximising the clinical utility of data at a local level; and producing reports that are meaningful to a range of audiences. Conclusion AMHOCN’s efforts have contributed to routine outcome measurement gaining a firm foothold in Australia’s public sector mental health services. PMID:22640939
Doyle, Eva I.; Caro, Carla M.; Lysoby, Linda; Auld, M. Elaine; Smith, Becky J.; Muenzen, Patricia M.
The National Health Educator Job Analysis 2010 was conducted to update the competencies model for entry- and advanced-level health educators. Qualitative and quantitative methods were used. Structured interviews, focus groups, and a modified Delphi technique were implemented to engage 59 health educators from diverse work settings and experience…
Becher, J C; Garcia, J G; Kaplan, D W; Gil, A R; Li, J; Main, D; Herrera, J A; Arias, L; Bromet, A
A survey on the reproductive health risk behaviors of adolescent students in Colombia was conducted. 230 9th and 11th graders participated in a survey using the Centers for Disease Control and Prevention's self-administered Youth Risk Behavior Survey. The sample was composed of 62% females and 38% males, aged 13-18 years. It was found that 29% had engaged in sexual intercourse; among these, 13% were 9th graders and 43% were 11th graders. Increasing age and male gender were significantly correlated with past sexual activity. Older males have more prevalent sexual activity than older females, while younger adolescents showed no gender differences. Male gender was significantly associated with early age of initiation of intercourse. Furthermore, 48% reported using contraception during their last sexual encounter, of which 63% used an effective method (condom, oral contraception, withdrawal) and 37% used a method of low or unknown efficacy. Use of alcohol prior to the last sexual intercourse accounted for 14%. The majority of the participants had discussed or received information on HIV infection at school (92%) or from family (77%). Results showed unmet health needs of the adolescent groups and lower frequency of contraceptive use. PMID:10195806
Blake, Kelly D; Chou, Wen-Ying Sylvia; Prestin, Abby
Background Recent eHealth developments have elevated the importance of assessing the extent to which technology has empowered patients and improved health, particularly among the most vulnerable populations. With noted disparities across racial and social groups in chronic health outcomes, such as cancer, obesity, and diabetes, it is essential that researchers examine any differences in the implementation, uptake, and impact of eHealth strategies across groups that bear a disproportionate burden of disease. Objective The goal was to examine eHealth use by sociodemographic factors, such as race/ethnicity, socioeconomic status (SES), age, and sex. Methods We drew data from National Cancer Institute’s 2012 Health Information National Trends Survey (HINTS) (N=3959) which is publicly available online. We estimated multivariable logistic regression models to assess sociodemographic predictors of eHealth use among adult Internet users (N=2358) across 3 health communication domains (health care, health information–seeking, and user-generated content/sharing). Results Among online adults, we saw no evidence of a digital use divide by race/ethnicity. However, there were significant differences in use by SES, particularly for health care and health information–seeking items. Patients with lower levels of education had significantly lower odds of going online to look for a health care provider (high school or less: OR 0.50, 95% CI 0.33-0.76) using email or the Internet to communicate with a doctor (high school or less: OR 0.46, 95% CI 0.29-0.72), tracking their personal health information online (high school or less: OR 0.53, 95% CI 0.32-0.84), using a website to help track diet, weight, and physical activity (high school or less: OR 0.64, 95% CI 0.42-0.98; some college: OR 0.67, 95% CI 0.49-0.93), or downloading health information to a mobile device (some college: OR 0.54, 95% CI 0.33-0.89). Being female was a consistent predictor of eHealth use across health care and
Background Little is known about the time spent on specific health related activities by older adult informal carers who assist people with chronic illness. Research has not yet addressed the association between carer health status and their care demands. Such information could inform policy and health system efforts to manage chronic illness. Methods We conducted an Australia wide survey using recall questionnaires to record time use. The study asked how much time is spent on “most days” for the most common activities like taking medication, self-treatment and testing, and how much time in the last month on less common activities like attending a physician or shopping associated with health needs. The survey was mailed to 5,000 members of National Seniors Australia; 2,500 registrants on the National Diabetes Services Scheme; and 3,100 members of the Australian Lung Foundation. A total of 2519 people responded, including 313 people who identified as informal carers. Statistical analysis was undertaken using Stata 11. Standard errors and confidence intervals were derived using bootstrapping techniques within Stata 11. Results Most carers (96.2%) had chronic illness themselves, and those with greater numbers of chronic illnesses were those who faced the greatest overall time demands. The top decile of carers devoted between 8.5 and 10 hours a day to personal and caring health related activities. Informal carers with chronic illness spent more time managing their own health than people with chronic illness who were not informal carers. These carers spent more time on caring for others than on caring for their own health. High levels of caring responsibility were associated with poorer reported carer health. Conclusions Policy and health care services will need to adapt to recognise and reduce the time burden on carers who themselves have chronic illness. More carefully targeted investment in the social infrastructure of formal care would free up carers for other
The Continuing Survey Of Food Intakes By Individuals (CSFII) And The Diet And Health Knowledge Survey (DHKS), popularly known as the What We Eat in America Survey, were conducted by the Agricultural Research Service (ARS) of the U.S. Department of Agriculture (USDA). The CSFII 19...
Shaikh, Simran; Mburu, Gitau; Arumugam, Viswanathan; Mattipalli, Naveen; Aher, Abhina; Mehta, Sonal; Robertson, James
Introduction Transgender populations face inequalities in access to HIV, health and social services. In addition, there is limited documentation of models for providing appropriately tailored services and social support for transgender populations in low- and middle-income countries. This paper presents outcomes of the Global Fund-supported Pehchan programme, which aimed to strengthen community systems and provide HIV, health, legal and social services to transgender communities across 18 Indian states through a rights-based empowerment approach. Methods We used a pre- and post-intervention cross-sectional survey design with retrospective analysis of programmatic data. Using stratified sampling, we identified 268 transgender participants in six Indian states from a total of 48,280 transgender people served by Pehchan through 186 community-based organizations. We quantified the impact of interventions by comparing baseline and end line indicators of accessed health social and legal services. We also assessed end line self-efficacy and collective action with regard to social support networks. Results There were significant increases in community-based demand and use of tailored health, legal, social and psychological services over the time of the Pehchan programme. We report significant increases in access to condoms (12.5%, p<0.001) and condom use at last anal sex with both regular (18.1%, p<0.001) and casual (8.1%, p<0.001) male partners. Access to HIV outreach education and testing and counselling services significantly increased (20.10%, p<0.001; 33.7%, p<0.001). In addition, significant increases in access to emergency crisis response (19.7%, p<0.001), legal support (26.8%, p<0.001) and mental health services (33.0%, p<0.001) were identified. Finally, we note that the Pehchan programme successfully provided a platform for the formation, collectivization and visibility of peer support groups. Conclusions The Pehchan programme's community involvement, rights
Mostofsky, Elizabeth; Mukamal, Kenneth J.; Giovannucci, Ed L.; Stampfer, Meir J.
Objectives. To review critical contributions from the Nurses’ Health Study (NHS) on alcohol consumption and health outcomes. Methods. We performed a narrative review of NHS (1980–2012) and NHS II (1989–2011) publications. Results. Using detailed information on self-reported alcohol drinking patterns obtained approximately every 4 years combined with extensive information on diet, lifestyle habits, and physician-diagnosed health conditions, NHS investigators have prospectively examined the risks and benefits associated with alcohol consumption. Moderate intake, defined as up to 1 drink a day, is associated with a lower risk of hypertension, myocardial infarction, stroke, sudden cardiac death, gallstones, cognitive decline, and all-cause mortality. However, even moderate intake places women at higher risk for breast cancer and bone fractures, and higher intake increases risk for colon polyps and colon cancer. Conclusions. Regular alcohol intake has both risks and benefits. In analyses using repeated assessments of alcohol over time and deaths from all causes, women with low to moderate intake and regular frequency (> 3 days/week) had the lowest risk of mortality compared with abstainers and women who consumed substantially more than 1 drink per day. PMID:27459455
Steyerberg, E.W.; Eijkemans, M.J.C.; Dippel, D.W.J.; Scholte Op Reimer, W.J.M.; Van Houwelingen, H.C.
Background: Measuring quality of care and ranking hospitals with outcome measures poses two major methodological challenges: case-mix adjustment and variation that exists by chance. Aim: To compare methods for comparing and ranking hospitals that considers these. Methods: The Netherlands Stroke Survey was conducted in 10 hospitals in the Netherlands, between October 2002 and May 2003, with prospective and consecutive enrolment of patients with acute brain ischaemia. Poor outcome was defined as death or disability after 1 year (modified Rankin scale of ⩾3). We calculated fixed and random hospital effects on poor outcome, unadjusted and adjusted for patient characteristics. We compared the hospitals using the expected rank, a novel statistical measure incorporating the magnitude and the uncertainty of differences in outcome. Results: At 1 year after stroke, 268 of the total 505 patients (53%) had a poor outcome. There were substantial differences in outcome between hospitals in unadjusted analysis (χ2 = 48, 9 df, P < 0.0001). Adjustment for 12 confounders led to halving of the χ2 (χ2 = 24). The same pattern was observed in random effects analysis. Estimated performance of individual hospitals changed considerably between unadjusted and adjusted analysis. Further changes were seen with random effect estimation, especially for smaller hospitals. Ordering by expected rank led to shrinkage of the original ranks of 1–10 towards the median rank of 5.5 and to a different order of the hospitals, compared to ranking based on fixed effects. Conclusion: In comparing and ranking hospitals, case-mix-adjusted random effect estimates and the expected ranks are more robust alternatives to traditional fixed effect estimates and simple rankings. PMID:20008321
Mann, David R; Honeycutt, Todd
Disability status-experiencing a functional limitation caused by a health condition-is dynamic throughout the life cycle, even during adolescence and young adulthood. We use data from the 1997 cohort of the National Longitudinal Survey of Youth to better understand these dynamics, examining how health condition and limitation statuses evolve during adolescence and young adulthood as well as how changes in these characteristics are related to survey nonresponse and attrition. Health condition and limitation dynamics are evident in our data: the proportion of sample members who reported having a limitation in their activities for any interview increased from approximately 12 % during the initial interview (when sample members were 12 to 17 years old) to almost 25 % 13 years later. Multivariate analyses revealed that women are more likely than men to report changes in health condition or limitation status. Those with mild limitations were relatively less likely than those without limitations or with severe limitations to experience changes in limitation status. Somewhat surprisingly, a survival analysis of survey participation outcomes found limited correlation among health conditions, limitations, and either missing a survey interview for the first time or permanently leaving the survey sample. PMID:27083196
Edwards, D; Burnard, P; Coyle, D; Fothergill, A; Hannigan, B
The All-Wales Community Mental Health Nurse Stress Study was the largest study undertaken in the UK to date to investigate stress, burnout and coping amongst the CMHN workforce. The aim of the study was to examine the variety, frequency and severity of stressors, to describe coping strategies used to reduce work-based stress, and to determine stress outcomes. Questionnaires were sent out to 614 CMHNs from ten NHS Trusts throughout Wales. The response rate was 49% (n = 301). The measures used included the Maslach Human Services Survey, the CPN Stress Questionnaire, the Psychnurse Methods of Coping Questionnaire, the Rosenberg Self-Esteem Scale and the General Health Questionnaire GHQ-12. Community mental health nurses indicated that trying to maintain a good quality service in the midst of long waiting lists, poor resources, and having too many interruptions while trying to work in the office were particularly stressful items. The coping strategies that CMHNs utilized the most were having a stable home life and looking forward to going home at the end of the day, having outside interests and hobbies and talking to people that they got on well with. Forty per cent of CMHNs tended to view themselves negatively, feeling that others did not hold much respect for them. The GHQ-12 measure indicated that 35% of CMHNs had crossed a threshold of psychiatric caseness. Measured against a normative sample of mental health workers, 51% of CMHNs were experiencing high levels of long-term emotional exhaustion. Twenty-four per cent were suffering from high levels of depersonalization burnout and were not relating well to clients, whilst 14% were experiencing severe long-term feelings of lack of personal accomplishment. The results from the study provided us with a picture of stress and coping in CMHNs in Wales. Addressing these factors may help to reduce levels of experienced stress and burnout. PMID:11933511
Han, Xuesong; Nguyen, Binh T.; Drope, Jeffrey; Jemal, Ahmedin
Introduction States’ decisions not to expand Medicaid under the Affordable Care Act (ACA) could potentially affect access to care and health status among their low-income residents. Methods The 2010–2012 nationally representative Medical Expenditure Panel Survey data were analyzed in 2015 to compare 9755 low-income adults aged 18–64 years from Medicaid-expanding states with 7455 adults from nonexpanding states. Multivariate logistic regression models were fitted to evaluate the differences in access to care, receipt of preventive services, quality of care, attitudes about health and self-reported health status by Medicaid expansion status. The differences in care utilization and medical expenditures between the two groups were examined using a 2-part modeling approach. Results Compared to their counterparts in Medicaid expansion states, low income adults in the nonexpanding states were more likely to be black and reside in rural areas and were less likely to have a usual source of care (prevalence ratio[PR] 0.86, 95% confidence interval[CI] 0.82–0.91) and recommended preventive services such as dental checkups (PR = 0.86; CI = 0.79–0.94), routine checks (PR = 0.89; CI = 0.83–0.95), flu vaccinations (PR = 0.89; CI = 0.81–0.98), and blood pressure checks (PR = 0.96; CI = 0.94–0.99). They also had less care utilization, fewer prescriptions, and less medical expenditures, but more out-of-pocket expenditures (all p-value <0.05). Conclusions Low-income adults in Medicaid nonexpanding states, who are disproportionately represented by blacks and rural residents, were worse off for multiple health-related outcomes compared to their counterparts in Medicaid expanding states at the baseline of ACA implementation, suggesting that low income adults residing in nonexpanding states may benefit markedly from the expansion of Medicaid. PMID:26720311
Mbuagbaw, Lawrence; Medley, Nancy; Darzi, Andrea J; Richardson, Marty; Habiba Garga, Kesso; Ongolo-Zogo, Pierre
Background The World Health Organization (WHO) recommends at least four antenatal care (ANC) visits for all pregnant women. Almost half of pregnant women worldwide, and especially in developing countries do not receive this amount of care. Poor attendance of ANC is associated with delivery of low birthweight babies and more neonatal deaths. ANC may include education on nutrition, potential problems with pregnancy or childbirth, child care and prevention or detection of disease during pregnancy. This review focused on community-based interventions and health systems-related interventions. Objectives To assess the effects of health system and community interventions for improving coverage of antenatal care and other perinatal health outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2015) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials (RCTs), quasi-randomised trials and cluster-randomised trials. Trials of any interventions to improve ANC coverage were eligible for inclusion. Trials were also eligible if they targeted specific and related outcomes, such as maternal or perinatal death, but also reported ANC coverage. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Main results We included 34 trials involving approximately 400,000 women. Some trials tested community-based interventions to improve uptake of antenatal care (media campaigns, education or financial incentives for pregnant women), while other trials looked at health systems interventions (home visits for pregnant women or equipment for clinics). Most trials took place in low- and middle-income countries, and 29 of the 34 trials used a cluster-randomised design. We assessed 30 of the 34 trials as of low or unclear overall risk of bias. Comparison 1: One intervention versus no intervention We
Wheatcroft, M. G.; Klimt, C. R.
This report presents the results of an oral health survey of 4324 individuals in three villages near Cairo, Egypt. The results show that the incidence of dental decay (expressed as the number of carious teeth per individual) in this group of Egyptians was lower than that reported for the over-all population of the USA, and that the prevalence of periodontal disease in the group studied was about three times as high as that reported in the USA. There was a statistically significant relationship between the occurrence of asymptomatic enlargement of the parotid glands and the occurrence of angular cheilosis in the same individuals. Other forms of oral disease were observed infrequently. Water samples from the survey area were assayed for fluorides and were shown to contain fluoride levels below that considered to give protection against dental caries. PMID:13638795
Sacker, A.; Clarke, P.; Wiggins, R.; Bartley, M.
Objectives: To study how social inequalities change as people age, this paper presents a growth curve model of self assessed health, which accommodates changes in occupational class and individual health with age. Design: Nationally representative interview based longitudinal survey of adults in Great Britain. Setting: Representative members of private households of Great Britain in 1991. Participants: Survey respondents (n = 6705), aged 21–59 years in 1991 and followed up annually until 2001. Main outcome measure: Self assessed health. Results: On average, self assessed health declines slowly from early adulthood to retirement age. No significant class differences in health were observed at age 21. Health inequalities emerged later in life with the gap between mean levels of self assessed health of those in managerial and professional occupations and routine occupations widening approaching retirement. Individual variability in health trajectories increased between ages 40 and 59 years so that this widening of mean differences between occupational classes was not significant. When the analysis is confined to people whose occupational class remained constant over time, a far greater difference in health trajectories between occupational classes was seen. Conclusions: The understanding of social inequalities in health at the population level is enriched by an analysis of individual variation in age related declines by social position. PMID:15911646
Ziebland, Sue; Valderas, Jose; Lupiáñez-Villanueva, Francisco
Background The production of health information has begun to shift from commercial organizations to health care users themselves. People increasingly go online to share their own health and illness experiences and to access information others have posted, but this behavior has not been investigated at a population level in the United Kingdom. Objective This study aims to explore access and production of user-generated health content among UK Internet users and to investigate relationships between frequency of use and other variables. Methods We undertook an online survey of 1000 UK Internet users. Descriptive and multivariate statistical analyses were used to interpret the data. Results Nearly one-quarter of respondents (23.7%, 237/1000) reported accessing and sharing user-generated health content online, whereas more than 20% (22.2%, 222/1000) were unaware that it was possible to do this. Respondents could be divided into 3 groups based on frequency of use: rare users (78.7%, 612/778) who accessed and shared content less than weekly, users (13.9%, 108/778) who did so weekly, and superusers (7.5%, 58/778) who did so on a daily basis. Superusers were more likely to be male (P<.001) and to be employed (P<.001), but there were no differences between the groups with respect to educational level (P=.99) or health status (P=.63). They were more likely to use the Internet for varied purposes such as banking and shopping (P<.001). Conclusions Although this study found reasonably widespread access of user-generated online health content, only a minority of respondents reported doing so frequently. As this type of content proliferates, superusers are likely to shape the health information that others access. Further research should assess the effect of user-generated online content on health outcomes and use of health services by Internet users. PMID:24784798
Lee, Soo; Knight, Denise
This article reports on a survey of district nurses' involvement in mental health interventions in one county. Seventy-nine questionnaires were sent and 46 were returned. Descriptive analysis was carried out using statistical software. The DNs reported encountering a wide range of mental health issues and interventions in practice: dementia, anxiety and depression featured highly. Over half (55%) of the respondents reported involvement in bereavement counselling, and 28% and 23% of respondents reported encountering anxiety management, and problem solving and alcohol advice respectively. A large proportion, however, reported no involvement in mental health interventions. Among the psychiatric professionals, district nurses tended to have most frequent contacts with social workers. GPs were the most likely person to whom DNs made referrals, followed by community psychiatric nurses. Despite the apparent awareness of the values of psychosocial interventions, DNs were equally influenced by the medical model of treatment. In order to realize the potential contribution of district nurses in mental health interventions, there is a need for primary care teams to foster a closer working relationship with mental health specialist services. PMID:16723902
Spitz, A. J. W.
Adequate knowledge of existing health and morbidity conditions is the basis for all planning of future health services. For this reason, a health and morbidity survey of the population of the Seychelles was carried out in 1956-57 under the joint auspices of the Seychelles Government and the World Health Organization. Statistical sampling methods were used and the information was obtained by the household interview method. Health, morbidity and relevant demographic data were thus disclosed for the first time for Seychelles. Basic information was obtained on: general morbidity of the population, including dental and nutritional status, malnutrition, incidence of intestinal diseases and other easily diagnosable conditions; growth and weight curves of children up to the age of 16; haemoglobin levels; erythrocyte sedimentation rates; general living conditions such as housing and overcrowding, social status and latrine arrangements; the connexion of soil pollution with the incidence of amoebiasis and helminthiasis; and lastly, the incidence of the sickle cell trait, eosinophilia and positive serological reactions to the Chediak test (for manifest or latent syphilis). The findings are presented with a minimum of remarks and interpretation. PMID:13833401
Moss, N; Stone, M C; Smith, J B
The purpose of this study was to investigate the effect of international migration, including refugee status, upon child health outcomes. Data were drawn from a survey conducted in 1989 in three settlements in Belize, Central America, that have a high proportion of refugees and economic immigrants living side-by-side with the local population. In two of the settlements, the entire population of mothers with children under 6 was interviewed; in the third settlement a two-thirds random sample was interviewed. Health history data were obtained for 255 children of 134 mothers, from whom sociodemographic data were also collected. The majority of children were born to Salvadoran or Guatemalan mothers, but native and naturalized Belizeans in the survey communities were included for comparison purposes. Migration, the exposure variable, was characterized by mother's residency/refugee legal status, nationality, and duration of time in country. Socioeconomic and proximate control variables were included as suggested by the Mosley-Chen framework. Despite normal birthweight averaging 3374 g, a large proportion of children are at the lowest percentiles of the weight-for-age curves (44% below the tenth percentile for the international reference population). A high incidence of diarrheal and respiratory illnesses (30% and 47% of children, respectively, having frequent episodes), and 50% of children with measles vaccination appropriate for age, indicate a population with high potential morbidity. Logistic regression was used to model the effects of migration on weight-for-age and frequency of diarrheal and respiratory tract episodes independent of socioeconomic and proximate factors, as suggested by the Mosley-Chen framework.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1738869
Anderson, Paul J; Wang, Zhen; Beebe, Timothy J; Murad, Mohammad Hassan
Objectives Regular exercise is a key component of obesity prevention and 48% of Americans do not meet minimum guidelines for weekly exercise. Social support has been shown to help individuals start and maintain exercise programmes. We evaluated social support among endurance athletes and explored the relationship between social support for exercise, health behaviours and health status. Design Survey. Setting The largest Nordic ski race in North America. Participants 5433 past participants responded to an online questionnaire. Outcome measures Social support, health behaviours and health status. Results The mean overall support score was 32.1 (SD=16.5; possible range=−16.0 to 88.0). The most common forms of social support were verbal such as discussing exercise, invitations to exercise and celebrating the enjoyment of exercise. We found that an increase of 10 points in the social support score was associated with a 5 min increase in weekly self-reported exercise (5.02, 95% CI 3.63 to 6.41). Conclusions Physical activity recommendations should incorporate the importance of participation in group activities, especially those connected to strong fitness cultures created by community and competitive events. PMID:27338876
Chabot, Marion Johnson; And Others
This overview of health and illness among children and youth in the United States is based on national studies conducted between 1963 and 1972. Major sources of data were four on-going surveys of health conducted by the National Center for Health Statistics (DHEW): (1) the health interview survey relies on household interviews for information on…
Coates, Hamish; Edwards, Daniel
The development of a strong and vibrant knowledge-based economy is linked in direct ways with successful graduate outcomes. Building evidence-based insights on such outcomes plays an important role in shaping planning and practice. With this broad objective in mind, this article analyses findings from the Graduate Pathways Survey, the first…
Liemburg, Edith J.; Castelein, Stynke; van Es, Frank; Scholte-Stalenhoef, Anne Neeltje; van de Willige, Gerard; Smid, Henderikus; Visser, Ellen; Knegtering, Henderikus; Bruggeman, Richard
Psychotic disorders are among the most complex medical conditions. Longitudinal cohort studies may offer further insight into determinants of functional outcome after a psychotic episode. This paper describes the Psychosis Recent Onset in GRoningen Survey (PROGR-S) that currently contains data on 1076 early-episode patients with psychosis, including symptoms, personality, cognition, life events and other outcome determinants. Our goal in this report is to give an overview of PROGR-S, as a point of reference for future publications on the effect of cognition, personality and psychosocial functioning on outcomes. PROGR-S contains an extensive, diagnostic battery including anamnesis, biography, socio-demographic characteristics, clinical status, drug use, neuropsychological assessment, personality questionnaires, and physical status tests. Extensive follow-up data is available on psychopathology, physical condition, medication use, and care consumption. Sample characteristics were determined and related to existing literature. PROGR-S (period 1997–2009, n = 718) included the majority of the expected referrals in the catchment area. The average age was 27 (SD = 8.6) and two-thirds were male. The average IQ was lower than that in the healthy control group. The majority had been diagnosed with a psychotic spectrum disorder. A substantial number of the patients had depressive symptoms (479/718, 78%) and current cannabis or alcohol use (465/718, 75%). The level of community functioning was moderate, i.e. most patients were not in a relationship and were unemployed. The PROGR-S database contains a valuable cohort to study a range of aspects related to symptomatic and functional outcomes of recent onset psychosis, which may play a role in the treatment of this complex and disabling disorder. Results reported here show interesting starting points for future research. Thus, we aim to investigate long-term outcomes on the basis of cognition, personality, negative
Coelho, Ken Russell; Galan, Chardee
Recent empirical findings document the role of nonverbal communication in cross-cultural interactions. As ethnic minority health disparities in the United States continue to persist, physician competence in this area is important. We examine physicians' abilities to decode nonverbal emotions across cultures, our hypothesis being that there is a relationship between physicians' skill in this area and their patients' satisfaction and outcomes. First part tested Caucasian and South Asian physicians' cross-cultural emotional recognition ability. Physicians completed a fully balanced forced multiple-choice test of decoding accuracy judging emotions based on facial expressions and vocal tones. In the second part, patients reported on satisfaction and health outcomes with their physicians using a survey. Scores from the patient survey were correlated with scores from the physician decoding accuracy test. Physicians, regardless of their ethnicity, were more accurate at rating Caucasian faces and vocal tones. South Asian physicians were no better at decoding the facial expressions or vocal tones of South Asian patients, who were also less likely to be satisfied with the quality of care provided by their physicians and to adhere to their physicians' recommendations. Implications include the development of cultural sensitivity training programs in medical schools, continuing medical education and public health programs. PMID:22792459
Saxena, Deepak; Vangani, Ruchi; Mavalankar, Dileep V.; Thomsen, Sarah
Background Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Methods Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3) carried out during 2007–2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes – Institutional delivery, antenatal care (ANC), and use of modern contraception – and selected intermediary and structural determinants of health using multiple logistic regression. Results Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Discussion and conclusions Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste) has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic education and
Kesselheim, Aaron S; Huybrechts, Krista F; Choudhry, Niteesh K; Fulchino, Lisa A; Isaman, Danielle L; Kowal, Mary K; Brennan, Troyen A
Previous reviews have shown that changes in prescription drug insurance benefits can affect medication use and adherence. We conducted a systematic review of the literature to identify studies addressing the association between prescription drug coverage and health outcomes. Studies were included if they collected empirical data on expansions or restrictions of prescription drug coverage and if they reported clinical outcomes. We found 23 studies demonstrating that broader prescription drug insurance reduces use of other health care services and has a positive impact on patient outcomes. Coverage gaps or caps on drug insurance generally led to worse outcomes. States should consider implementing the Affordable Care Act expansions in drug coverage to improve the health of low-income patients receiving state-based health insurance. PMID:25521879
Tsuchiya, Aki; Dolan, Paul
When deciding how to weigh benefits to different groups, standard economic models assume that people focus on the final distribution of utility, health or whatever. Thus, an egalitarian is assumed to be an egalitarian in the outcome space. But what about egalitarianism in the gains space, such that people focus instead on how equally benefits are distributed? This paper reports on a study in which members of the public were asked to rank a number of health programmes that differed in the distribution of benefits and final outcomes in ways that enabled us to distinguish between different types of egalitarianism. The results suggest that outcome egalitarianism dominates, particularly for differences in health by social class, but a sizeable minority of respondents appear to be gain egalitarians, especially when the health differences are by sex. These results have important implications for how we think about outcome-based social welfare functions in economics. PMID:18484571
Zendjidjian, Xavier Y.; Boyer, Laurent
Patient-reported outcomes (PROs) are increasingly important in health care and mental health research. Furthermore, caregivers become partners in care for patients with mental disorders, and health workers are more attentive to the expectations and needs of caregivers. A number of outcomes for caregivers are measured and used in daily practice in order to promote actions to improve health care systems and progress in research on the impact of mental disorders on their caregivers. This paper proposes an inventory of the different outcomes and different measurement tools used to assess the impact of disorders, raising a number of methodological and conceptual issues that limit the relevance of measurement tools and complicate their use. Finally, we propose some recommendations promoting the development of relevant outcome measures for caregivers and their integration into current systems of care. PMID:25152655
Riley, William T.; Pilkonis, Paul; Cella, David
Background The Patient-Reported Outcomes Measurement Information System (PROMIS) is a National Institutes of Health initiative to develop item banks measuring patient-reported outcomes (PROs) and to create and make available a computerized adaptive testing system (CAT) that allows for efficient and precise assessment of PROs in clinical research and practice. Aims of the Study Based on the presentation from a symposium on “Evidence-based Outcomes in Psychiatry: Updates on Measurement Using Patient-Reported Outcomes (PRO)” at the 2011 American Psychiatry Association Convention, this paper provides an overview of PROMIS and its application to mental health research. Methods The PROMIS methodology for item bank development and testing is described, with a focus on the implications of this work for mental health research. Results Utilizing qualitative item review and state-of-the-art applications of item response theory (IRT), PROMIS investigators have developed, tested, and released item banks measuring physical, mental, and social health components. Ongoing efforts continue to add new item banks and further validate existing banks. Discussion PROMIS provides item banks measuring several domains of interest to mental health researchers including emotional distress, social function, and sleep. PROMIS methodology also provides a rigorous standard for the development of new mental health measures. Implications for Health Care Provision Web-based CAT or administration of short forms derived from PROMIS item banks provide efficient and precise dimensional estimates of clinical outcomes that can be utilized to monitor patient progress and assess quality improvement. Implications for Future Research Use of the dimensional PROMIS metrics (and co-calibration of the PROMIS item banks with existing PROs) will allow comparisons of mental health and related health outcomes across disorders and studies. PMID:22345362
Pantalone, David W.; Hessler, Danielle M.; Simoni, Jane M.
Objective: We examined mental health pathways between interpersonal violence (IPV) and health-related outcomes in HIV-positive sexual minority men engaged with medical care. Method: HIV-positive gay and bisexual men (N = 178) were recruited for this cross-sectional study from 2 public HIV primary care clinics that treated outpatients in an urban…
Murphy, J Michael; Guzmán, Javier; McCarthy, Alyssa E; Squicciarini, Ana María; George, Myriam; Canenguez, Katia M; Dunn, Erin C; Baer, Lee; Simonsohn, Ariela; Smoller, Jordan W; Jellinek, Michael S
The world's largest school-based mental health program, Habilidades para la Vida [Skills for Life (SFL)], has been operating on a national scale in Chile for 15 years. SFL's activities include using standardized measures to screen elementary school students and providing preventive workshops to students at risk for mental health problems. This paper used SFL's data on 37,397 students who were in first grade in 2009 and third grade in 2011 to ascertain whether first grade mental health predicted subsequent academic achievement and whether remission of mental health problems predicted improved academic outcomes. Results showed that mental health was a significant predictor of future academic performance and that, overall, students whose mental health improved between first and third grade made better academic progress than students whose mental health did not improve or worsened. Our findings suggest that school-based mental health programs like SFL may help improve students' academic outcomes. PMID:24771270
Murphy, J. Michael; Guzmán, Javier; McCarthy, Alyssa; Squicciarini, Ana María; George, Myriam; Canenguez, Katia; Dunn, Erin C.; Baer, Lee; Simonsohn, Ariela; Smoller, Jordan W.; Jellinek, Michael
The world’s largest school-based mental health program, Habilidades para la Vida [Skills for Life, SFL], has been operating at a national scale in Chile for fifteen years. SFL’s activities include using standardized measures to screen elementary school students and providing preventive workshops to students at risk for mental health problems. This paper used SFL’s data on 37,397 students who were in first grade in 2009 and third grade in 2011 to ascertain whether first grade mental health predicted subsequent academic achievement and whether remission of mental health problems predicted improved academic outcomes. Results showed that mental health was a significant predictor of future academic performance and that, overall, students whose mental health improved between first and third grade made better academic progress than students whose mental health did not improve or worsened. Our findings suggest that school-based mental health programs like SFL may help improve students’ academic outcomes. PMID:24771270
Vinikoor-Imler, L C; Messer, L C; Evenson, K R; Laraia, B A
Women residing in neighborhoods of low socioeconomic status are more likely to experience adverse reproductive outcomes; however, few studies explore which specific neighborhood features are associated with poor maternal health behaviors and pregnancy outcomes. Based upon our conceptual model, directly observed street-level data from four North Carolina US counties were used to create five neighborhood indices: physical incivilities (neighborhood degradation), social spaces (public space for socializing), walkability (walkable neighborhoods), borders (property boundaries), and arterial features (traffic safety). Singleton birth records (2001-2005) were obtained from the North Carolina State Center for Vital Statistics and maternal health behavior information (smoking, inadequate or excessive weight gain) and pregnancy outcomes (pregnancy-induced hypertension/pre-eclampsia, low birthweight, preterm birth) were abstracted. Race-stratified random effect models were used to estimate associations between neighborhood indices and women's reproductive behaviors and outcomes. In adjusted models, higher amounts of physical incivilities were positively associated with maternal smoking and inadequate weight gain, while walkability was associated with lower odds of these maternal health behaviors. Social spaces were also associated with inadequate weight gain during pregnancy. Among pregnancy outcomes, high levels of physical incivilities were consistently associated with all adverse pregnancy outcomes, and high levels of walkability were inversely associated with pregnancy-induced hypertension and preterm birth for Non-Hispanic white women only. None of the indices were associated with adverse birth outcomes for Non-Hispanic black women. In conclusion, certain neighborhood conditions were associated with maternal health behaviors and pregnancy outcomes. PMID:21920650
Madkour, Aubrey S.; Xie, Yiqiong; Harville, Emily W.
Background: Adverse birth outcomes are more common among adolescent versus adult mothers, but little is known about school-based services that may improve birth outcomes in this group. Methods: Data from Waves I and IV of the National Longitudinal Study of Adolescent Health were analyzed. Girls and women who gave birth to singleton live infants…
Willinsky, John; Maggio, Lauren
Background In 2008, the National Institutes of Health (NIH) Public Access Policy mandated open access for publications resulting from NIH funding (following a 12-month embargo). The large increase in access to research that will take place in the years to come has potential implications for evidence-based practice (EBP) and lifelong learning for health personnel. Objective This study assesses health personnel’s current use of research to establish whether grounds exist for expecting, preparing for, and further measuring the impact of the NIH Public Access Policy on health care quality and outcomes in light of time constraints and existing information resources. Methods In all, 14 interviews and 90 surveys of health personnel were conducted at a community-based clinic and an independent teaching hospital in 2010. Health personnel were asked about the research sources they consulted and the frequency with which they consulted these sources, as well as motivation and search strategies used to locate articles, perceived level of access to research, and knowledge of the NIH Public Access Policy. Results In terms of current access to health information, 65% (57/88) of the health personnel reported being satisfied, while 32% (28/88) reported feeling underserved. Among the sources health personnel reported that they relied upon and consulted weekly, 83% (73/88) reported turning to colleagues, 77% (67/87) reported using synthesized information resources (eg, UpToDate and Cochrane Systematic Reviews), while 32% (28/88) reported that they consulted primary research literature. The dominant resources health personnel consulted when actively searching for health information were Google and Wikipedia, while 27% (24/89) reported using PubMed weekly. The most prevalent reason given for accessing research on a weekly basis, reported by 35% (31/88) of survey respondents, was to help a specific patient, while 31% (26/84) were motivated by general interest in research. Conclusions
This article presents summary statistics gathered from the 1998 Nicaragua Demographic and Health Survey (Encuesta Nicaraguense de Demografia y Salud 1998, ENDESA-98). Data from the nationally representative ENDESA-98 were collected from 11,528 households. Interviews were conducted with 13,634 women aged 15-49 years and 2912 men aged 15-59 years between December 1, 1997, and May 31, 1998. The statistics presented were on fertility trends, fertility differentials, age-specific fertility, fertility preferences, current contraceptive use, contraception, marital and contraceptive status, differentials in median age at first birth, postpartum variables, and infant mortality. In addition, statistical data on the health and nutritional status of children were also presented. PMID:10907282
Delgado, Irebert R.; Dempsey, Paula J.; Simon, Donald L.
A brief review is presented on the state-of-the-art in rotorcraft engine health monitoring technologies including summaries on current practices in the area of sensors, data acquisition, monitoring and analysis. Also, presented are guidelines for verification and validation of Health Usage Monitoring System (HUMS) and specifically for maintenance credits to extend part life. Finally, a number of new efforts in HUMS are summarized as well as lessons learned and future challenges. In particular, gaps are identified to supporting maintenance credits to extend rotorcraft engine part life. A number of data sources were consulted and include results from a survey from the HUMS community, Society of Automotive Engineers (SAE) documents, American Helicopter Society (AHS) papers, as well as references from Defence Science & Technology Organization (DSTO), Civil Aviation Authority (CAA), and Federal Aviation Administration (FAA).
Macnee, Carol L; Edwards, Joellen; Kaplan, Amy; Reed, Sue; Bradford, Susanne; Walls, Jennie; Schaller-Ayers, Jennifer M
This study evaluated the accomplishment of the Nursing Outcomes Classification (NOC) outcome "Health Seeking Behavior" in 5 nurse-managed clinics. Nurse practitioners and registered nurses rated patients on 11 indicators of health seeking behaviors, and recorded their level of knowledge of the patient. A total of 556 evaluations were collected. Health seeking behavior scores were lowest in a rural county school-based clinic and highest in a federally qualified health center. Ratings increased with nurses' knowledge of patients and for older patients. PMID:16816605
Taylor, Yhenneko J; Nies, Mary A
Improving maternal and child health is a key objective of the United Nations' Millennium Development Goals and the Healthy People goals for improving the health of Americans. Government initiatives are important particularly for reducing disparities that affect disadvantaged populations. Head Start, Healthy Start, WIC and Medicaid are four federal programs that target disparities in maternal and child health outcomes. This paper reviews recent evaluations of these programs to identify outcomes assessed and opportunities for further evaluation of these programs. We conducted a review of recent evaluation studies assessing the impact of four maternal and child health programs on a health or healthcare outcome. Sources for published literature included the PubMed, Academic Search Complete, CINAHL and PsycInfo databases. Titles and abstracts of studies were examined to determine if they met inclusion criteria. Included studies were categorized by type of outcome examined. Twenty peer-reviewed studies published between January 2006 and June 2011 met inclusion criteria. The majority of studies examined infant outcomes (11), followed by breastfeeding/nutrition (4), maternal health (3), and unintended pregnancy (2). Measures used were consistent across studies; however, findings on the impact of programs were mixed reflecting differences in selection of comparison group, data source and statistical methods. The impact of maternal and child health programs may vary by setting and population served, but inconclusive findings remain. Health service researchers can build upon current evaluations to increase our understanding of what works, help target resources, and improve evaluation of programs in the future. PMID:22729661
Lavallee, Danielle C; Chenok, Kate E; Love, Rebecca M; Petersen, Carolyn; Holve, Erin; Segal, Courtney D; Franklin, Patricia D
The provision of patient-centered care requires a health care environment that fosters engagement between patients and their health care team. One way to encourage patient-centered care is to incorporate patient-reported outcomes into clinical settings. Collecting these outcomes in routine care ensures that important information only the patient can provide is captured. This provides insights into patients' experiences of symptoms, quality of life, and functioning; values and preferences; and goals for health care. Previously embraced in the research realm, patient-reported outcomes have started to play a role in successful shared decision making, which can enhance the safe and effective delivery of health care. We examine the opportunities for using patient-reported outcomes to enhance care delivery and outcomes as health care information needs and technology platforms change. We highlight emerging practices in which patient-reported outcomes provide value to patients and clinicians and improve care delivery. Finally, we examine present and future challenges to maximizing the use of patient-reported outcomes in the clinic. PMID:27044954
Pillemer, Karl; Fuller-Rowell, Thomas E.; Reid, M. C.; Wells, Nancy M.
Purpose: This study tested the hypothesis that volunteering in environmental organizations in midlife is associated with greater physical activity and improved mental and physical health over a 20-year period. Design and Methods: The study used data from two waves (1974 and 1994) of the Alameda County Study, a longitudinal study of health and…
Fallah, Nader; Park, So Eyun; Dumont, Frédéric S.; Leblond, Jean; Cobb, John; Noreau, Luc
Background: Persons with spinal cord injury (SCI) living in the community have high health care utilization (HCU). To date, the interrelationships among multiple secondary health conditions (multimorbidity due to comorbidities and complications) that drive HCU and their impact on patient outcomes are unknown. Objective: To determine the association among multimorbidity, HCU, health status, and quality of life. Methods: Community-dwelling persons with traumatic SCI participated in an online/phone SCI Community Survey. Participants were grouped using the 7-item HCU questionnaire (group 1 did not receive needed care and/or rehospitalized; group 2 received needed care but rehospitalized; group 3 received needed care and not rehospitalized). Personal, injury, and environmental factors; multimorbidity (presence/absence of 30 comorbidities/ complications); health status (Short Form-12); and quality of life measures (Life Satisfaction-11 first question and single-item quality of life measure) were collected. Associations among these variables were assessed using multivariate analysis. Results: The 1,137 survey participants were divided into 3 groups: group 1 (n = 292), group 2 (n = 194), and group 3 (n = 650). Group 1 had the greatest number of secondary health conditions (15.14 ± 3.86) followed by group 2 (13.60 ± 4.00) and group 3 (12.00 ± 4.16) (P < .05). Multimorbidity and HCU were significant risk factors for having a lower SF-12 Mental (P < .001) and Physical Component Score (P < .001). They in turn were associated with participants reporting a lower quality of life (P < .001, for both questions). Conclusions: Multimorbidity and HCU are interrelated and associated with lower health status, which in turn is associated with lower quality of life. Future work will include the development of a screening tool to identify persons with SCI at risk of inappropriate HCU (eg, rehospitalization, not able to access care), which should lead to better patient outcomes and cost
Elfeddali, Iman; van der Feltz-Cornelis, Christina M; van Os, Jim; Knappe, Susanne; Vieta, Eduard; Wittchen, Hans-Ulrich; Obradors-Tarragó, Carla; Haro, Josep Maria
Within the ROAMER project, which aims to provide a Roadmap for Mental Health Research in Europe, a two-stage Delphi survey among 86 European experts was conducted in order to identify research priorities in clinical mental health research. Expert consensus existed with regard to the importance of three challenges in the field of clinical mental health research: (1) the development of new, safe and effective interventions for mental disorders; (2) understanding the mechanisms of disease in order to be able to develop such new interventions; and (3) defining outcomes (an improved set of outcomes, including alternative outcomes) to use for clinical mental health research evaluation. Proposed actions involved increasing the utilization of tailored approaches (personalized medicine), developing blended eHealth/mHealth decision aids/guidance tools that help the clinician to choose between various treatment modalities, developing specific treatments in order to better target comorbidity and (further) development of biological, psychological and psychopharmacological interventions. The experts indicated that addressing these priorities will result in increased efficacy and impact across Europe; with a high probability of success, given that Europe has important strengths, such as skilled academics and a long research history. Finally, the experts stressed the importance of creating funding and coordinated networking as essential action needed in order to target the variety of challenges in clinical mental health research. PMID:25337940
Elfeddali, Iman; van der Feltz-Cornelis, Christina M.; van Os, Jim; Knappe, Susanne; Vieta, Eduard; Wittchen, Hans-Ulrich; Obradors-Tarragó, Carla; Haro, Josep Maria
Within the ROAMER project, which aims to provide a Roadmap for Mental Health Research in Europe, a two-stage Delphi survey among 86 European experts was conducted in order to identify research priorities in clinical mental health research. Expert consensus existed with regard to the importance of three challenges in the field of clinical mental health research: (1) the development of new, safe and effective interventions for mental disorders; (2) understanding the mechanisms of disease in order to be able to develop such new interventions; and (3) defining outcomes (an improved set of outcomes, including alternative outcomes) to use for clinical mental health research evaluation. Proposed actions involved increasing the utilization of tailored approaches (personalized medicine), developing blended eHealth/mHealth decision aids/guidance tools that help the clinician to choose between various treatment modalities, developing specific treatments in order to better target comorbidity and (further) development of biological, psychological and psychopharmacological interventions. The experts indicated that addressing these priorities will result in increased efficacy and impact across Europe; with a high probability of success, given that Europe has important strengths, such as skilled academics and a long research history. Finally, the experts stressed the importance of creating funding and coordinated networking as essential action needed in order to target the variety of challenges in clinical mental health research. PMID:25337940
Parmar, Divya; Ioannidis, John P A
Objective To systematically identify, critically appraise, and synthesise empirical studies about the impact of the 2008 financial crisis in Europe on health outcomes. Design Systematic literature review. Data sources Structural searches of key databases, healthcare journals, and organisation based websites. Review methods Empirical studies reporting on the impact of the financial crisis on health outcomes in Europe, published from January 2008 to December 2015, were included. All selected studies were assessed for risk of bias. Owing to the heterogeneity of studies in terms of study design and analysis and the use of overlapping datasets across studies, studies were analysed thematically per outcome, and the evidence was synthesised on different health outcomes without formal meta-analysis. Results 41 studies met the inclusion criteria, and focused on suicide, mental health, self rated health, mortality, and other health outcomes. Of those studies, 30 (73%) were deemed to be at high risk of bias, nine (22%) at moderate risk of bias, and only two (5%) at low risk of bias, limiting the conclusions that can be drawn. Although there were differences across countries and groups, there was some indication that suicides increased and mental health deteriorated during the crisis. The crisis did not seem to reverse the trend of decreasing overall mortality. Evidence on self rated health and other indicators was mixed. Conclusions Most published studies on the impact of financial crisis on health in Europe had a substantial risk of bias; therefore, results need to be cautiously interpreted. Overall, the financial crisis in Europe seemed to have had heterogeneous effects on health outcomes, with the evidence being most consistent for suicides and mental health. There is a need for better empirical studies, especially those focused on identifying mechanisms that can mitigate the adverse effects of the crisis. PMID:27601477
Ramontja, R M; Wagstaff, L A; Khomo, N E
The role, desirability and success of community health workers is debated. Conflicting reports have highlighted important concerns and provided guidelines. Particular issues identified are the necessity for both community and health professional input to determine needs and to ensure an acceptable selection process, training, support and accountability. Such steps were followed in the Greater Soweto Maternal Child Project. These are described together with the results achieved. Eight trained Soweto community health workers centered at Chiawelo Clinic and providing home based and neighbourhood health care undertake supervised Tuberculosis treatment, tracing of immunisation defaulters, and health education based on GOBI FFF (Grant JP, UNICEF:1985;94) and "Facts for Life" (UNICEF 1989-1993). They form a link between the community and government health care services and also other available resources. Over a period of 26 months, working from their own homes, they provided 14,254 health related services and in addition undertook 14,501 neighbourhood home visits. They were responsible for 8,710 referrals to the clinic or other relevant agencies for assistance. Incremental training has included HIV/AIDS counselling, advice on family planning with regular report back sessions and discussions. Participatory management involves all major role players. The community health workers have the approval and support of the Local Soweto Health Authority, the Civic Association and the communities they serve. On completion of the project, all were redeployed into local health service posts where it is intended that they form the nucleus of an expanding service. Delegation of selected tasks allows for cost effective functioning of more highly trained staff, an improved service and better use of available resources. PMID:11040587
Linehan, Christine; Walsh, P. N.; Van Schrojenstein Lantman-de Valk, H. M. J.; Kerr, M. P.; Dawson, Frances
Background: Evidence suggests that people with intellectual disabilities experience secondary health conditions and report inequities in health status and access to health systems. Reliable information is essential to identify health disparities. A review of health interview and health examination surveys conducted in 17 European countries was…
Lee, Eun-Kyoung Othelia; Yeo, Younsook
Despite the popularity of relaxation practices as mind-body therapy in the United States, little is known about those who practice these techniques. Using cross-sectional data from the 2007 National Health Interview Survey Alternative Medicine Supplement, this study examined potential correlates of engagement in relaxation practices, including sociodemographic characteristics, health behaviors, medical conditions, physical activity, drinking, smoking, and prayer for health. Individuals who engaged in relaxation practices were less likely to be older, male, Hispanic, high income, or residents in the South and Midwest. They were more likely to be college-educated, uninsured, and have one to two chronic conditions. Those with higher psychological distress and with asthma and pulmonary diseases practiced relaxation techniques more than individuals without these conditions. Findings suggest that relaxation practice is associated with lifestyles habits such as regular physical activity and prayer for health. Thus, relaxation practice has the potential to enhance health behaviors and lifestyle change. PMID:23463812
Raymond, S U
Sustainability of development assistance programs depends greatly on the perceptions of priorities by recipient countries. A written survey was sent by the Catholic University of America's Institute for International Health and Development to 66 ministers of health in low-income and middle-income countries to assess their views of priority problems in health sector development. Response rate was 33%, coming from countries with highly diverse gross national products (GNPs), growth rates, mortality rates and life expectancies. Nevertheless, there was widespread agreement about priorities: 1) meeting costs of health care; 2) improving health care management and administration; and 3) extending communicable disease control. Communicable disease control and child health programs were more important to low-income countries than to middle-income countries. Costs, management and administration and the control of noncommunicable diseases were predicted to increase in importance. In demographics, urbanization, overall population growth and shift of workers from agriculture to industry and services were seen as the major problems of the past, and urbanization and the aging of populations accompanied by increasing life expectancies the major challenges of the future. Highest predicted training needs were for system managers and paramedical personnel. Government budgets, user fees and donor agencies were seen as the most important sources of past funding, with social security systems and fee-based payments increasing in importance in the future. The role of donor agencies would increase as would the need for more responsiveness. Future uncertainties include national economic growth, environmental problems, issues in ethics and changes in disease and technology. PMID:12342422
Boothroyd, Lynda G; Scott, Isabel; Gray, Alan W; Coombes, Claire I; Pound, Nicholas
Evolutionary theories of human attraction draw heavily upon nonhuman literature, and currently the Immunocompetence Handicap Hypothesis dominates research into female attraction to male facial masculinity. Although some studies have shown links between masculinity and some measures of health, other data have failed to support the Immunocompetence Hypothesis as applied to human face preferences. Here we summarize that literature and present new data regarding links between masculinity and multiple measures of health condition in human males. Undergraduate males were photographed and their faces were assessed for sexual dimorphism using multiple methods and rated for apparent healthiness and attractiveness. Participants also reported recent health experiences both prior to being photographed and then again 10 weeks later. Although both attractiveness and rated health were associated with better actual health in the past and future (mainly indexed by lower antibiotic use), results were mixed for masculinity. With respect to respiratory illnesses, facial masculinity (assessed using morphometric techniques) was associated with better past health but with worse future health. Possible reasons for the complex and inconsistent findings are discussed and some potentially fruitful avenues of future research are outlined. PMID:24252513
Nakas, Enita; Tiro, Alisa; Vrazalica, Lejla Redzepagic; Hadzihasanovic, Dzana; Dzemidzic, Vildana
Aim: The aim of our study is to compare incidence of orthodontic malocclusion based on occlusal indices and Index of Orthodontic Treatment Need (IOTN), and to evaluate the most commonly used method among the dentists for orthodontic treatment in Sarajevo. Material and Methods: The sample consisted of 110 (31 female and 79 male)subjects older than 16 years with complete permanent dentition. Subjects were examined according to Occlusal Index (Angle classification of malocclusion, overjet, overbite, dental arch crowding and tooth rotation) and IOTN index. We conduct survey regarding which indexes are used in deciding on orthodontic treatment need, among primary health care and Orthodontist. Results: The present study show differences between the presence of malocclusion and treatment need as assessed by these two used indices. Based on the survey that we conduct all primary health care doctors use Occlusal Index to decide need for orthodontic treatment, more than 95% of orthodontic specialist use Occlusal Index for treatment need estimation. Conclusion: When measuring and grading treatment needs we should rely on Index of orthodontic treatment need. In such high demand for orthodontic treatment need it is necessary to establish need for the orthodontic treatment as fundamental, so that individuals with greatest treatment need can be assigned priority. PMID:27147922
Shaikh, Ulfat; Byrd, Robert S
Childhood asthma is a prevalent and costly chronic condition. Optimal management enables secondary and tertiary prevention. The goal was to identify population health considerations for pediatric asthma in California to inform the development of quality improvement interventions. California Health Interview Survey 2011-2012 is a random-digit dial telephone survey conducted in 5 languages. It includes 44,000 households from all 58 counties in California. This study assessed factors related to symptom control and health care use in children ages 2-11 years with asthma. An estimated 492,385 (9.6%) of children in California currently have asthma. Urban and rural residents face comparable asthma disease burdens. School-age male children as well as Asian and African American children are disproportionately affected. Asthma causes significant morbidity, with poorer health status, high utilization of emergency care, and the need for daily medication use. Only 38% of children with asthma have a recent asthma management plan. Half of all children with asthma did not receive influenza immunization in the past year, although this reflects the overall low rate of influenza vaccination. Parents of children with asthma frequently utilize the Internet for health information and communication with their child's health care provider. Children with asthma in California face several population-level challenges, including poor health status, low influenza vaccination rates, high use of emergency care, and suboptimal use of health literacy tools. Focusing on improved care coordination and preventive care for high-risk groups is especially urgent given the expansion of public health insurance and impending shortages in the primary care workforce. (Population Health Management 2016;19:145-151). PMID:26103063
Objectives The aim of this study is to identify the oral health status as well as oral health practices and access for care of graduating senior high school Tibetan students in Shannan prefecture of Tibet. Methods Based on standards of the 3rd Chinese National Oral Epidemiological Survey and WHO Oral Health Surveys, 1907 graduating students from three senior high schools were examined for caries, periodontitis, dental fluorosis, and oral hygiene status. The questionnaire to the students addressed oral health practices and present access to oral medical services. Results Dental caries prevalence (39.96%) and mean DMFT (0.97) were high in Tibetan students. In community periodontal indexes, the detection rate of gingivitis and dental calculus were 59.50% and 62.64%, respectively. Oral hygiene index-simplified was 0.69, with 0.36 and 0.33 in debris index-simplified and calculus index-simplified, respectively. Community dental fluorosis index was 0.29, with 8.13% in prevalence rate. The questionnaire showed students had poor oral health practices and unawareness for their needs for oral health services. It was also noted that the local area provides inadequate oral medical services. Conclusions Tibetan students had higher prevalence of dental diseases and lower awareness of oral health needs. The main reasons were geographical environment, dietary habit, students’ attitude to oral health, and lack of oral health promotion and education. Oral health education and local dentists training should be strengthened to get effective prevention of dental diseases. PMID:24884668
Westlake, Cheryl; Sethares, Kristen; Davidson, Patricia
Health literacy is discussed in papers from 25 countries where findings suggest that approximately a third up to one half of the people in developed countries have low health literacy. Specifically, health literacy is the mechanism by which individuals obtain and use health information to make health decisions about individual treatments in the home, access care in the community, promote provider-patient interactions, structure self-care, and navigate health care programs both locally and nationally. Further, health literacy is a key determinant of health and a critical dimension for assessing individuals' needs, and, importantly, their capacity for self-care. Poorer health knowledge/status, more medication errors, costs, and higher rates of morbidity, readmissions, emergency room visits, and mortality among patients with health illiteracy have been demonstrated. Individuals at high risk for low health literacy include the elderly, disabled, Blacks, those with a poverty-level income, some or less high school education, either no insurance or Medicare or Medicaid, and those for whom English is a second language. As a consequence, health literacy is a complex, multifaceted, and evolving construct including aspects of social, psychological, cultural and economic circumstances. The purpose of this paper is to describe the mechanisms and consequences of health illiteracy. Specifically, the prevalence, associated demographics, and models of health literacy are described. The mechanism of health illiteracy's influence on outcomes in heart failure is proposed. Tools for health literacy assessment are described and compared. Finally, the health outcomes and general interventions to enhance the health outcomes in heart failure are discussed. PMID:23873404
Rivas-Drake, Deborah; Seaton, Eleanor K; Markstrom, Carol; Quintana, Stephen; Syed, Moin; Lee, Richard M; Schwartz, Seth J; Umaña-Taylor, Adriana J; French, Sabine; Yip, Tiffany
The construction of an ethnic or racial identity is considered an important developmental milestone for youth of color. This review summarizes research on links between ethnic and racial identity (ERI) with psychosocial, academic, and health risk outcomes among ethnic minority adolescents. With notable exceptions, aspects of ERI are generally associated with adaptive outcomes. ERI are generally beneficial for African American adolescents' adjustment across all three domains, whereas the evidence is somewhat mixed for Latino and American Indian youth. There is a dearth of research for academic and health risk outcomes among Asian American and Pacific Islander adolescents. The review concludes with suggestions for future research on ERI among minority youth. PMID:24490891
Background Several measurement tools have been developed to measure health literacy. The tools vary in their approach and design, but few have focused on comprehensive health literacy in populations. This paper describes the design and development of the European Health Literacy Survey Questionnaire (HLS-EU-Q), an innovative, comprehensive tool to measure health literacy in populations. Methods Based on a conceptual model and definition, the process involved item development, pre-testing, field-testing, external consultation, plain language check, and translation from English to Bulgarian, Dutch, German, Greek, Polish, and Spanish. Results The development process resulted in the HLS-EU-Q, which entailed two sections, a core health literacy section and a section on determinants and outcomes associated to health literacy. The health literacy section included 47 items addressing self-reported difficulties in accessing, understanding, appraising and applying information in tasks concerning decisions making in healthcare, disease prevention, and health promotion. The second section included items related to, health behaviour, health status, health service use, community participation, socio-demographic and socio-economic factors. Conclusions By illuminating the detailed steps in the design and development process of the HLS-EU-Q, it is the aim to provide a deeper understanding of its purpose, its capability and its limitations for others using the tool. By stimulating a wide application it is the vision that HLS-EU-Q will be validated in more countries to enhance the understanding of health literacy in different populations. PMID:24112855
The interaction between environmental conditions and human health transpire from complex processes. Environmental exposures tend to cluster and disamenities such as landfills or industrial plants are often located in areas with high a percentage of minority and poor residents. Wh...
Background This paper establishes empirical evidence relating the agriculture and health sectors in Uganda. The analysis explores linkages between agricultural management, malaria and implications for improving community health outcomes in rural Uganda. The goal of this exploratory work is to expand the evidence-base for collaboration between the agricultural and health sectors in Uganda. Methods The paper presents an analysis of data from the 2006 Uganda National Household Survey using a parametric multivariate Two-Limit Tobit model to identify correlations between agro-ecological variables including geographically joined daily seasonal precipitation records and household level malaria risk. The analysis of agricultural and environmental factors as they affect household malaria rates, disaggregated by age-group, is inspired by a complimentary review of existing agricultural malaria literature indicating a gap in evidence with respect to agricultural management as a form of malaria vector management. Crop choices and agricultural management practices may contribute to vector control through the simultaneous effects of reducing malaria transmission, improving housing and nutrition through income gains, and reducing insecticide resistance in both malaria vectors and agricultural pests. Results The econometric results show the existence of statistically significant correlations between crops, such as sweet potatoes/yams, beans, millet and sorghum, with household malaria risk. Local environmental factors are also influential- daily maximum temperature is negatively correlated with malaria, while daily minimum temperature is positively correlated with malaria, confirming trends in the broader literature are applicable to the Ugandan context. Conclusions Although not necessarily causative, the findings provide sufficient evidence to warrant purposefully designed work to test for agriculture health causation in vector management. A key constraint to modeling the
Yanos, Philip T.; Kopelovich, Sarah L.; Koerner, Joshua; Alexander, Mary Jane
Internationally, one effort to reduce the number of people with serious mental illness (SMI) in jails and prisons is the development of Mental Health Courts (MHC). Research on MHCs to date has been disproportionately focused on the study of recidivism and re-incarceration over the potential of these problem-solving courts to facilitate mental health recovery and affect the slope or gradient of opportunity for recovery. Despite the strong conceptual links between the MHC approach and the recovery-orientation in mental health, the capacity for MHCs to facilitate recovery has not been explored. This user-informed mental health and criminal justice (MH/CJ) community based participatory (CBPR) study assesses the extent to which MHC practices align with recovery-oriented principles and may subsequently affect criminal justice outcomes. We report on the experiences and perceptions of 51 MHC participants across four metropolitan Mental Health Courts. Specifically, the current study assesses: 1) how defendants’ perceptions of court practices, particularly with regard to procedural justice and coercion, relate to perceptions of mental health recovery and psychiatric symptoms, and, 2) how perceptions of procedural justice and mental health recovery relate to subsequent criminal justice outcomes. The authors hypothesized that perceived coercion and mental health recovery would be inversely related, that perceived coercion would be associated with worse criminal justice outcomes, and perceptions of mental health recovery would be associated with better criminal justice outcomes. Results suggest that perceived coercion in the MHC experience was negatively associated with perceptions of recovery among MHC participants. Perceptions of “negative pressures,” a component of coercion, were important predictors of criminal justice involvement in the 12 month period following MHC admission, even when controlling for other factors that were related to criminal justice outcomes, and
Garfield, R M; Frieden, T; Vermund, S H
Since 1983, war in Nicaragua has slowed improvements in health which had developed rapidly from 1979-82. The rate of war-related deaths among Nicaraguans now exceeds that of the United States citizens in either the Vietnam War or World War II. Forty-two of the 84 documented war-related casualties among Nicaraguan health workers have been deaths. This high case fatality rate reflects the targeting of health workers by contra troops. The number of staff and services of the public medical system decreased by approximately 10 per cent from 1983 to 1985. Population movements, the establishment of new settlements, and war-related destruction of the primary health infrastructure are associated with recent epidemics of malaria, dengue, measles, and leishmaniasis. The estimated rate of infant mortality in Nicaragua, which had declined from 120 per 1,000 in 1978 to 76/1,000 live births in 1983, has since shown no further decline. Internationally mandated protections enjoyed by civilians and health workers during times of war do not appear to operate in this so-called "low intensity" conflict. Further declines in infant mortality, prevention of epidemics, and improvement in other health indicators will likely await the cessation of military hostilities. PMID:3565659
Seymour, J; Newell, D; Shiell, A
This study reviews the extent of evaluation of health outcomes in three general medical journals over the past decade by examining papers published in the original research section of the New England Journal of Medicine (NEJM), The Lancet, and the Medical Journal of Australia (MJA) in 1982 and 1992. Evaluations were identified and classified according to the type of comparison group and the type of outcome measures employed. They were divided into three categories: those employing a comparison group; those employing a before-and-after study design (or own comparison group); and those with no comparison group. The categories of outcome measures were mortality, clinical or intermediate measures of health state, and final outcome measures (quality of life). Results show that the proportion of papers evaluating a health services intervention remained stable over the period. However, the MJA published considerably fewer evaluations than the other journals. In the NEJM and The Lancet, 75 per cent of evaluations incorporated comparison groups, in the MJA, less than 40 per cent. Overall, the proportion of papers reporting final outcome measures increased significantly between 1982 and 1992 (p = 0.04) but the change in each journal individually did not reach statistical significance. This study indicates that the reporting of health outcomes evaluations has remained constant but there has been some change in the use of comparison groups and final outcome measures over time. PMID:10165947
Bush, Heather; Oslin, David
Abstract Objective: This study examined the effectiveness of a telephone-based referral-care management (TBR-CM) intervention on psychiatric health outcomes. Materials and Methods: Between September 2005 and May 2006, primary care patients (n = 169) at the Philadelphia Veterans Affairs Medical Center completed a psychiatric interview over the telephone, of which 113 gave consent and were randomized into the TBR-CM usual care or intervention groups (n = 40 [39%] depression, n = 40 [39%] substance abuse, and n = 33 [22%] comorbid condition: depression and substance abuse). Usual care consisted of participants receiving a psychiatric appointment, followed up with standard institutional reminders. The intervention care group received the same, with the addition of brief motivational telephone sessions. Baseline and 6-month interviews were used to obtain study data. Results: Results indicated that there was improvement in mental health functioning (p < 0.0001), depression (p < 0.0001), and binge (p < 0.0332) outcomes over the 6-month interview (78% retention). However, there was no change observed for physical health functioning and drinks per week outcomes. For mental health functioning, depression, and binge rates there were no randomization group assignment effects, indicating that the intervention care group did not show better health outcomes despite showing higher levels of psychiatric appointment attendance. Conclusions: Patients who are exposed to the intervention have similar health outcomes as patients in usual care. In conclusion, the TBR-CM intervention does not lead to relatively improved psychiatric health outcomes. Further research is necessary to examine the efforts needed to extend increased treatment engagement into improved health outcomes for intervention recipients. PMID:20575721
Pierce, S F
With the advent of profit maximization in health care came an increased focus on defining quality through outcomes achieved. The article describes an analysis of the nursing literature from 1974 to 1996 using Donabedian's structure-process-outcome framework and the specific indicators identified by the American Nurses Association report card, the Institute of Medicine, and the nursing-sensitive outcomes classification. Although evidence exists documenting nursing's positive impact on patient outcomes, this analysis suggests a real need to integrate our clinical and administrative studies and to employ a more comprehensive, longitudinal, multifacility approach if we are to answer the scientific question regarding which nursing structures and processes truly produce the best health outcomes. PMID:9097521
Qi, Yaqiang; Niu, Jianlin
Using data collected from the 2008 survey of Internal Migration and Health in China, this study examines the impact of late childhood nutrition intakes on a wide range of indicators of adult health. The results show that respondents who consume rich nutrients (meat, fish, milk, etc.) less frequently during late childhood have worse health outcomes when they grow up. They are more likely to rate their health as 'fair/poor', report a greater number of chronic diseases, have a higher incidence of acute illness, perceive greater numbers of physical pains/discomforts and to suffer more from insomnia and depression. With respect to objective biometrics, respondents who have less access to rich nutrients at age 14 tend to attain a shorter stature, gain more weight as an adult, and are more likely to become obese or have low lung capacity. Taken together, the evidence in support of a harmful impact of late childhood undernutrition on adult health is stronger and more consistent for subjective health indicators than for the objective biometrics examined in this study. Moreover, the results also indicate that the long-term health impact of late childhood nutrition deprivation is especially detrimental for females in China. PMID:26217918
Background In-service training is a key strategic approach to addressing the severe shortage of health care workers in many countries. However, there is a lack of evidence linking these health care worker trainings to improved health outcomes. In response, the United States President’s Emergency Plan for AIDS Relief’s Human Resources for Health Technical Working Group initiated a project to develop an outcome-focused training evaluation framework. This paper presents the methods and results of that project. Methods A general inductive methodology was used for the conceptualization and development of the framework. Fifteen key informant interviews were conducted to explore contextual factors, perceived needs, barriers and facilitators affecting the evaluation of training outcomes. In addition, a thematic analysis of 70 published articles reporting health care worker training outcomes identified key themes and categories. These were integrated, synthesized and compared to several existing training evaluation models. This formed an overall typology which was used to draft a new framework. Finally, the framework was refined and validated through an iterative process of feedback, pilot testing and revision. Results The inductive process resulted in identification of themes and categories, as well as relationships among several levels and types of outcomes. The resulting framework includes nine distinct types of outcomes that can be evaluated, which are organized within three nested levels: individual, organizational and health system/population. The outcome types are: (1) individual knowledge, attitudes and skills; (2) individual performance; (3) individual patient health; (4) organizational systems; (5) organizational performance; (6) organizational-level patient health; (7) health systems; (8) population-level performance; and (9) population-level health. The framework also addresses contextual factors which may influence the outcomes of training, as well as the
Murgatroyd, Darnel F.; Casey, Petrina P.; Cameron, Ian D.; Harris, Ian A.
The effect of financial compensation on health outcomes following musculoskeletal injury requires further exploration because results to date are varied and controversial. This systematic review identifies compensation related factors associated with poorer health outcomes following musculoskeletal injury. Searches were conducted using electronic medical journal databases (Medline, CINAHL, Embase, Informit, Web of Science) for prospective studies published up to October 2012. Selection criteria included: prognostic factors associated with validated health outcomes; six or more months follow up; and multivariate statistical analysis. Studies solely measuring return to work outcomes were excluded. Twenty nine articles were synthesised and then assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to determine evidence levels. The results were mixed. There was strong evidence of an association between compensation status and poorer psychological function; and legal representation and poorer physical function. There was moderate evidence of an association between compensation status and poorer physical function; and legal representation and poorer psychological function. There was limited evidence of an association between compensation status and increased pain. In seven studies the association depended on the outcome measured. No studies reported an association between compensation related factors and improved health outcomes. Further research is needed to find plausible reasons why compensation related factors are associated with poorer health following musculoskeletal injury. PMID:25680118
Kanehara, Akiko; Umeda, Maki; Kawakami, Norito
Aim The reasons for accessing and maintaining access to mental health services in Japan may be unique in those of other countries. Using the World Health Organization World Mental Health Japan survey data, this study investigated the prevalence of sociodemographic correlates of barriers for the use of, reasons for delayed access to, and reasons for dropping out from mental health care in a Japanese community-based sample. Methods An interview survey was conducted with a random sample of residents living in 11 communities across Japan during the years 2002–2006. Data from 4,130 participants were analyzed. Results The most frequently reported reason for not seeking mental health care was a low perceived need (63.9%). The most common reason for delaying access to help was the wish to handle the problem on one's own (68.8%), while the most common reason for dropping out of care was also a low perceived need (54.2%). Being a woman and of younger age were key sociodemographic barriers to the use of mental health services. Conclusion Low perceived need was a major reason for not seeking, delay in using, and dropout from mental health services in Japan. In addition, low perceived need and structural barriers were more frequently reported than attitudinal barriers, with the exception of a desire to handle the problem on one's own. These findings suggest that to improve therapist-patient communication and quality of mental health care, as well as mental health literacy education in the community, might improve access to care in Japan. PMID:25523280
Massagli, Michael; Frost, Jeana; Brownstein, Catherine; Okun, Sally; Vaughan, Timothy; Bradley, Richard; Heywood, James
Background PatientsLikeMe is an online quantitative personal research platform for patients with life-changing illnesses to share their experience using patient-reported outcomes, find other patients like them matched on demographic and clinical characteristics, and learn from the aggregated data reports of others to improve their outcomes. The goal of the website is to help patients answer the question: “Given my status, what is the best outcome I can hope to achieve, and how do I get there?” Objective Using a cross-sectional online survey, we sought to describe the potential benefits of PatientsLikeMe in terms of treatment decisions, symptom management, clinical management, and outcomes. Methods Almost 7,000 members from six PatientsLikeMe communities (amyotrophic lateral sclerosis [ALS], Multiple Sclerosis [MS], Parkinson’s Disease, human immunodeficiency virus [HIV], fibromyalgia, and mood disorders) were sent a survey invitation using an internal survey tool (PatientsLikeMe Lens). Results Complete responses were received from 1323 participants (19% of invited members). Between-group demographics varied according to disease community. Users perceived the greatest benefit in learning about a symptom they had experienced; 72% (952 of 1323) rated the site “moderately” or “very helpful.” Patients also found the site helpful for understanding the side effects of their treatments (n = 757, 57%). Nearly half of patients (n = 559, 42%) agreed that the site had helped them find another patient who had helped them understand what it was like to take a specific treatment for their condition. More patients found the site helpful with decisions to start a medication (n = 496, 37%) than to change a medication (n = 359, 27%), change a dosage (n = 336, 25%), or stop a medication (n = 290, 22%). Almost all participants (n = 1,249, 94%) were diagnosed when they joined the site. Most (n = 824, 62%) experienced no change in their confidence in that diagnosis or had
Tsugawa, Yusuke; Hasegawa, Kohei; Hiraide, Atsushi; Jha, Ashish K
Objectives Japan is considering policies to set the target health expenditure level for each region, a policy approach that has been considered in many other countries. The objective of this study was to examine the relationship between regional health expenditure and health outcomes after out-of-hospital cardiac arrest (OHCA), which incorporates the qualities of prehospital, in-hospital and posthospital care systems. Design We examined the association between prefecture-level per capita health expenditure and patients’ health outcomes after OHCA. Setting We used a nationwide, population-based registry system of OHCAs that captured all cases with OHCA resuscitated by emergency responders in Japan from 2005 to 2011. Participants All patients with OHCA aged 1–100 years were analysed. Outcome measures The patients’ 1-month survival rate, and favourable neurological outcome (defined as cerebral performance category 1–2) at 1-month. Results Among 618 154 cases with OHCA, the risk-adjusted 1-month survival rate varied from 3.3% (95% CI 2.9% to 3.7%) to 8.4% (95% CI 7.7% to 9.1%) across prefectures. The risk-adjusted probabilities of favourable neurological outcome ranged from 1.6% (95% CI 1.4% to 1.9%) to 3.7% (95% CI 3.4% to 3.9%). Compared with prefectures with lowest tertile health expenditure, 1-month survival rate was significantly higher in medium-spending (adjusted OR 1.31, 95% CI 1.03 to 1.66, p=0.03) and high-spending prefectures (adjusted OR 1.30, 95% CI 1.03 to 1.64, p=0.02), after adjusting for patient characteristics. There was no difference in the survival between medium-spending and high-spending regions. We observed similar patterns for favourable neurological outcome. Additional adjustment for regional per capita income did not affect our overall findings. Conclusions We observed a wide variation in the health outcomes after OHCA across regions. Low-spending regions had significantly worse health outcomes compared with medium-spending or high
Pesola, Francesca; Williams, Julie; Bird, Victoria; Freidl, Marion; Le Boutillier, Clair; Leamy, Mary; Macpherson, Rob; Slade, Mike
Pre-defined, researcher-selected outcomes are routinely used as the clinical end-point in randomized controlled trials (RCTs); however, individualized approaches may be an effective way to assess outcome in mental health research. The present study describes the development and evaluation of the Individualized Outcome Measure (IOM), which is a patient-specific outcome measure to be used for RCTs of complex interventions. IOM was developed using a narrative review, expert consultation and piloting with mental health service users (n = 20). The final version of IOM comprises two components: Goal Attainment (GA) and Personalized Primary Outcome (PPO). For GA, patients identify one relevant goal at baseline and rate its attainment at follow-up. For PPO, patients choose an outcome domain related to their goal from a pre-defined list at baseline, and complete a standardized questionnaire assessing the chosen outcome domain at baseline and follow-up. A feasibility study indicated that IOM had adequate completion (89%) and acceptability (96%) rates in a clinical sample (n = 84). IOM was then evaluated in a RCT (ISRCTN02507940). GA and PPO components were associated with each other and with the trial primary outcome. The use of the PPO component of IOM as the primary outcome could be considered in future RCTs. Copyright © 2015 John Wiley & Sons, Ltd. PMID:26184686
Redshaw, Maggie; Hennegan, Julie M; Henderson, Jane
Objectives To compare mental health and well-being outcomes at 3 and 9 months after the stillbirth among women who held or did not hold their baby, adjusting for demographic and clinical differences. Design Secondary analyses of data from a postal population survey. Population Women with a registered stillbirth in England in 2012. Methods 468 eligible responses were compared. Differences in demographic, clinical and care characteristics between those who held or did not hold their infant were described and adjusted for in subsequent analysis. Mental health and well-being outcomes were compared, and subgroup comparisons tested hypothesised moderating factors. Outcome Measures Self-reported depression, anxiety, post-traumatic stress disorder (PTSD) symptoms and relationship difficulties. Results There was a 30.2% response rate to the survey. Most women saw (97%, n=434) and held (84%, n=394) their baby after stillbirth. There were some demographic differences with migrant women, women who had a multiple birth and those whose pregnancy resulted from fertility treatment being less likely to hold their baby. Women who held their stillborn baby consistently reported higher rates of mental health and relationship difficulties. After adjustment, women who held their baby had 2.12 times higher odds (95% CI 1.11 to 4.04) of reporting anxiety at 9 months and 5.33 times higher odds (95% CI 1.26 to 22.53) of reporting relationship difficulties with family. Some evidence for proposed moderators was observed with poorer mental health reported by women who had held a stillborn baby of <33 weeks’ gestation, and those pregnant at outcome assessment. Conclusions This study supports concern about the negative impact of holding the infant after stillbirth. Results are limited by the observational nature of the study, survey response rate and inability to adjust for women's baseline anxiety. Findings add important evidence to a mixed body of literature. PMID:27540097
Elman, Cheryl; Wray, Linda A; Xi, Juan
Recent studies find lasting effects of poor youth health on educational attainment but use young samples and narrow life course windows of observation to explore outcomes. We apply a life course framework to three sets of Health and Retirement Study birth cohorts to examine early health status effects on education and skills attainment measured late in life. The older cohorts that we study were the earliest recipients of U.S. policies promoting continuing education through the GI Bill, community college expansions and new credentials such as the GED. We examine a wide range of outcomes but focus on GEDs, postsecondary school entry and adult human capital as job-related training. We find that older U.S. cohorts had considerable exposure to these forms of attainment and that the effects of youth health on them vary by outcome: health selection and ascription group effects are weak or fade, respectively, in outcomes associated with delayed or adult attainment. However, poorer health and social disadvantage in youth and barriers associated with ascription carry forward to limit attainment of key credentials such as diplomas and college degrees. We find that the human capital - health gradient is dynamic and that narrow windows of observation in existing studies miss much of it. National context also matters for studying health-education linkages over the life course. PMID:24267756
Fraser, Simon Ds; George, Steve
Several health outcomes (including mortality) and health-related behaviors are known to be worse in Scotland than in comparable areas of Europe and the United Kingdom. Within Scotland, Greater Glasgow (in West Central Scotland) experiences disproportionately poorer outcomes independent of measurable variation in socioeconomic status and other important determinants. Many reasons for this have been proposed, particularly related to deprivation, inequalities, and variation in health behaviors. The use of models (such as the application of Bradford Hill's viewpoints on causality to the different hypotheses) has provided useful insights on potentially causal mechanisms, with health behaviors and inequalities likely to represent the strongest individual candidates. This review describes the evolution of our understanding of Glasgow's excess mortality, summarizes some of the key work in this area, and provides some suggestions for future areas of exploration. In the context of demographic change, the experience in Glasgow is an important example of the complexity that frequently lies behind observed variations in health outcomes within and between populations. A comprehensive explanation of Glasgow's excess mortality may continue to remain elusive, but is likely to lie in a complex and difficult-to-measure interplay of health determinants acting at different levels in society throughout the life course. Lessons learned from the detailed examination of different potentially causative determinants in Scotland may provide useful methodological insights that may be applied in other settings. Ongoing efforts to unravel the causal mechanisms are needed to inform public health efforts to reduce health inequalities and improve outcomes in Scotland. PMID:26124684
Sullivan, Christopher J.; Sacks, Stanley; McKendrick, Karen; Banks, Steven; Sacks, Joann Y.; Stommel, Joseph
This paper examines outcomes 12 months post-prison release for offenders with co-occurring disorders (n = 185) randomly assigned to either a mental health control treatment (C) or a modified therapeutic community (E). Significant between-group differences were not found for mental health measures, although improvements were observed for each…
Larney, Sarah; Burns, Lucy
Individuals in contact with the criminal justice system are a key population of concern to public health. Record linkage studies can be useful for studying health outcomes for this group, but the use of aliases complicates the process of linking records across databases. This study was undertaken to determine the impact of aliases on sensitivity…
Engelke, Martha Keehner; Guttu, Martha; Warren, Michelle B.; Swanson, Melvin
More children with chronic illnesses are attending school, and some of them struggle academically because of issues related to their health. School-based case management has been suggested as one strategy to improve the academic success of these children. This study tracked the academic, health, and quality of life outcomes for 114 children with…
Quality of life of youth and disease-specific family behavior have both been shown to be important in the study of health outcomes across a broad range of chronic physical conditions of childhood. Very few studies have addressed quality of life, the family’s role in diabetes management, and health o...
Cullen, Karen Weber; Baranowski, Tom; Baranowski, Janice; Hebert, David; deMoor, Carl; Hearn, Marsha Davis; Resnicow, Ken
Assessed the impact of school organizational characteristics on outcomes of a teacher health behavior change program. Organizational, dietary, and psychologic data from intervention and control schools indicated that teachers at intervention schools with high organizational climate, organizational health, and job satisfaction reported better…
Muftic, Lisa R; Finn, Mary A
Human trafficking is recognized as a major public health problem and a tragic transnational crime. Little is known about the health outcomes of victims of human trafficking. This study identifies the relationship of risk factors to physical, sexual, and mental health outcomes in three groups of women (N = 38) exploited for sex in the United States: international trafficking victims, domestic trafficking victims, and nontrafficked sex workers. To date this is the first study to examine the impact of risk factors on health outcomes using a sample of women trafficked for sex in the United States that includes both domestic and international victims. Overall, findings suggest that the experiences in sex work of domestic trafficking victims were dissimilar to those of international trafficking victims. Moreover, domestic trafficking victims displayed poorer health outcomes compared to international trafficking victims. In terms of risk factors, a higher percentage of women involved in street prostitution reported sexual health problems, co-occurring health issues, and addiction. Childhood physical/sexual victimization was related to poor physical health. PMID:23295378
Petch, Alison; Cook, Ailsa; Miller, Emma
Working in partnership, both across social care and health and with service users, has been a persistent theme of the health and social care modernisation agenda in the United Kingdom. Despite a relatively underdeveloped evidence base, the development of health and social care partnerships has continued to feature in recent policy and legislative initiatives in the United Kingdom. At the same time there has been a major shift in focus towards the outcomes that support services deliver. A central question remaining is whether the policy initiatives driving the development of health and social care partnerships are delivering improved outcomes, particularly the outcomes valued by people who use services. This article outlines research designed to explore this issue across 15 health and social care partnerships in England and Scotland, building from previous research by the Social Policy Research Unit based at the University of York. It sought to assess the extent to which health and social care partnerships deliver the outcomes that people who use services value, and to determine the features of partnership working associated with the delivery of these outcomes. A robust outcomes framework was defined, which provided the basis for interviews with those receiving support from partnerships. Working with three user-researcher organisations, interviews were completed with 230 individuals in 2006. On the basis of this, some service users were able to identify features of partnership that particularly contributed to improved outcomes. These included continuity of staff and sufficient staff and a range of resources, including the availability of long-term and preventative services. Given the definitional and methodological complexity surrounding partnership working, and the challenges of attribution, the study faced some limitations in its ability to make wider inferences about partnership and outcomes. A theory of change should be employed in future studies of this type
Acampora, Giovanni; Cook, Diane J.; Rashidi, Parisa; Vasilakos, Athanasios V.
Ambient Intelligence (AmI) is a new paradigm in information technology aimed at empowering people’s capabilities by the means of digital environments that are sensitive, adaptive, and responsive to human needs, habits, gestures, and emotions. This futuristic vision of daily environment will enable innovative human-machine interactions characterized by pervasive, unobtrusive and anticipatory communications. Such innovative interaction paradigms make ambient intelligence technology a suitable candidate for developing various real life solutions, including in the health care domain. This survey will discuss the emergence of ambient intelligence (AmI) techniques in the health care domain, in order to provide the research community with the necessary background. We will examine the infrastructure and technology required for achieving the vision of ambient intelligence, such as smart environments and wearable medical devices. We will summarize of the state of the art artificial intelligence methodologies used for developing AmI system in the health care domain, including various learning techniques (for learning from user interaction), reasoning techniques (for reasoning about users’ goals and intensions) and planning techniques (for planning activities and interactions). We will also discuss how AmI technology might support people affected by various physical or mental disabilities or chronic disease. Finally, we will point to some of the successful case studies in the area and we will look at the current and future challenges to draw upon the possible future research paths. PMID:24431472
Ashmore, R; Jones, J; Jackson, A; Smoyak, S
Although an increasing amount of literature has appeared in recent years on the subject of stalking, little is known about mental health nurses' (MHNs) experiences of this phenomenon. The aims of the study were to investigate: (1) the incidence of stalking among a sample of MHNs in the UK; (2) who the perpetrators were; (3) the impact of stalking on MHNs; and (4) how MHNs manage their experiences. Employing a survey design, the British version of the Rutgers-Penn clinicians and stalking questionnaire was distributed to a convenience sample of 400 MHNs in the UK. Data were analysed by means of descriptive statistics and McNemar test. The findings reveal that: (1) 50% (n = 56) of MHNs who completed the questionnaire had been stalked; (2) on the whole, victims were female (78.6%) and stalkers males (82.1%); (3) stalkers were from a variety of social groups including mental health service users and MHNs; (4) victims were threatened, followed, physically assaulted and received unwanted communication; (5) MHNs reported a variety of stress-related (psychological and behavioural) responses to their experiences; and (6) employed a range of coping strategies. This study serves to raise awareness of a number of issues surrounding an under-reported phenomenon in mental health nursing and points to the need for further research to explore the reliability and consequences of the findings. PMID:16965475
Birdsall, P D; Hayes, J H; Cleary, R; Pinder, I M; Moran, C G; Sher, J L
Between 1992 and 1994 we performed a prospective study of the effect of total knee replacement (TKR) on the health status of 119 patients over the age of 80 years who had had a primary unilateral TKR. The Nottingham Health Profile was used to assess this before and at three and 12 months after operation. We found a significant improvement in the scores for pain, emotional reaction, sleep and physical mobility at three months. After 12 months, the scores for pain and sleep were well maintained. The other factors had deteriorated slightly but remained better than before operation. Our findings show that TKR leads to a significant improvement in the general health status of the very elderly. PMID:10463740
Background The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Methods Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Results Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. Conclusion This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its
Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Office of Applied Studies.
This report presents the first information from the 2002 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. Prior to 2002, the survey was called the National Household Survey on Drug Abuse (NHSDA). This initial report on the 2002 data…
Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Office of Applied Studies.
This report presents the first information from the 2002 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. Prior to 2002, the survey was called the National Household Survey on Drug Abuse (NHSDA). This brief Overview report provides a…
Najafi, Farid; Karami-Matin, Behzad; Rezaei, Satar; Rajabi-Gilan, Nader; Soofi, Moslem
Background: Responsiveness is one of the three main goals of the health system introduced by World Health Organization. This study aimed at examining health system responsiveness after Health Sector Evolution Plan in Kermanshah, Western Iran. Methods: A sample of 335 hospitalized patients was selected using proportionate allocation to population size method in the city of Kermanshah (Iran) in 2015. World Health Survey (WHS) questionnaire was used to collect data. Data were analyzed using descriptive statistics and principal component analysis by STATA 12. Results: The overall health system responsiveness score was 72.6. The best and worst performance for domains of dignity and autonomy were 82.2 and 62.5, respectively. Socio-demographic variables of the patients had no significant effect on the total health system responsiveness score. The principal component analysis findings indicated that 68% of the variance of the overall responsiveness score was explained by four components. Conclusion: The overall responsiveness score of each of the domains was higher than that of other similar previous studies in Iran. Although it is difficult to reach a conclusion, our findings may show better responsiveness of the health system compared to the previous reports PMID:27493931
Berge, Jerica M.; Bauer, Katherine W.; Eisenberg, Marla E.; Denny, Kara; Neumark-Sztainer, Dianne
Purpose Previous research has shown a relationship between childhood/adolescent chronic conditions and negative health behaviors, psychological outcomes, and social outcomes. Less is known about whether these negative outcomes are experienced by young adults with chronic health conditions. The purpose of this paper is to investigate how young adults’ BMI, health behaviors, and psychological and social outcomes differ depending on whether they have diabetes, asthma, or neither of these chronic conditions. Methods Data were drawn from the third wave of Project EAT-III: Eating and Activity in Young Adults, a population-based study of 2287 young adults (mean age = 25.3; range 19.8 – 31.2). General linear models were used to test differences in BMI, health behaviors (e.g., fast food intake) and psychosocial outcomes (e.g. depressive symptoms) by young adults’ chronic disease status. Results Young adults with diabetes had higher BMIs, engaged in less physical activity and more unhealthy weight control behaviors and binge eating, had lower self-esteem and lower body satisfaction, and experienced more depressive symptoms and appearance-based teasing compared to young adults with asthma or no chronic conditions, after adjusting for age, race/ethnicity, socio-economic status (SES) and, when relevant, for BMI. There were no significant differences between young adults with asthma and young adults with no chronic condition on all of the psychosocial and health behavior outcomes. Conclusions Young adults with diabetes reported higher prevalence of negative health behaviors and psychosocial outcomes. Providers may find it useful to assess for negative health behaviors and psychosocial variables with young adults with diabetes in order to improve treatment and quality of life for these individuals. PMID:24298429
Liu, Yong-Bing; Liu, Liu; Li, Yan-Fei; Chen, Yan-Li
Background: Despite the large volume of research dedicated to health-related behavior change, chronic disease costs continue to rise, thus creating a major public health burden. Health literacy, the ability to seek, understand, and utilize health information, has been identified as an important factor in the course of chronic conditions. Little research has been conducted on the relationship between health literacy and health-related behaviors and health status in elderly Chinese. The aim of this study was to elucidate the relationship between health literacy and health-related behaviors and health status in China. Methods: The subjects enrolled in this study were selected based on a stratified cluster random sampling design. Information involving >4500 older adults in 44 pension institutions in Urumqi, Changji, Karamay, and Shihezi of Xinjiang between September 2011 and June 2012 was collected. The Chinese Citizen Health Literacy Questionnaire (China Health Education Centre, 2008) and a Scale of the General Status were administered and the information was obtained through face-to-face inquiries by investigators. A total of 1452 respondents met the inclusion criteria. A total of 1452 questionnaires were issued and the valid response rate was 96.14% (1396 of 1452). Factors affecting health literacy and the relationship to health literacy were identified by one-way ANOVA and a multiple linear regression model. Results: The average health literacy level of the elderly in nursing homes was relatively low (71.74 ± 28.35 points). There were significant differences in the health literacy score among the factors of age, gender, race, education level, household income, marital conditions, and former occupation (p < 0.001). The health literacy score was significantly associated with smoking, drinking, physical exercise, and health examination (p < 0.001). The elderly with higher health literacy scores were significantly less likely to have risky behaviors (smoking, regular
Reynolds, Kerry A.; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda
Objective To examine the relation of behavioral autonomy to psychological, behavioral, and physical health among emerging adults with and without type 1 diabetes. Methods High school seniors with (n = 118) and without type 1 diabetes (n = 122) completed online questionnaires for three consecutive years. Behavioral autonomy, psychological health, risk behaviors, and diabetes outcomes were assessed. Regression analyses were conducted to predict Time 2 and 3 outcomes, controlling for Time 1 outcomes. Results There were no group differences in behavioral autonomy. Behavioral autonomy predicted better psychological health but only for emerging adults without diabetes. Behavioral autonomy was related to increased risk behavior for both groups. Behavioral autonomy was unrelated to self-care but predicted better glycemic control for females. Conclusions Behavioral autonomy may be beneficial for psychological health, but is related to increased risk behavior. The implications of behavioral autonomy for emerging adults with type 1 diabetes require careful consideration. PMID:25157070
The National Health and Nutrition Examination Survey (NHANES) is used to evaluate the health and nutrition of the United States. It is composed of cross-sectional, nationally representative health examination surveys of the U.S. civilian, non-institutionalized population. A complex, stratified, mult...
Weismuller, Penny C.; Grasska, Merry A.; Alexander, Marilyn; White, Catherine G.; Kramer, Pat
Regular school attendance is a necessary part of the learning process; student absenteeism has a direct association with poor academic performance. School nurses can influence student attendance. This study describes the impact of school nurse interventions on student absenteeism and student health. A retrospective review of 240 randomly selected…
Essex, Marilyn J.; Kraemer, Helena C.; Slattery, Marcia J.; Burk, Linnea R.; Boyce, W. Thomas; Woodward, Hermi R.; Kupfer, David J.
Background: Many childhood psychiatric problems are transient. Consequently, screening procedures to accurately identify children with problems unlikely to remit and thus, in need of intervention, are of major public health concern. This study aimed to develop a universal school-based screening procedure based on the answers to three questions:…
Atkins, Catherine J.; And Others
As part of a family cardiovascular health promotion project, 111 Mexican-American and 95 Anglo-American families with fifth or sixth grade children were assigned to either a primary prevention program involving 18 sessions or to a control condition. Correlates of attendance were low baseline scores on physical activity and cardiovascular fitness…
Haefeli, M.; Elfering, A.; Aebi, M.; Freeman, B. J. C.; Fritzell, P.; Guimaraes Consciencia, J.; Lamartina, C.; Mayer, M.; Lund, T.
Standardized and validated self-administered outcome-instruments are broadly used in spinal surgery. Despite a plethora of articles on outcome research, no systematic evaluation is available on what actually comprises a good outcome in spinal surgery from the patients’ and surgeons’ perspective, respectively. However, this is a prerequisite for improving outcome instruments. In performing a cross-sectional survey among spine patients from different European regions and spine surgeons of the SSE, the study attempted (1) to identify the most important domains determining a good outcome from a patients’ as well as a surgeon’s perspective, and (2) to explore regional differences in the identified domains. For this purpose, a structured interview was performed among 30 spine surgeons of the SSE and 353 spine surgery patients (representing Northern, Central and Southern Europe) to investigate their criteria for a good outcome. A qualitative and descriptive approach was used to evaluate the data. Results revealed a high agreement on what comprises a good outcome among surgeons and patients, respectively. The main parameters determining good outcome were achieving the patients’ expectations/satisfaction, pain relief, improvement of disability and social reintegration. Younger patients more often expected a complete pain relief, an improved work capacity, and better social life participation. Patients in southern Europe more often wanted to improve work capacity compared to those from central and northern European countries. No substantial differences were found when patients’ and surgeons’ perspective were compared. However, age and differences in national social security and health care system (“black flags”) have an impact on what is considered a good outcome in spinal surgery. PMID:17990007
Eysenbach, Gunther; Wyatt, Jeremy
This paper concerns the use of the Internet in the research process, from identifying research issues through qualitative research, through using the Web for surveys and clinical trials, to pre-publishing and publishing research results. Material published on the Internet may be a valuable resource for researchers desiring to understand people and the social and cultural contexts within which they live outside of experimental settings, with due emphasis on the interpretations, experiences, and views of 'real world' people. Reviews of information posted by consumers on the Internet may help to identify health beliefs, common topics, motives, information, and emotional needs of patients, and point to areas where research is needed. The Internet can further be used for survey research. Internet-based surveys may be conducted by means of interactive interviews or by questionnaires designed for self-completion. Electronic one-to-one interviews can be conducted via e-mail or using chat rooms. Questionnaires can be administered by e-mail (e.g. using mailing lists), by posting to newsgroups, and on the Web using fill-in forms. In "open" web-based surveys, selection bias occurs due to the non-representative nature of the Internet population, and (more importantly) through self-selection of participants, i.e. the non-representative nature of respondents, also called the 'volunteer effect'. A synopsis of important techniques and tips for implementing Web-based surveys is given. Ethical issues involved in any type of online research are discussed. Internet addresses for finding methods and protocols are provided. The Web is also being used to assist in the identification and conduction of clinical trials. For example, the web can be used by researchers doing a systematic review who are looking for unpublished trials. Finally, the web is used for two distinct types of electronic publication. Type 1 publication is unrefereed publication of protocols or work in progress (a 'post
Teerawichitchainan, Bussarawan; Korinek, Kim
War is deemed a major threat to public health; yet, the long-term effects of war on individual health have rarely been examined in the context of developing countries. Based on data collected as a pilot follow-up to the Vietnam Longitudinal Survey, this study examines current health profiles of northern Vietnamese war survivors who entered early adulthood during the Vietnam War and now represent Vietnam's older adult population. To ascertain how war and military service in the early life course may have had long-term impacts on health status of Vietnam's current older adults, we compare multi-dimensional measures of health among veterans and nonveterans, and within these groups, regardless of their military service, between combatants and noncombatants. Multivariate results suggest that despite prolonged exposure to war, veterans and those who served in combat roles are not significantly different from their civilian and noncombatant counterparts on most health outcomes later in life. This is in contrast to American veterans who fought on the opposing side of the war. The near absence of differences in older adult health among northern Vietnamese with varying degrees of war involvement might be explained by the encompassing extent of war; the notion that time heals; and the hardiness and resilience against ill health that are by-products of shared struggle in war and a victorious outcome. PMID:22475403
Kim, Harris Hyun-Soo
Research on the social determinants of health suggests that interpersonal networks play a critical role in facilitating individual mental and physical well-being. Prior studies also indicate that ecological or contextual factors contribute to positive health outcomes. This study extends prior research by examining the factors associated with adolescent health in an Asian context. Based on the multilevel analysis of the Korean Youth Panel Survey (2006 & 2007), a longitudinal project funded by the Korean government, it investigates some of the key variables related to the mental health of Korean students. Much of previous research focuses on the functions of social capital. This study contributes to the social epidemiology literature by investigating the possible downside of network ties. Specifically, it asks whether having delinquent friends is associated with negative mental health experiences. In addition, little research has been conducted concerning the associations between adolescent health outcomes and school characteristics. This study moves in that direction by examining the relationship between mental well-being of students and a variety of school related variables (e.g., subjective attitude toward sc