Bowen, Sonya E
The Medicare Health Outcomes Survey (HOS) provides a rich source of outcomes data on the Medicare Advantage (MA) program for the US Department of Health and Human Services, managed care organizations participating in Medicare, quality improvement organizations, and health services researchers working to improve quality of care for Medicare enrollees. Since 1998, the Centers for Medicare and Medicaid Services has collected longitudinal functional status information to assess the performance of Medicare managed care organizations. This introduction reviews the goals of the HOS program, how the HOS supports health care reform, and outlines recent HOS studies exploring data applications for monitoring outcomes and implementing quality improvement activities.
Background The need for a mobile workforce inevitably means that the length of the total work day (working and traveling time) will increase, but the health effects of commuting have been surprisingly little studied apart from perceived stress and the benefits of physically active commuting. Methods We used data from two cross-sectional population-based public health surveys performed in 2004 and 2008 in Scania, Sweden (56% response rate). The final study population was 21, 088 persons aged 18-65, working > 30 h/week. Duration (one-way) and mode of commuting were reported. The outcomes studied were perceived poor sleep quality, everyday stress, low vitality, mental health, self-reported health, and absence from work due to sickness during the past 12 months. Covariates indicating socioeconomic status and family situation, overtime, job strain and urban/rural residency were included in multivariate analyses. Subjects walking or cycling to work < 30 min were used as a reference category. Results Monotonous relations were found between duration of public transport commuting and the health outcomes. For the category commuting > 60 min odds ratios (ORs) ranged from 1.2 - 1.6 for the different outcomes. For car commuting, the relationships were concave downward or flat, with increasing subjective health complaints up to 30-60 min (ORs ranging from 1.2 - 1.4), and lower ORs in the > 60 min category. A similar concave downward relationship was observed for sickness absence, regardless of mode of transport. Conclusions The results of this study are concordant with the few earlier studies in the field, in that associations were found between commutation and negative health outcomes. This further demonstrates the need to consider the negative side-effects of commuting when discussing policies aimed at increasing the mobility of the workforce. Studies identifying population groups with increased susceptibility are warranted. PMID:22039952
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
Carty, Denise C; Kruger, Daniel J; Turner, Tonya M; Campbell, Bettina; DeLoney, E Hill; Lewis, E Yvonne
Many community-based participatory research (CBPR) partnerships address social determinants of health as a central consideration. However, research studies that explicitly address racism are scarce in the CBPR literature, and there is a dearth of available community-generated data to empirically examine how racism influences health disparities at the local level. In this paper, we provide results of a cross-sectional, population-based health survey conducted in the urban areas of Genesee and Saginaw Counties in Michigan to assess how a sustained community intervention to reduce racism and infant mortality influenced knowledge, beliefs, and experiences of racism and to explore how perceived racism is associated with self-rated health and birth outcomes. We used ANOVA and regression models to compare the responses of intervention participants and non-participants as well as African Americans and European Americans (N = 629). We found that intervention participants reported greater acknowledgment of the enduring and differential impact of racism in comparison to the non-intervention participants. Moreover, survey analyses revealed that racism was associated with health in the following ways: (1) experiences of racial discrimination predicted self-rated physical health, mental health, and smoking status; (2) perceived racism against one's racial group predicted lower self-rated physical health; and (3) emotional responses to racism-related experiences were marginally associated with lower birth-weight births in the study sample. Our study bolsters the published findings on perceived racism and health outcomes and highlights the usefulness of CBPR and community surveys to empirically investigate racism as a social determinant of health.
Scheirer, Mary Ann; Hartling, Gretchen; Hagerman, Diane
Evaluative research for questions of program sustainability has expanded substantially in recent years, but definitional issues remain. This paper presents definitions for four different types of sustainability as potential outcomes of health programs. We then illustrate these definitions with descriptive findings from an on-line survey to "look back" at the extent and types of sustainability that occurred among 48 community-based projects that had received short-term funding from a foundation-funded health program in New Jersey. We found that large percentages of respondents reported positively to each of four types of sustainability measures-maintaining program activities, continuing to serve substantial numbers of clients, building and sustaining collaborative structures, and maintaining attention to the ideas underlying the projects by disseminating them to others. Strengths and limitations of this methodology for future evaluation are also discussed.
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Akobirshoev, Ilhom; Bowser, Diana; Parish, Susan L; Thomas, Cindy; Bachman, Sara S
Although the United States has made great strides in ensuring near universal health care access for children, the health insurance coverage gap between children and their parents remains high. This study analyzed aggregated data from the 2006-2013 National Health Interview Survey to investigate the direct relationships between parental uninsurance and children's health outcomes. Authors explored how parental health mediates the relationship between parents' health and children's health outcomes. Results suggest that insured children of uninsured parents have worse health status and are at higher risk of asthma, attention-deficit/hyperactivity disorder, developmental delays, learning disabilities, and mental disabilities compared with insured children of insured parents. Parental health mediated this relationship. These findings illuminate the pathway between parental uninsurance and child health outcomes and suggest that policies that provide health insurance coverage to both children and their parents may improve both parental health and children's health outcomes. This study fills an important gap in the literature related to how parental uninsurance affects children's health outcomes mediated by the impact of uninsurance on parental health.
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…
Savel, Craig; Mierzwa, Stan; Gorbach, Pamina M.; Souidi, Samir; Lally, Michelle; Zimet, Gregory; Interventions, AIDS
This paper reports on a specific Web-based self-report data collection system that was developed for a public health research study in the United States. Our focus is on technical outcome results and lessons learned that may be useful to other projects requiring such a solution. The system was accessible from any device that had a browser that supported HTML5. Report findings include: which hardware devices, Web browsers, and operating systems were used; the rate of survey completion; and key considerations for employing Web-based surveys in a clinical trial setting. PMID:28149445
Savel, Craig; Mierzwa, Stan; Gorbach, Pamina M; Souidi, Samir; Lally, Michelle; Zimet, Gregory; Interventions, Aids
This paper reports on a specific Web-based self-report data collection system that was developed for a public health research study in the United States. Our focus is on technical outcome results and lessons learned that may be useful to other projects requiring such a solution. The system was accessible from any device that had a browser that supported HTML5. Report findings include: which hardware devices, Web browsers, and operating systems were used; the rate of survey completion; and key considerations for employing Web-based surveys in a clinical trial setting.
Ormshaw, Michael James; Kokko, Sami Petteri; Villberg, Jari; Kannas, Lasse
Purpose: The purpose of this paper is to utilise the collective opinion of a group of Finnish experts to identify the most important learning outcomes of secondary-level school-based health education, in the specific domains of physical activity and nutrition. Design/ Methodology/ Approach: The study uses a Delphi survey technique to collect the…
Patty, Willard W.
This 1949 paper considers the evaluation of health education outcomes. It describes the nature of health education, discusses whether it is possible to measure all health education outcomes, then examines how to evaluate student health habits and skills, health attitudes, and health knowledge. It concludes that it is important to evaluate health…
Background The aim was to survey current practice in glucocorticoid replacement therapy and self-perceived health outcomes in patients with adrenal insufficiency. Methods Participants were recruited via patient organizations to respond anonymously to a web-based survey developed by clinical experts. Unique entries were set up for each patient organization enabling geographical localization of the entries. Results 1245 participants responded (primary adrenal insufficiency: 84%; secondary adrenal insufficiency: 11%; unsure: 5%). Therapies included hydrocortisone (75%), prednisone/prednisolone (11%), cortisone acetate (6%) and dexamethasone (4%). Dosing regimens were once daily (10%), twice daily (42%), thrice daily (32%) or other (17%). Compromised subjective health necessitating changes to physical activity or social-, work- or family life was reported by 64% of the participants. 40% of the participants reported absence from work/school in the last 3 months. Irrespective of diagnosis, 76% were concerned about long-term side-effects of therapy, mainly osteoporosis (78%), obesity (64%) and cardiovascular morbidity (46%). 38% of the participants had been hospitalized in the last year. Conclusions Glucocorticoid replacement therapy among the respondents consisted primarily of hydrocortisone administered twice or thrice daily. A majority reported impact of their disease or treatment on subjective health requiring alterations in e.g. physical activity or family life. Three quarters reported concerns about long-term side-effects of the treatment. These data demonstrate - from the patients' perspective - a need for improvement in the management of adrenal insufficiency. PMID:22695167
Motomura, Kenichiro; Ganchimeg, Togoobaatar; Nagata, Chie; Ota, Erika; Vogel, Joshua P.; Betran, Ana Pilar; Torloni, Maria Regina; Jayaratne, Kapila; Jwa, Seung Chik; Mittal, Suneeta; Dy Recidoro, Zenaida; Matsumoto, Kenji; Fujieda, Mikiya; Nafiou, Idi; Yunis, Khalid; Qureshi, Zahida; Souza, Joao Paulo; Mori, Rintaro
Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium- or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (≤6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth <37 weeks (AOR 3.52). Women with uterine rupture had significantly higher risk of maternal death (AOR 4.45) and perinatal death (AOR 33.34). Women with prior CS, especially in resource-limited settings, are facing higher risk of uterine rupture and subsequent adverse outcomes. Further studies are needed for prevention/management strategies in these settings. PMID:28281576
Setia, Maninder Singh; Quesnel-Vallee, Amelie; Abrahamowicz, Michal; Tousignant, Pierre; Lynch, John
The response of immigrants to new societies is dynamic. There may be an initial period of happiness followed by peaks of stressful periods. These reactions along with socio-economic changes are likely to influence their health, which may start converging towards the average health of the host population. We used a longitudinal analysis to assess the differences in health outcomes (mental health and self-rated health), separately in men and women, in Canadian born and immigrants over a 12-year period (and the associated socio-economic factors). We used random effects logistic regression models for evaluation of these health outcomes in 3,081 men and 4,187 women from the National Population Health Survey (1994/95 to 2006/07). After adjusting for all the covariates, non-white immigrants were less likely to have severe psychological distress compared with the Canadian born individuals [odds ratio (OR) Men: 0.49, 95% confidence intervals (CI) 0.24-1.00, Women-OR: 0.54; 95% CI: 0.32-0.92]. Immigrant women (white and non-white) were more likely to rate their health as poor through this 12-year period than the Canadian born women (White-OR: 1.64, 95% CI: 1.17-2.64; Non-white-OR: 1.82, 95% CI: 1.01-3.28). Immigrants in the lowest income adequacy category reported higher psychological distress and poorer health than those in the highest income categories. We did not find any significant differences in the mental health and self-rated health of Canadian men and white male immigrants throughout this 12-year period. Though, non-white immigrant women were less likely to have severe psychological distress through this 12 year period, they were the ones most likely to rate their health as poor.
Secor-Turner, Molly; Sieving, Renee; Widome, Rachel; Plowman, Shari; Vanden Berk, Eric
Background: To achieve high participation rates and a representative sample, active parent consent procedures require a significant investment of study resources. The purpose of this article is to describe processes and outcomes of utilizing active parent consent procedures with sixth-grade students from urban, ethnically diverse, economically…
Heidkamp, Rebecca A; Ayoya, Mohamed Ag; Teta, Ismael Ngnie; Stoltzfus, Rebecca J; Marhone, Joseline Pierre
The Haitian National Nutrition Policy identifies the promotion of optimal complementary feeding (CF) practices as a priority action to prevent childhood malnutrition. We analysed data from the nationally representative 2005-2006 Haiti Demographic Health Survey using the World Health Organization 2008 infant and young child feeding indicators to describe feeding practices among children aged 6-23 months and thus inform policy and programme planning. Multivariate regression analyses were used to identify the determinants of CF practices and to examine their association with child growth outcomes. Overall, 87.3% of 6-8-month-olds received soft, solid or semi-solid foods in the previous 24 h. Minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) were achieved in 29.2%, 45.3% and 17.1% of children aged 6-23 months, respectively. Non-breastfed children were more likely to achieve MDD than breastfed children of the same age (37.3% vs. 25.8%; P < 0.001). The proportion of children achieving MMF varied significantly by age (P < 0.001). Children with overweight mothers were more likely to achieve MDD, MMF and MAD [odds ratio (OR) 2.08, P = 0.012; OR 1.81, P = 0.02; and OR 2.4, P = 0.01, respectively] than children of normal weight mothers. Odds of achieving MDD and MMF increased with household wealth. Among mothers with secondary or more education, achieving MDD or MAD was significantly associated with lower mean weight-for-age z-score and height-for-age z-score (P-value <0.05 for infants and young child feeding indicator × maternal education interaction). CF practices were mostly inadequate and contributed to growth faltering among Haitian children 6-23 months old.
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.
Seil, Kacie S.; Desai, Mayur M.
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
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.
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…
Thorne, Frederick C.
The Personal Health Survey (PHS) is a 200-item inventory designed to sample symptomatology as subjective experiences from the 12 principal domains of organ system and psychophysiological functioning. This study investigates the factorial validity of the empirically constructed scales. (Author)
Walsh, Madeline; Garg, Priya; Steel, Alexis; Mehta, Sahil; Data, Santorino; Petersen, Rebecca; Guarino, Anthony J; Bailey, Elizabeth; Bangsberg, David R
Background Healthcare-focused hackathons are 48-hour platforms intended to accelerate novel medical technology. However, debate exists about how much they contribute to medical technology innovation. The Consortium for Affordable Medical Technologies (CAMTech) has developed a three-pronged model to maximise their effectiveness. To gauge the success of this model, we examined follow-up outcomes. Methods Outcomes of 12 hackathons from 2012 to 2015 in India, Uganda and the USA were measured using emailed surveys. To minimise response bias, non-responding teams were coded as having made no progress. Results 331 individuals provided information on 196 of 356 projects (55.1% response rate), with no difference in responses from teams participating in different countries (Cramer's V=0.09, p=0.17). 30.3% of projects had made progress after a mean of 12.2 months. 88 (24.7%) teams had initiated pilot testing, with 42 (11.8%) piloting with care providers and 24 (6.7%) with patients. Overall, 97 teams (8.1 per hackathon) drafted business plans, 22 (1.8 per hackathon) had filed patents on their innovations and 15 (1.3 per hackathon) had formed new companies. Teams raised US$64.08 million in funding (average US$5.34 million per hackathon; median award size of $1800). In addition, 108 teams (30.3%) reported at least one member working on additional technologies with people they met at a hackathon. Individual confidence to address medical technology challenges was significantly increased after attending (t(1282)=192.77, p 0.001). Conclusion CAMTech healthcare hackathons lead to consistent output with respect to medical technology innovation, including clinical trials, business plan development, securing investment capital/funding and new company formation. PMID:28250965
Heidkamp, Rebecca; Ayoya, Mohamed Ag; Teta, Ismael Ngnie; Stoltzfus, Rebecca J; Marhone, Joseline Pierre
Haiti's national nutrition policy prioritises breastfeeding, but limited data are available to inform strategy. We examined national trends in early initiation of breastfeeding (ErIBF) and exclusive breastfeeding (EBF) over a 10-year period using data from three Haitian Demographic and Health Surveys (1994-1995, 2000 and 2005-2006). We used multivariate regression methods to identify determinants of ErIBF and EBF in the 2005-2006 data set and to examine relationships to growth. There was no change in ErIBF across surveys [1994-1995: 36.6%, 95% confidence interval (CI) 29.9-43.9; 2000: 49.4%, 95% CI 44.1-54.8; 2005-2006: 43.8%, 95% CI 40.5-47.1]. EBF among 0-5-month-olds increased sharply (1994-18995: 1.1%, 95% CI 0.4-3.2; 2000: 22.4%, 95% CI 16.5-29.5; 2005-2006: 41.2%, 95% CI 35.4-47.2). The proportion of breastfeeding children 0-5 months who received soft, solid or semi-solid foods decreased (1994-1995: 68.5%, 95% CI 57.3-77.9; 2000: 46.3%, 95% CI 39.3-53.4; 2005-2006: 30.9%, 95% CI 25.9-36.5). Child age at time of survey [odds ratio (OR) 1.73; P = 0.027], lower maternal education (OR = 2.14, P = 0.004) and residence in the Artibonite Department (OR 0.31; P = 0.001) were associated with ErIBF among children 0-23 months. Age group and department were significant predictors of EBF among children 0-5 months. ErIBF was associated with higher weight-for-age z-scores [effect size (ES) 0.22; P = 0.033] and height-for-age z-scores (ES 0.20; P = 0.044). There was no statistically significant relationship between EBF and growth. The 10-year ErIBF and EBF trends in Haiti echo global and regional trends. ErIBF and EBF are related practices but with different determinants in the Haitian context. These differences have implications for intervention delivery.
This paper examines the relationship between the inequality in workplace conditions and health-related outcomes in Japan. It analyzes the effect of changes in the work conditions and work arrangements on the subjective health, activity restriction, and depression symptoms, using the Japanese Life Course Panel Survey (JLPS). The 2007 JLPS consists of nationally representative sample of the youth (20 to 34 yr old) and the middle-aged (35 to 40 yr old). The original respondents were followed up in 2008, and 2,719 respondents for the youth panel and 1,246 for the middle-aged panel returned the questionnaires. The first major conclusion is that there are substantial changes in health conditions between the two waves even though the distributions of health-related outcomes are very similar at two time points. The second major conclusion is that the effects of work conditions depend on different health-related outcomes. Self-reported health and depression symptoms are affected by a variety of job-related factors. The atmosphere of helping each other and the control over the pace of work are two important factors which affect both depression and self-reported health. All these findings suggest that the workplace conditions and job characteristics have profound influence on the workers' health.
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
Salo, Päivi M.; Calatroni, Agustin; Gergen, Peter J.; Hoppin, Jane A.; Sever, Michelle L.; Jaramillo, Renee; Arbes, Samuel J.; Zeldin, Darryl C.
Background The National Health and Nutrition Examination Survey (NHANES) 2005–2006 was the first population-based study to investigate levels of serum total and allergen-specific immunoglobulin E (IgE) in the general US population. Objective We estimated prevalence of allergy-related outcomes and examined relationships between serum IgE levels and these outcomes in a representative sample of the US population. Methods Data for this cross-sectional analysis were obtained from the NHANES 2005–2006. Study subjects aged 6 years and older (N=8086) had blood taken for measurement of total IgE and 19 specific IgEs against common aeroallergens, including Alternaria alternata, Aspergillus fumigatus, Bermuda grass, birch, oak, ragweed, Russian thistle, rye grass, cat dander, cockroach, dog dander, dust mite (Dermatophagoides farinae and D. pteronyssinus), mouse and rat urine proteins; and selected foods (egg white, cow’s milk, peanut, and shrimp). Serum samples were analyzed for total and allergen-specific IgEs using the Pharmacia CAP System. Information on allergy-related outcomes and demographics was collected by questionnaire. Results In the NHANES 2005–2006, 6.6% reported current hay fever and 23.5% suffered from current allergies. Allergy-related outcomes increased with increasing total IgE (adjusted ORs for a 10-fold increase in total IgE =1.86, 95% CI:1.44–2.41 for hay fever and 1.64, 95% CI: 1.41–1.91 for allergies). Elevated levels of plant-, pet-, and mold-specific IgEs contributed independently to allergy-related symptoms. The greatest increase in odds was observed for hay fever and plant-specific IgEs (adjusted OR=4.75, 95% CI:3.83–5.88). Conclusion In the US population, self-reported allergy symptoms are most consistently associated with elevated levels of plant-, pet-, and mold-specific IgEs. PMID:21320720
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.
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,…
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…
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.
Stewart, T; May, P; Muneta, A
The findings of a health consumer survey of 309 Navajo families in three areas of the Navajo Reservation are reported. The survey shows that access to facilities and lack of safe water and sanitary supplies are continuing problems for these families. The families show consistent use of Indian Health Service providers, particularly nurses, pharmacists and physicians, as well as traditional Navajo medicine practitioners. Only incidental utilization of private medical services is reported. Extended waiting times and translation from English to Navajo are major concerns in their contacts with providers. A surprisingly high availability of third-party insurance is noted. Comparisons are made between this data base and selected national and regional surveys, and with family surveys from other groups assumed to be disadvantaged in obtaining health care. The comparisons indicate somewhat lower utilization rates and more problems in access to care for this Navajo sample. The discussion suggests that attitudes regarding free health care eventually may be a factor for Navajo people and other groups, that cultural considerations are often ignored or accepted as truisms in delivering care, and that the Navajo Reservation may serve as a unique microcosm of health care in the U.S.
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…
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...
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…
Lundborg, Petter; Nilsson, Anton; Rooth, Dan-Olof
Whereas a large literature has shown the importance of early life health for adult socioeconomic outcomes, there is little evidence on the importance of adolescent health. We contribute to the literature by studying the impact of adolescent health status on adult labor market outcomes using a unique and large-scale dataset covering almost the entire population of Swedish males. We show that most types of major conditions have long-run effects on future outcomes, and that the strongest effects result from mental conditions. Including sibling fixed effects or twin pair fixed effects reduces the magnitudes of the estimates, but they remain substantial.
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…
Background The District Health Information System was developed in South Africa to collect aggregated routine data from public health facilities. In Amajuba District, KwaZulu-Natal, ward-based data collection has been initiated to facilitate improved responsiveness to community health needs and improve health outcomes and patient satisfaction. Aim To assess the application of the municipal ward-based health data in the decision-making process to improve child health outcomes. Setting The study was conducted in 25 primary health care service sites in Amajuba. Methods A cross-sectional mixed methods’ approach was used. The study population comprised operational managers, professional nurses, ward-based outreach team leaders and supervisors. Quantitative data were collected using a semi-structured questionnaire and analysed using descriptive statistics. Qualitative data were collected using focus group discussions and analysed using thematic analysis. Results Of the 131 respondents, 83 (67.5%) provided targeted child interventions to a certain or a large extent to improve child health outcomes, but only 74 (57.4%) respondents reported using municipal ward-based health data to a certain or large extent in order to inform their decisions. This discrepancy indicates poor utilisation of local health information for decision-making. Conclusion The study showed that municipal ward-based health data are not fully utilised for making informed decisions to improve child health outcomes. It is imperative to inculcate a culture of evidence-informed decisions that leads to provision of targeted interventions in order to mitigate the challenge of scarcity of resources and to improve child health outcomes. PMID:28155323
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…
Ferguson, T S; Tulloch-Reid, M K; Gordon-Strachan, G; Hamilton, P; Wilks, R J
Over the last six decades, comprehensive national health surveys have become important data-gathering mechanisms to inform countries on their health status and provide information for health policy and programme planning. Developing countries have only recently begun such surveys and Jamaica has been at the forefront of this effort. Jamaica's Reproductive Health Surveys and programme response to their findings have resulted in an almost 50% reduction infertility rates over three decades as well as a 40% reduction in unmet contraceptive needs and a 40% reduction in unplanned pregnancies over the last two decades. The Jamaica Health and Lifestyle Surveys have served to reinforce the major burden that non-communicable diseases place on the society and the extent to which these are driven by unhealthy lifestyles. These surveys have shown that obesity, hypertension, diabetes and dyslipidaemia affect approximately 50%, 25%, 10% and 10% of the adult population, respectively. These surveys have documented low rates of treatment and control for these chronic non-communicable diseases despite two major policy initiatives, the National Programme for the Promotion of Healthy Lifestyles and the creation of the National Health Fund which subsidizes healthcare provision for chronic diseases. In order to maximize the uptake of the findings of future surveys into effective health policy, there will need to be effective collaborations between academia, policy-makers, regional and international health agencies, non-government organizations and civil society. Such collaborations should take into account the social, political and economic issues, thus ensuring a more comprehensive approach to health policy and result in improvement of the nation's health status and by extension national development.
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…
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.
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
American School Health Association, Kent, OH.
The National Adolescent Student Health Survey (NASHS), initiated in 1985, is conducted to examine the health-related knowledge, practices, and attitudes of the nation's youth in the following health areas: AIDS; Nutrition; Consumer Health; Sexually Transmitted Disease; Drug and Alcohol Use; Suicide; Injury Prevention; and Violence. Findings…
Farag, Marwa; Nandakumar, A K; Wallack, Stanley; Hodgkin, Dominic; Gaumer, Gary; Erbil, Can
This paper examines the relationship between country health spending and selected health outcomes (infant mortality and child mortality), using data from 133 low and middle-income countries for the years 1995, 2000, 2005, and 2006. Health spending has a significant effect on reducing infant and under-5 child mortality with an elasticity of 0.13 to 0.33 for infant mortality and 0.15 to 0.38 for under-5 child mortality in models estimated using fixed effects methods (depending on models employed). Government health spending also has a significant effect on reducing infant and child mortality and the size of the coefficient depends on the level of good governance achieved by the country, indicating that good governance increases the effectiveness of health spending. This paper contributes to the new evidence pointing to the importance of investing in health care services and the importance of governance in improving health outcomes.
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.
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.
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
The Student Outcomes Survey is an annual national survey of vocational education and training (VET) students. Since 1995, participants have been asked to rate their satisfaction with different aspects of their training, grouped under three main themes: teaching, assessment, and generic skills and learning experiences. While the composition of the…
Pinkerton, JoAnn V; Stovall, Dale W
Changes in ovarian hormone production may affect numerous health outcomes including vasomotor symptoms, cardiovascular disease (CVD), osteoporosis, cognition, depression, mood disorders, sexual function, and vaginal atrophy. We will compare age-related changes to those associated with reproductive aging and menopause and the effects of estrogen therapy on selected health outcomes. Hormone therapy (HT) reduces frequency and severity of hot flashes, prevents bone loss and osteoporotic fractures, and relieves vaginal atrophy. Nonhormone therapy trials with antidepressants or gabapentin for hot flash relief are promising. To date, clinical trial data are insufficient to recommend the use of HT for prevention or treatment of CVD, mood disorders, cognition, or sleep disorders. For some disease states, such as CVD and cognition, a "critical time window" has been proposed but not proven, such that estrogen use early in the menopause transition may be beneficial while estrogen use later in life would lead to increased health risks.
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
The NHIS collects data on a broad range of health topics through personal household interviews. The results of NHIS provide data to track health status, health care access, and progress toward achieving national health objectives.
Ota, Erika; Ganchimeg, Togoobaatar; Morisaki, Naho; Vogel, Joshua P.; Pileggi, Cynthia; Ortiz-Panozo, Eduardo; Souza, João P.; Mori, Rintaro
Background Small for gestational age (SGA) is not only a major indicator of perinatal mortality and morbidity, but also the morbidity risks in later in life. We aim to estimate the association between the birth of SGA infants and the risk factors and adverse perinatal outcomes among twenty-nine countries in Africa, Latin America, the Middle East and Asia in 359 health facilities in 2010–11. Methods We analysed facility-based, cross-sectional data from the WHO Multi-country Survey on Maternal and Newborn Health. We constructed multilevel logistic regression models with random effects for facilities and countries to estimate the risk factors for SGA infants using country-specific birthweight reference standards in preterm and term delivery, and SGA’s association with adverse perinatal outcomes. We compared the risks and adverse perinatal outcomes with appropriate for gestational age (AGA) infants categorized by preterm and term delivery. Results A total of 295,829 singleton infants delivered were analysed. The overall prevalence of SGA was highest in Cambodia (18.8%), Nepal (17.9%), the Occupied Palestinian Territory (16.1%), and Japan (16.0%), while the lowest was observed in Afghanistan (4.8%), Uganda (6.6%) and Thailand (9.7%). The risk of preterm SGA infants was significantly higher among nulliparous mothers and mothers with chronic hypertension and preeclampsia/eclampsia (aOR: 2.89; 95% CI: 2.55–3.28) compared with AGA infants. Higher risks of term SGA were observed among sociodemographic factors and women with preeclampsia/eclampsia, anaemia and other medical conditions. Multiparity (> = 3) (AOR: 0.88; 95% CI: 0.83–0.92) was a protective factor for term SGA. The risk of perinatal mortality was significantly higher in preterm SGA deliveries in low to high HDI countries. Conclusion Preterm SGA is associated with medical conditions related to preeclampsia, but not with sociodemographic status. Term SGA is associated with sociodemographic status and
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
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
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,…
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
Dutta, Mousumi; Husain, Zakir
In this paper, we examine the relationship between socio-economic status (SES) and the usage of in-patient services, and analyze the impact of introducing health insurance in India - a major developing country with poor health outcomes. In contrast to results of similar works undertaken for developed countries, our results reveal that the positive relation between usage of in-patient services and SES persists even in the presence of health insurance. This implies that health insurance is unable to eliminate the inequities in accessing healthcare services that stem from disparities in SES. In fact, insurance aggravates inequity in the healthcare market. The study is based on unit-level data from the 2005-06 Morbidity and Health Care Survey undertaken by National Sample Survey Organization.
Eisner, Mark D.; Blanc, Paul D.; Omachi, Theodore A.; Yelin, Edward H.; Sidney, Stephen; Katz, Patricia P.; Ackerson, Lynn M.; Sanchez, Gabriela; Tolstykh, Irina; Iribarren, Carlos
Background Although COPD is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race-ethnicity on health outcomes. Methods We aimed to determine the independent impacts of SES and race-ethnicity on COPD severity status, functional limitations, and acute exacerbations of COPD among patients with access to health care. Data were used from the FLOW cohort study of 1,202 Kaiser Permanente Northern California Medical Care Plan members with COPD. Results Lower educational attainment and household income were consistently related to greater disease severity, poorer lung function, and greater physical functional limitations in cross-sectional analysis. Black race was associated with greater COPD severity, but these differences were no longer apparent after controlling for SES variables and other covariates (comorbidities, smoking, body mass index, and occupational exposures). Both lower education and income were independently related to a greater prospective risk of acute COPD exacerbation (HR 1.5; 95% CI 1.01 to 2.1; and HR 2.1; 95% CI 1.4 to 3.4, respectively). Conclusion Low SES is a risk factor for a broad array of adverse COPD health outcomes. Clinicians and disease management programs should consider SES as a key patient-level marker of risk for poor outcomes. PMID:19854747
Yasumura, Seiji; Abe, Masafumi
After the Great East Japan Earthquake on March 11, 2011, the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Plant accident occurred. The Fukushima prefectural government decided to launch the Fukushima Health Management Survey; Fukushima Medical University was entrusted to design and implement the survey. The survey process and development is described from the standpoint of its background and aim. An overview of the basic survey and 4 detailed surveys is briefly provided. Issues related to the survey are discussed from the perspective of supporting the Fukushima residents.
Russ, Christiana M.; Tran, Tony; Silverman, Melanie; Palfrey, Judith
Background and Objectives: To identify the effects of global health electives over a decade in a pediatric residency program. Methods: This was an anonymous email survey of the Boston Combined Residency alumni funded for global health electives from 2002 to 2011. A test for trend in binomial proportions and logistic regression were used to document associations between elective and participant characteristics and the effects of the electives. Qualitative data were also analyzed. Results: Of the 104 alumni with available email addresses, 69 (66%) responded, describing 94 electives. Elective products included 27 curricula developed, 11 conference presentations, and 7 academic publications. Thirty-two (46%) alumni continued global health work. Previous experience, previous travel to the site, number of global electives, and cumulative global elective time were associated with postresidency work in global health or with the underserved. Conclusions: Resident global electives resulted in significant scholarship and teaching and contributed to long-term career trajectories. PMID:28229096
Torrance, G W
Economic evaluation of health programs consists of the comparative analysis of alternative courses of action in terms of both costs and consequences. The five analytic techniques are cost-consequence analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. Although all techniques have the same objective of informing decision making in the health programs, they come from different theoretic backgrounds and relate differently to the discipline of economics. Cost-utility analysis formally incorporates the measured preferences of individuals for the health outcome consequences of the alternative programs. The individuals may be actual patients who are experiencing or have experienced the outcomes, or they may be a representative sample of the community, many of whom may someday face the outcomes. The health outcomes, at the most general level, consist of changes in the quantity and quality of life; that is, changes in mortality and morbidity. Changes in quantity of life are measured with mortality; changes in quality of life are measured with health-related quality-of-life instruments. Utilities represent a particular approach to the measurement of health-related quality of life that is founded on a well specified theory and provides an interval scale metric. Changes in quantity of life, as measured in years, can be combined with changes in quality of life, as measured in utilities, to determine the number of quality-adjusted life years gained by a particular health program. This can be compared with the incremental cost of the program to determine the cost per quality-adjusted life-year gained. Utilities may be measured directly on patients or other respondents by means of techniques such as visual analog scaling, standard gamble, or time trade-off. Utilities may be determined indirectly by means of a preference-weighted multi-attribute health status classification system such as the health utilities index
Allen-Ramey, Felicia C; Gupta, Shaloo; DiBonaventura, Marco daCosta
Background: Recent literature has suggested that emphysema and chronic bronchitis, traditionally considered to be entities overlapping within chronic obstructive pulmonary disease (COPD), may be distinct disorders. Few studies have examined the differences in patient characteristics and health outcomes between these conditions. This study examined whether COPD phenotypes represent distinct patient populations, in a large nationally representative US sample. Methods: Data were obtained from the 2010 US National Health and Wellness Survey (NHWS). NHWS respondents (n = 75,000) were categorized as a COPD phenotype based on their self-reported diagnosis of COPD only (n = 970), emphysema only (n = 399), or chronic bronchitis only (n = 2071). Phenotypes were compared on demographics, health characteristics, treatment patterns, health outcomes, work productivity, and resource use. Variables were compared using Chi-square and analysis of variance tests for categorical and continuous outcomes, respectively. Health outcomes were also examined using regression modeling, controlling for demographic and health characteristic covariates. Results: Patients with chronic bronchitis were significantly younger (51.38 years versus 63.24 years for COPD versus 63.30 years for emphysema, P < 0.05) and more likely to be employed (46.98% versus 23.81% for COPD versus 28.33% for emphysema, P < 0.05). Relative to the other phenotypes, patients with chronic bronchitis were also significantly more likely to be female, nonwhite, and to exercise currently (all P < 0.05), and were significantly less likely to be a current or former smoker (P < 0.05). Controlling for demographic and health characteristics, patients self-identified as having COPD only reported significantly worse physical quality of life (adjusted mean 36.69) and health utilities (adjusted mean 0.65) and significantly more absenteeism (adjusted mean 7.08%), presenteeism (adjusted mean 30.73%), overall work impairment (adjusted mean
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.
Bennett, Rachel E.; Boulos, David; Garber, Bryan G.; Jetly, Rakesh; Sareen, Jitender
Objective: The 2013 Canadian Forces Mental Health Survey (CFMHS) collected detailed information on mental health problems, their impacts, occupational and nonoccupational determinants of mental health, and the use of mental health services from a random sample of 8200 serving personnel. The objective of this article is to provide a firm scientific foundation for understanding and interpreting the CFMHS findings. Methods: This narrative review first provides a snapshot of the Canadian Armed Forces (CAF), focusing on 2 key determinants of mental health: the deployment of more than 40,000 personnel in support of the mission in Afghanistan and the extensive renewal of the CAF mental health system. The findings of recent population-based CAF mental health research are reviewed, with a focus on findings from the very similar mental health survey done in 2002. Finally, key aspects of the methods of the 2013 CFMHS are presented. Results: The findings of 20 peer-reviewed publications using the 2002 mental health survey data are reviewed, along with those of 25 publications from other major CAF mental health research projects executed over the past decade. Conclusions: More than a decade of population-based mental health research in the CAF has provided a detailed picture of its mental health and use of mental health services. This knowledge base and the homology of the 2013 survey with the 2002 CAF survey and general population surveys in 2002 and 2012 will provide an unusual opportunity to use the CFMHS to situate mental health in the CAF in a historical and societal perspective. PMID:27270738
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
Hays, R D; Sherbourne, C D; Mazel, R M
Recently, Ware and Sherbourne published a new short-form health survey, the MOS 36-Item Short-Form Health Survey (SF-36), consisting of 36 items included in long-form measures developed for the Medical Outcomes Study. The SF-36 taps eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, general mental health, social functioning, energy/fatigue, and general health perceptions. It also includes a single item that provides an indication of perceived change in health. The SF-36 items and scoring rules are distributed by MOS Trust, Inc. Strict adherence to item wording and scoring recommendations is required in order to use the SF-36 trademark. The RAND 36-Item Health Survey 1.0 (distributed by RAND) includes the same items as those in the SF-36, but the recommended scoring algorithm is somewhat different from that of the SF-36. Scoring differences are discussed here and new T-scores are presented for the 8 multi-item scales and two factor analytically-derived physical and mental health composite scores.
Ishii, Kayoko; Goto, Aya; Ota, Misao; Yasumura, Seiji; Fujimori, Keiya
The Pregnancy and Birth Survey was started by Fukushima Medical University as part of the Fukushima Health Management Survey in 2011 in order to assess the physical and mental health of mothers and provide parenting support (telephone counseling) for those in need. The present study reviewed the major findings from 4 annual surveys conducted from 2011 to 2014. Overall proportions of preterm deliveries, low birth weight infants, and congenital anomalies in the first year were almost the same as those in national surveillance data. The prevalence of depressive symptoms among the mothers held steady at about 25% over the 4 years. Regarding the content of parenting counseling, the proportion of mothers who voiced concerns about radiation decreased each year. This survey should be continued to provide support to mothers in Fukushima.
Lewis, P A; Charny, M
Medical students were taught survey methodology by participating in all phases of a large community survey. The survey examined health beliefs, knowledge and behaviour in a sample of 5150 people drawn from the electoral register of the City of Cardiff. The study achieved several educational objectives for the medical students: they met well people in their own homes and had an opportunity to get to know a community; by taking part in a study from the initial phases to the conclusion they could appreciate the context of the theoretical teaching they were being given concurrently in their undergraduate course; they learnt to analyse raw data and produce reports; and they gained insights into the health knowledge, behaviour, attitudes and beliefs of a population. In addition, the survey produced a substantial quantity of valuable data which staff and students are analysing and intend to publish.
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…
Haskell, William L; Blair, Steven N; Hill, James O
This manuscript presents a brief summary of the substantial data supporting an inverse relationship between the amount of habitual physical activity performed and a variety of negative health outcomes throughout the lifespan. It points out that despite these data a large segment of the US population remain insufficiently active resulting in a high population attributable risk for chronic disease due to inactivity. The accumulated data support the need for more comprehensive health promoting physical activity policies and programs, especially for the economically and socially disadvantaged and medically underserved.
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.
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
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.
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…
Richardson, Glenn E.; Jose, Nancy
The need for a code of ethics for health educators is discussed, and results of a survey of school health educators' opinions on curriculum-related ethical issses are reported. Ethical issues of concern include use of scare tactics, efforts to change behavior and attitudes, and appropriate subject matter. (PP)
In 1990, a telephone survey was conducted of health services offered by California's community colleges. Statewide, 42 of the 71 districts in California levied a health service fee, 18 districts offered services without charge, and 11 offered no service. Districts operating programs collected an average of $15.81 in student fees per credit average…
Kvasnica, Barbara; And Others
The results of a study on the health care needs and utilization patterns of Hispanic (primarily Mexican American) families in southeastern Wisconsin are presented in this report. The methodology of the study, which included two surveys in a 9 county area, is described. Findings of the two studies, one focusing on health services utilization by…
Avey, Holly; Matheny, Kenneth B.; Robbins, Anna; Jacobson, Terry A.
In order to assess health care providers' training, perceptions, and practices regarding stress and health outcomes, a survey was administered to primary care providers in the outpatient medical clinics of a southeastern urban hospital serving a predominantly African-American indigent population. One-hundred-fifty-one of 210 providers (72%) responded. Forty-two percent of respondents reported receiving no instruction regarding stress and health outcomes during their medical/professional education. While 90% believed stress management was "very" or "somewhat" effective in improving health outcomes, 45% "rarely" or "never" discussed stress management with their patients. Respondents were twice as likely to believe that counseling patients about smoking, nutrition, or exercise was more important than counseling them about stress. Seventy-six percent lacked confidence in their ability to counsel patients about stress. The majority of respondents (57%) "rarely" or "never" practiced stress reduction techniques themselves. Belief in the importance of stress counseling, its effectiveness in improving health, and confidence in one's ability to teach relaxation techniques were all related to the probability that providers would counsel patients regarding stress. There is a need for curriculum reform that emphasizes new knowledge about stress and disease, new skills in stress reduction, and more positive beliefs about mind/body medicine and its integration into the existing health care structure. PMID:14527051
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…
Krakauer, R S
It is important that physicians participate in the debate and planning process that will ultimately guide how we reform the way health care is financed and delivered in the United States. Herein is offered a perspective on the problem, one which is not necessarily appreciated by health planners. While we deliver the best quality of care in the world to most of our population, our system has been severely criticized because we fail to provide for access to a substantial minority of our population. Additionally, the cost of the product is considerably greater than that in comparable countries. Attempts to control costs without diminishing quality have introduced expensive complexities into our system without any real success in cutting costs. Several proposals have been advanced to address the issues of cost and access. One of these is a single payer system, common in Europe and Canada, whereby a single agent or group of agents finances all health care through universal rules and means. A system operating in Hawaii is a simple employer mandate to provide health insurance. A uniquely American plan is the Jackson Hole Plan or Managed Competition (now called "Managed Cooperation"). This system is currently popular among national health planners, and involves a defined minimum managed health plan offered by various groups of providers to employees and individuals through health plan purchasing cooperatives. This plan is interesting, but has not been implemented in any jurisdiction, and it is not certain it would accomplish its goals in practice since it is difficult to predict behavior of all parties to such a system.
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.
Barta, Valerie; Thakkar, Jyotsana; Sakhiya, Vipulbhai; Miller, Ilene
Abstract Background. Pregnancy occurs among 1–7% of women on chronic dialysis. Experience regarding pregnancy and dialysis originates from anecdotal reports, case series and surveys. This survey updates the US nephrologists’ experience with pregnancy on hemodialysis (HD) over the past 5 years. We evaluated maternal and fetal outcomes, certain practice patterns such as dialysis regimens utilized and nephrologist knowledge and comfort level when caring for a pregnant patient on HD. Methods. An anonymous Internet-based 23-question survey was e-mailed to end-stage renal disease Networks of America program directors for forwarding to practicing nephrologists. Results. A total of 196 nephrologists responded to the survey, reporting >187 pregnancies. Of the respondents, 45% had cared for pregnant females on HD and 78% of pregnancies resulted in live births. In 44% of the pregnancies a diagnosis of preeclampsia was made. There were no maternal deaths. Nephrologists most commonly prescribe 4–4.5 h of HD 6 days/week for pregnant women on dialysis. Women dialyzed cumulatively for >20 h/week were 2.2 times more likely to develop preeclampsia than those who received ≤20 h of HD per week. Conclusion. Providing intensive HD is a common treatment approach when dialyzing pregnant women. Maternal and fetal outcomes can be improved. There is a trend toward better live birthrates with more intense HD. Whether more cumulative hours of dialysis per week increases the risk of preeclampsia needs to be further investigated.
Corsi, Daniel J; Neuman, Melissa; Finlay, Jocelyn E; Subramanian, S V
Demographic and Health Surveys (DHS) are comparable nationally representative household surveys that have been conducted in more than 85 countries worldwide since 1984. The DHS were initially designed to expand on demographic, fertility and family planning data collected in the World Fertility Surveys and Contraceptive Prevalence Surveys, and continue to provide an important resource for the monitoring of vital statistics and population health indicators in low- and middle-income countries. The DHS collect a wide range of objective and self-reported data with a strong focus on indicators of fertility, reproductive health, maternal and child health, mortality, nutrition and self-reported health behaviours among adults. Key advantages of the DHS include high response rates, national coverage, high quality interviewer training, standardized data collection procedures across countries and consistent content over time, allowing comparability across populations cross-sectionally and over time. Data from DHS facilitate epidemiological research focused on monitoring of prevalence, trends and inequalities. A variety of robust observational data analysis methods have been used, including cross-sectional designs, repeated cross-sectional designs, spatial and multilevel analyses, intra-household designs and cross-comparative analyses. In this profile, we present an overview of the DHS along with an introduction to the potential scope for these data in contributing to the field of micro- and macro-epidemiology. DHS datasets are available for researchers through MEASURE DHS at www.measuredhs.com.
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
Hoffman, Karen; Cole, Elaine; Playford, E. Diane; Grill, Eva; Soberg, Helene L.; Brohi, Karim
Importance Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients. Objective To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma. Data Sources MEDLINE, EMBASE, and CINAHL (from 2006–2012) were searched for studies evaluating health outcome after traumatic injuries. Study selection and data extraction Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts. Results 34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%). Conclusion Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care. PMID:25051353
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
Wagner, E H; Wickizer, T M; Cheadle, A; Psaty, B M; Koepsell, T D; Diehr, P; Curry, S J; Von Korff, M; Anderman, C; Beery, W L; Pearson, D C; Perrin, E B
OBJECTIVES: To present results from an outcome evaluation of the Henry J. Kaiser Family Foundation's Community Health Promotion Grants Program (CHPGP) in the West, which represented a major community-based initiative designed to promote improved health by changing community norms, environmental conditions, and individual behavior in 11 western communities. METHODS: The evaluation design: 14 randomly assigned intervention and control communities, 4 intervention communities selected on special merit, and 4 matched controls. Data for the outcome evaluation were obtained from surveys, administered every two years at three points in time, of community leaders and representative adults and adolescents, and from specially designed surveys of grocery stores. Outcomes for each of the 11 intervention communities were compared with outcomes in control communities. RESULTS: With the exception of two intervention communities-a largely Hispanic community and a Native American reservation-we found little evidence of positive changes in the outcomes targeted by the 11 intervention communities. The programs that demonstrated positive outcomes targeted dietary behavior and adolescent substance abuse. CONCLUSIONS: Improvement of health through community-based interventions remains a critical public health challenge. The CHPGP, like other prominent community-based initiatives, generally failed to produce measurable changes in the targeted health outcomes. Efforts should focus on developing theories and methods that can improve the design and evaluation of community-based interventions. PMID:10966086
Oak Ridge Institute for Science and Education
This annual survey collects 2006 data on the number of health physics degrees awarded as well as the number of students enrolled in health physics academic programs. Thirty universities offer health physics degrees; all responded to the survey.
Colorado State Dept. of Employment, Denver. Research and Analysis Section.
This study was conducted to supply information for vocational education planners concerning the employment needs of the health services industry in Colorado. It should also provide some indication of the demand for trained workers in the occupations surveyed by coordinating expected company expansion and replacement needs with the number to be…
Cotton, Sian; Zebracki, Kathy; Rosenthal, Susan L; Tsevat, Joel; Drotar, Dennis
Religion/spirituality is important to adolescents, is usually considered a protective factor against a host of negative health outcomes, and is often included in adolescent health outcomes research. Previous reviews of the relationship among spirituality, religion, and adolescent health have been limited by scope, focusing primarily on distal aspects of religion/spirituality (e.g., attendance at religious services). We reviewed the literature examining proximal domains of religion/spirituality (e.g., spiritual coping) in adolescent health outcomes research. Constructs such as spiritual coping and religious decision-making were the ones most often studied and were generally positively associated with health outcomes. Measurement of proximal domains, associations of proximal domains with health outcomes, methodological issues and recommendations for future research were covered in this review.
Hollier, Lauren P; Pettigrew, Simone; Minto, Carolyn; Slevin, Terry; Strickland, Mark
Issue addressed: Online surveys are becoming increasingly popular in health research because of the low cost and fast completion time. A large proportion of online survey costs are allocated to setup and administration expenses, which suggests that conducting fewer, longer surveys would be a cost-effective approach. The current study assessed whether the incorporation of a health campaign evaluation survey within a longitudinal attitudes and behaviours tracking survey produced different outcomes compared with the separate administration of the evaluation survey.Methods: Data were collected via an online panel, with 688 respondents completing the combined survey and 657 respondents completing the evaluation-only survey. Regression analyses were conducted to examine whether survey type was related to the campaign evaluation results.Results: Those who completed the combined survey perceived the campaign advertisement to be more personally relevant than those completing the evaluation-only survey. There were no differences in results relating to campaign awareness and reported behavioural change as a result of campaign exposure.Conclusions: There were minimal differences between results obtained from combining an attitude/behaviour tracking survey with a campaign evaluation survey. Any priming or order effects were limited to respondents' cognitive responses to the advertisement.So what?: The results suggest that health practitioners with limited resources available for tracking and evaluation research may be able to maximise outcomes by administering fewer, longer surveys.
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
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 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 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...
... 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 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...
Aday, L A; Andersen, R; Anderson, O W
The authors explore the utility of applying social survey data (a) to evaluate the impact of existing health programs and (b) to rank-order priorities concerning future health care policies. Based on national survey data from 1963, 1970, and 1976, they concluded that although Medicare and Medicaid have enabled more people to see a physician than ever before, a large proportion of the population still registers dissatisfaction with the health care they received--particularly with respect to their out-of-pocket costs for obtaining it. However, national health insurance options favored by the majority of the population--particularly those who can best afford the cost of care--suggest preferences for programs that incorporate some mix of existing modes of financing rather than those that provide for substantial restructuring of the current system. PMID:337340
Krause, James S; Broderick, Lynne E; Saladin, Lisa K; Broyles, Joy
Objective: The purpose of this study was to investigate heath disparities as a function of race and gender and the extent to which socioeconomic factors mediate disparities among participants with spinal cord injury. Design: Survey methodology. Cross-sectional data. Setting: A large Southeastern specialty hospital. Participants: There were 1,342 participants in the current analysis, all of whom were identified from patient records. There were 3 inclusion criteria: (a) traumatic SCI, (b) at least 18 years of age at the time of study, and (c) injury duration of more than 1 year. Main outcome measures: Six outcomes were measured, including 3 general outcomes (self-ratings, days impacted by poor health, days impacted by poor mental health) and 3 that reflect utilization of services (hospitalizations, days hospitalized, and nonroutine physician visits in the past 2 years). Results: Results of multivariate analysis of variance (MANOVA) indicated significant main effects for both race and gender. Follow-up tests identified racial disparities on 3 of the 6 outcomes, whereas gender disparities were observed for a single outcome. Years of education and household income mediated interrelationships between race and health (but not gender) as racial disparities disappeared after consideration of these factors. Conclusions: These findings suggest the need to work more diligently to promote better health outcomes among African Americans and to further investigate how socioeconomic factors and access to health care related to diminished health outcomes among African Americans with spinal cord injury. PMID:16572561
Michalopoulou, Georgia; Falzarano, Pamela; Butkus, Michael; Zeman, Lori; Vershave, Judy; Arfken, Cynthia
Minorities in the United States have well-documented health disparities. Cultural barriers and biases by health care providers may contribute to lower quality of services which may contribute to these disparities. However, evidence linking cultural competency and health outcomes is lacking. This study, part of an ongoing quality improvement effort, tested the mediation hypothesis that patients' perception of provider cultural competency indirectly influences patients' health outcomes through process of care. Data were from patient satisfaction surveys collected in seven mental health clinics (n=94 minority patients). Consistent with our hypothesis, patients' perception of clinicians' cultural competency was indirectly associated with patients' self-reported improvements in social interactions, improvements in performance at work or school, and improvements in managing life problems through the patients' experience of respect, trust, and communication with the clinician. These findings indicate that process of care characteristics during the clinical encounter influence patients' perceptions of clinicians' cultural competency and affect functional outcomes.
Bayati, Mohsen; Feyzabadi, Vahid Yazdi; Rashidian, Arash
Background: Women's health is a key factor affecting the health of the whole population. Tackling inequality in determinants of health is recognized as the main path toward reducing the inequality in health outcomes. This study aimed to analyze the provincial inequality in determinants of women's health and health care in Iran. Methods: Using the Moss's model (2002) as a comprehensive framework of determinants of women's health, including “geopolitical environment,” “culture, norms, sanctions,” “women's roles in reproduction and production,” “health-related mediators,” and “health outcome” categories, we chose 13 indicators. Afterward, using data sources including the Iranian Multiple Indicators of Demographics and Health Survey, the National Organization for Civil Registration, and Statistics Centre of Iran, we analyzed provincial inequality in these indicators in Iran (2011). Gini coefficient and Lorenz curve were used for measuring inequality. Results: Gini coefficients calculated as follows; life satisfaction level (0.027), literate women (0.398), women with proper knowledge about HIV/AIDS prevention (0.483), unemployed women (0.380), women without an income (0.384), women who use at least one type of mass media (0.389), women who used computer or internet (0.467), women who had received pregnancy care from a skill birth attendant (SBA) (0.420), women who had delivered with the help of an SBA (0.426), women who currently smoke cigarettes (0.603), women who currently consume hookah (0.561), women with at least one chronic disease (0.438), and women's deaths in 2010 and 2011 (0.393 and 0.359, respectively). Conclusions: We found large provincial disparities in determinants of women's health in Iran. Determinants such as lifestyle, health behavior, health knowledge, and health-care services availability should be considered by health policymakers in addressing the inequality in women's health at a provincial level. PMID:28348721
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
This report surveys the state of the art in applications of virtual environments and related technologies for health care. Applications of these technologies are being developed for health care in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); medical therapy; preventive medicine and patient education; medical education and training; visualization of massive medical databases; skill enhancement and rehabilitation; and architectural design for health-care facilities. To date, such applications have improved the quality of health care, and in the future they will result in substantial cost savings. Tools that respond to the needs of present virtual environment systems are being refined or developed. However, additional large-scale research is necessary in the following areas: user studies, use of robots for telepresence procedures, enhanced system reality, and improved system functionality.
Hsieh, Yu-Chin Jerrie; Apostolopoulos, Yorghos; Hatzudis, Kiki; Sönmez, Sevil
The poor working conditions of Latina hotel cleaners render them particularly vulnerable to elevated occupational hazards that lead to adverse health outcomes. This article presents a comprehensive review of occupational risks (including physical, chemical, biological, and psychosocial risk factors) and health outcomes (including musculoskeletal disorders, respiratory diseases, dermatological diseases and allergies, and psychological disorders) for Latina hotel cleaners, within their unique sociocultural contexts. Preventive interventions for improving Latina hotel cleaners' work and health conditions are recommended.
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.
Schelling, E; Greter, H; Kessely, H; Abakar, M F; Ngandolo, B N; Crump, L; Bold, B; Kasymbekov, J; Baljinnyam, Z; Fokou, G; Zinsstag, J; Bonfoh, B; Hattendorf, J; Béchir, M
Valid human and livestock health surveys, including longitudinal follow-up, are feasible among mobile pastoralists and provide fundamental information to agencies for interventions that are responsive to realities and effective in addressing the needs of pastoralists. However, pastoralists are often excluded from studies, surveillance systems and health programmes. The occurrence of preventable and treatable diseases such as perinatal tetanus, measles and tuberculosis are indicative of limited access to health providers and information. It is difficult for health services to include effective outreach with their available financial and human resources. One consequence is that maternal mortality rates among pastoralists are unacceptably high. Environmental determinants such as the quality of water and the pasture ecosystems further influence the morbidity of pastoralists. In the Sahel, the nutritional status of pastoralist children is seasonally better than that of settled children; but pastoralist women tend to have higher acute malnutrition rates. Pastoralist women are more vulnerable than men to exclusion from health services for different context-specific reasons. Evidence-based control measures can be assessed in cluster surveys with simultaneous assessments of health among people and livestock, where data on costs of disease and interventions are also collected. These provide important arguments for governmental and non-governmental agencies for intervention development. New, integrated One Health surveillance systems making use of mobile technology and taking into account local concepts and the experiences and priorities of pastoralist communities, combined with sound field data, are essential to develop and provide adapted human and animal health services that are inclusive for mobile pastoralist communities and allow them to maintain their mobile way of life.
Tonso, Michael A; Prematunga, Roshani Kanchana; Norris, Stephen J; Williams, Lloyd; Sands, Natisha; Elsom, Stephen J
The international literature suggests workplace violence in mental health settings is a significant issue, yet little is known about the frequency, nature, severity and health consequences of staff exposure to violence in Australian mental health services. To address this gap, we examined these aspects of workplace violence as reported by mental health services employees in Victoria, Australia. The project used a cross-sectional, exploratory descriptive design. A random sample of 1600 Health and Community Services Union members were invited to complete a survey investigating exposure to violence in the workplace, and related psychological health outcomes. Participants comprised employees from multiple disciplines including nursing, social work, occupational therapy, psychology and administration staff. A total of 411 members responded to the survey (26% response rate). Of the total sample, 83% reported exposure to at least one form of violence in the previous 12 months. The most frequently reported form of violence was verbal abuse (80%) followed by physical violence (34%) and then bullying/mobbing (30%). Almost one in three victims of violence (33%) rated themselves as being in psychological distress, 54% of whom reported being in severe psychological distress. The more forms of violence to which victims were exposed, the greater the frequency of reports of psychological distress. Workplace violence is prevalent in mental health facilities in Victoria. The nature, severity and health impact of this violence represents a serious safety concern for mental health employees. Strategies must be considered and implemented by healthcare management and policy makers to reduce and prevent violence.
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
Ong, Wee Loon; Schouwenburg, Maartje G; van Bommel, Annelotte C M; Stowell, Caleb; Allison, Kim H; Benn, Karen E; Browne, John P; Cooter, Rodney D; Delaney, Geoff P; Duhoux, Francois P; Ganz, Patricia A; Hancock, Patricia; Jagsi, Reshma; Knaul, Felicia M; Knip, Anne M; Koppert, Linetta B; Kuerer, Henry M; McLaughin, Sarah; Mureau, Marc A M; Partridge, Ann H; Reid, Dereesa Purtell; Sheeran, Lisa; Smith, Thomas J; Stoutjesdijk, Mark J; Vrancken Peeters, Marie Jeanne T F D; Wengström, Yvonne; Yip, Cheng-Har; Saunders, Christobel
A major challenge in value-based health care is the lack of standardized health outcomes measurements, hindering optimal monitoring and comparison of the quality of health care across different settings globally. The International Consortium for Health Outcomes Measurement (ICHOM) assembled a multidisciplinary international working group, comprised of 26 health care providers and patient advocates, to develop a standard set of value-based patient-centered outcomes for breast cancer (BC). The working group convened via 8 teleconferences and completed a follow-up survey after each meeting. A modified 2-round Delphi method was used to achieve consensus on the outcomes and case-mix variables to be included. Patient focus group meetings (8 early or metastatic BC patients) and online anonymized surveys of 1225 multinational BC patients and survivors were also conducted to obtain patients' input. The standard set encompasses survival and cancer control, and disutility of care (eg, acute treatment complications) outcomes, to be collected through administrative data and/or clinical records. A combination of multiple patient-reported outcomes measurement (PROM) tools is recommended to capture long-term degree of health outcomes. Selected case-mix factors were recommended to be collected at baseline. The ICHOM will endeavor to achieve wide buy-in of this set and facilitate its implementation in routine clinical practice in various settings and institutions worldwide.
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.
Dimsdale, Joel E
Health care systems want quality but struggle to find the right tools because, typically, they track quality in only one or two ways. Because of the complexity of health care, high quality will emerge only when health care systems employ multiple approaches, including, importantly, patient-reported outcome perspectives. Sustained changes are unlikely to emerge in the absence of such multipronged interventions. PMID:28123314
... 460.202 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE... outcomes data. (a) A PACE organization must establish and maintain a health information system...
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
Chester, Kelley; Shah, Gulzar H.
Context: Public health practice is information-intensive and information-driven. Public health informatics is a nascent discipline, and most public health practitioners lack necessary skills in this area. Objective: To describe the staff development needs of local health departments (LHDs) related to informatics. Design: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County & City Health Officials. Participants: A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). Main Outcome Measure(s): Outcome measures included LHDs' specific staff development needs related to informatics. Predictors of interest included jurisdiction size and governance type. Results: Areas of workforce development and improvement in informatics staff of LHDs included using and interpreting quantitative data, designing and running reports from information systems, using and interpreting qualitative data, using statistical or other analytical software, project management, and using geographical information systems. Significant variation in informatics training needs exists depending on the size of the LHD population and governance type. Conclusion: Substantial training needs exist for LHDs across many areas of informatics ranging from very basic to specialized skills and are related to the size of LHD population and governance type. PMID:27684619
Manly, Jennifer J
A crucial issue for health researchers is how to measure health and health-related behaviors across racial/ethnic groups. This commentary outlines an approach that involves the deconstruction of race/ethnicity, which clarifies the independent influences of acculturation, quality of education, socioeconomic class, and racial socialization on outcomes of interest. Research on the influence of these variables on health outcomes in general, and cognitive test performance specifically, is presented. This research indicates that when variables such as quality of education, wealth, and perceived racism are taken into account, the effect of race/ethnicity on health outcomes is greatly reduced. In other words, race/ethnicity serves as a proxy for these more meaningful variables, and explicit measurement of these constructs will improve research of health within majority and minority ethnic groups.
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.
Pedraza, María S; Noriega, Nicolás H
Knowing patients opinion about mental healthcare services is highly important in clinical daily work settings, especially in the interior regions of the country. Since information on the subject is very scarce, gathering further data would be helpful to design active policies in this field. With this aim in mind, a work team composed of a Psychologist and an Immunologist of the city of Villa Marí in Córdoba, Argentina, conducted a survey to enquire about the population's knowledge regarding mental health care services and their degree of satisfaction. This survey was done using a database from a healthcare consultancy, and data collection was carried out by means of electronic mails, which contained mostly closed questions. Two conclusions were drawn as relevant information; the first one was that only 1% of the subjects answered the survey, which would reveal little interest in it. The second conclusion was that, in spite of the investigators assumptions, most of the population surveyed (over 50%), had thorough knowledge of the use of mental healthcare services.
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,…
Adolescence has long been regarded as a transition from childhood to adulthood. More recently it is become a concern of those wishing to avoid adverse health outcomes during middle and late adulthood. Most of this effort has been focused on behavioural risk factors such as tobacco and excessive alcohol use, physical exercise habits, dietary habits, as well as sexual and injury-related behaviours. The concern is that these habits are established during adolescence, continue into adulthood, and come to constitute ongoing risk factors for adverse health outcomes during middle and late adulthood. There is good reason to criticize this approach. These behaviours are themselves shaped by adolescents' living and working conditions and even then constitute a small proportion of the variance predicting adverse health outcomes during adulthood. More complex models of how adolescence serves as a gateway to adult health outcomes are presented. These are the socio-environmental, public policy, and political economy approaches. The argument is made that adolescence is a period during which public policy plays an especially important role in predicting future health outcomes. Yet, these public policies influence health all across the life span with adolescence providing only one of many important periods during which public policy shapes health prospects during middle and later adulthood. Ultimately one should consider a range of approaches ranging from the behavioural to the political to examine how adolescence serves as a gateway towards future adult prospects. An Adolescent Gateway Towards Adult Health Model is provided to assist in this process.
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
Wilson, Kanetha B; Thorpe, Roland J; LaVeist, Thomas A
Racial and ethnic disparities in health have been well-documented, and low SES is widely considered to be a driver of this relationship. However, the race-social class-health interrelationship is complex, as several studies have found race disparities between racial/ethnic minorities and whites at middle- income levels. Research on higher income persons is complicated by the lack of data for persons with incomes about $75,000. Most national datasets collect income data in categories with the highest income category being $75,000 and above. In our study, we examined racial/ethnic disparities in health status and behaviors among persons of very high income, reported income of $175,000 or above per year. Data are from the Medical Expenditure Panel Surveys (MEPS). Our findings revealed health disparities in 10 of the 16 health-related outcomes selected. African Americans were most dissimilar to whites at this income and with disadvantages on 6 health outcomes relative to whites. While results also showed some disparities for Asian Americans and Hispanic Americans relative to whites, these groups were advantaged, relative to whites on several health outcomes. Our findings indicate that income does not fully explain racial/ethnic disparities in health. Most public interventions are targeted to low income persons. However, public health interventions should target minority individuals of very high income as well, especially African Americans.
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
McCurdy, S; Sunyer, J; Zock, J; Anto, J; Kogevinas, M; European, C
Background: Smoking is among the most important personal and modifiable risk factors for adverse health outcomes. The workplace offers a potentially effective venue for tobacco prevention programmes; identifying occupational groups with high smoking prevalence may assist in targeting such programmes. Aims: To examine smoking prevalence among occupational groups in the European Union. Methods: The European Community Respiratory Health Survey (ECRHS), a cross sectional health survey conducted in 1992–93, was used to examine smoking prevalence by occupation among 14 565 subjects from 30 centres in 14 participating countries. Results: There was an approximately twofold range in smoking prevalence by occupation. For occupational groups with at least 50 subjects, the highest smoking prevalence was seen in metal making and treating for men (54.3%) and cleaners for women (50.7%). Increased smoking prevalence by occupation persisted after adjustment for age, country, and age at completion of education. Smoking was also increased among occupations with high exposure to mineral dust and gas or fumes. Conclusions: Smoking rates vary significantly by occupation. Prevention efforts in the workplace should focus on occupations with high smoking prevalence and large employment bases. PMID:12937184
Zhang, B; Zhai, F Y; Du, S F; Popkin, B 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.
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…
Yoshikawa, K; Agrawal, N R; Poudel, K C; Jimba, M
Intimate partner violence (IPV) is a global public health issue that threatens the reproductive health of women. Despite a growing demand for research on the potential threat of IPV in relation to adverse reproductive outcomes, there have been no population-based studies of India. The current study analyzed the National Family Health Survey 3, which contained detailed information on types of violence in relation to the single question of pregnancy outcomes. The dataset was used to assess the association between a lifetime experience of IPV and terminated pregnancies among married Indian women. Multiple logistic regression analysis was then used to assess the association between these variables, controlling for socio-demographic characteristics. Results showed that 39.6% of Indian women have experienced violence by their husbands, while 18.3% of women have terminated a pregnancy during their lifetimes. The odds ratio of a terminated pregnancy among women who had experienced any type of partner violence was 1.62 (95% CI (confidence interval) = 1.51-1.73). All combinations of violence except a combination of emotional and sexual violence were associated with an increased risk of a terminated pregnancy. These results suggest that prevention of IPV would reduce the high incidence of terminated pregnancies, thus improving maternal health in India.
Summary Objectives To provide a review of the current excellent research published in the field of Consumer Health Informatics. Method We searched MEDLINE® and WEB OF SCIENCE® databases for papers published in 2013 in relation with Consumer Health Informatics. The authors identified 16 candidate best papers, which were then reviewed by four reviewers. Results Five out of the 16 candidate papers were selected as best papers. One paper presents the key features of a system to automate the collection of web-based social media content for subsequent semantic annotation. This paper emphasizes the importance of mining social media to collect novel data from which new findings in drug abuse research were uncovered. The second paper presents a practical method to predict how a community structure would impact the spreading of information within the community. The third paper presents a method for improving the quality of online health communities. The fourth presents a new social network to allow the monitoring of the evolution of individuals’ health status and diagnostic deficiencies, difficulties or barriers in rehabilitation. The last paper reports on teenage patients’ perception on privacy and social media. Conclusion Selected papers not only show the value of using social media in the medical field but how to use these media to detect emergent diseases or risks, inform patients, promote disease prevention, and follow patients’ opinion on healthcare resources. PMID:25123742
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.
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
Anenberg, Susan C; Belova, Anna; Brandt, Jørgen; Fann, Neal; Greco, Sue; Guttikunda, Sarath; Heroux, Marie-Eve; Hurley, Fintan; Krzyzanowski, Michal; Medina, Sylvia; Miller, Brian; Pandey, Kiran; Roos, Joachim; Van Dingenen, Rita
Designing air quality policies that improve public health can benefit from information about air pollution health risks and impacts, which include respiratory and cardiovascular diseases and premature death. Several computer-based tools help automate air pollution health impact assessments and are being used for a variety of contexts. Expanding information gathered for a May 2014 World Health Organization expert meeting, we survey 12 multinational air pollution health impact assessment tools, categorize them according to key technical and operational characteristics, and identify limitations and challenges. Key characteristics include spatial resolution, pollutants and health effect outcomes evaluated, and method for characterizing population exposure, as well as tool format, accessibility, complexity, and degree of peer review and application in policy contexts. While many of the tools use common data sources for concentration-response associations, population, and baseline mortality rates, they vary in the exposure information source, format, and degree of technical complexity. We find that there is an important tradeoff between technical refinement and accessibility for a broad range of applications. Analysts should apply tools that provide the appropriate geographic scope, resolution, and maximum degree of technical rigor for the intended assessment, within resources constraints. A systematic intercomparison of the tools' inputs, assumptions, calculations, and results would be helpful to determine the appropriateness of each for different types of assessment. Future work would benefit from accounting for multiple uncertainty sources and integrating ambient air pollution health impact assessment tools with those addressing other related health risks (e.g., smoking, indoor pollution, climate change, vehicle accidents, physical activity).
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…
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
Reports describing significant health risks due to inadequate vitamin D status continue to generate considerable interest amongst the medical and lay communities alike. Recent research on the various molecular activities of the vitamin D system, including the nuclear vitamin D receptor and other receptors for 1,25-dihydroxyvitamin D and vitamin D metabolism, provides evidence that the vitamin D system carries out biological activities across a wide range of tissues similar to other nuclear receptor hormones. This knowledge provides physiological plausibility of the various health benefits claimed to be provided by vitamin D and supports the proposals for conducting clinical trials. The vitamin D system plays critical roles in the maintenance of plasma calcium and phosphate and bone mineral homeostasis. Recent evidence confirms that plasma calcium homeostasis is the critical factor modulating vitamin D activity. Vitamin D activities in the skeleton include stimulation or inhibition of bone resorption and inhibition or stimulation of bone formation. The three major bone cell types, which are osteoblasts, osteocytes and osteoclasts, can all respond to vitamin D via the classical nuclear vitamin D receptor and metabolize 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D to activate the vitamin D receptor and modulate gene expression. Dietary calcium intake interacts with vitamin D metabolism at both the renal and bone tissue levels to direct either a catabolic action on the bone through the endocrine system when calcium intake is inadequate or an anabolic action through a bone autocrine or paracrine system when calcium intake is sufficient. PMID:24790904
Lefkowitz, Eva S; Vasilenko, Sara A
Sexual behavior is an important aspect of adolescent development with implications for well-being. These chapters highlight important perspectives on studying sexual health from a normative, developmental perspective, such as viewing a range of sexual behaviors as life events; considering potentially positive physical health, mental health, social health, and identity outcomes; examining both intraindividual and interindividual differences in outcomes; recognizing the romantic relationship context of sexual behavior; and understanding how sexual media may impact sexual health outcomes. We suggest new directions for studying sexual health outcomes, such as studying behaviors beyond vaginal sex and condom use, new methodologies such as latent class analysis, sophisticated longitudinal designs, and collection and analysis of dyadic data. We recommend research on populations underrepresented in sexual health research such as late adolescents who do not attend traditional universities and adolescents from ethnic/racial minorities. Finally, we consider future directions for sexuality education and prevention efforts.
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.
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
There is a paucity of data on the associations of recent divorce on the health and military outcomes of service members during the recent conflicts...Participants of the Millennium Cohort Study who were divorced between baseline and follow-up surveys were compared with those who remained married...sociodemographic, baseline behavioral, and military covariates. Compared with those who remained married, service members who recently divorced were
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
Karlsen, Trine; Aamot, Inger-Lise; Haykowsky, Mark; Rognmo, Øivind
Regular physical activity or exercise training are important actions to improve cardiorespiratory fitness and maintain health throughout life. There is solid evidence that exercise is an effective preventative strategy against at least 25 medical conditions, including cardiovascular disease, stroke, hypertension, colon and breast cancer, and type 2 diabetes. Traditionally, endurance exercise training (ET) to improve health related outcomes has consisted of low- to moderate ET intensity. However, a growing body of evidence suggests that higher exercise intensities may be superior to moderate intensity for maximizing health outcomes. The primary objective of this review is to discuss how aerobic high-intensity interval training (HIIT) as compared to moderate continuous training may maximize outcomes, and to provide practical advices for successful clinical and home-based HIIT.
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.
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.
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
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.
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.
Lohr, K N
The Boston Working Group on Improving Health Care Outcomes Through Geriatric Rehabilitation was structured around four major themes: (1) defining disability or disablement; (2) the patient's experience of the processes and outcomes of care; (3) the role and value of clinical practice guidelines; and (4) the need for casemix and severity or risk adjustment procedures and measures. These discussions produced opening statements of policy or empiric issues and recommendations about the best means of demonstrating the benefits of geriatric rehabilitation and, in particular, how to measure, ensure, and improve the quality of rehabilitation services, especially for the elderly. This article summarizes the reports from the work groups and identifies some common themes. Critical points include: (1) the need to define and describe geriatric rehabilitation better for nonexperts in the health field and for patients and consumers in general; (2) the need for more research to link rehabilitation processes with measurable and clinically important outcomes; (3) the breadth and depth of domains of processes and outcomes of care that ideally could and should be measured; and (4) the need to reach many audiences with a clear message about the importance of geriatric rehabilitation in ensuring high quality of care and good health status and functional outcomes for all elderly patients.
Ahnquist, Johanna; Wamala, Sarah P; Lindstrom, Martin
Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the "social" and the "economic" indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16-84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health.
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
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 levels in a seven-step instrument development process. An online survey was then completed by 1,022 practicing health educators. Survey participants used 4-point ordinal scales to rank subcompetencies by frequency of use and importance and related knowledge items by cognitive levels based on the Revised Bloom's Taxonomy. Composite scores were calculated and subgroup comparisons conducted to validate 223 subcompetencies at entry (162), advanced-1 (42), and advanced-2 (19) levels of practice, along with 113 knowledge items. Advanced-level versus entry-level competencies and a comparison with the Competency Update Project model of 2006 are discussed. Implications and recommendations for the profession are provided.
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…
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…
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:…
Lu, Emily; Dayalu, Rashmi; Diop, Hafsatou; Harvey, Elizabeth M; Manning, Susan E; Uzogara, Stella G
This study explores how weight status is related to mental health status among Massachusetts children, aged 10-17 years. We used data from the 2007 National Survey of Children's Health to examine the association between weight status (body mass index-for-age) and parent-reported mental health status among Massachusetts children (N = 827). Multivariable log binomial regression was performed to calculate the adjusted prevalence ratios (aPR) of three mental health outcomes (behavioral, emotional, and social) as related to weight status, after controlling for covariates including physical activity, sex, race/ethnicity, maternal education, poverty status, special health needs, and neighborhood safety. Almost one-third (32.5 %) of Massachusetts children were either overweight or obese. Sex was a significant effect modifier of the association between weight status and negative emotions. After stratifying by sex and controlling for covariates, the relationship between weight status and negative emotions remained significant among girls (aPR = 1.8, 95 % CI 1.3-2.6). Children who did not exercise at all were significantly more likely to exhibit negative behaviors (aPR = 1.3, 95 % CI 1.0-1.6), negative emotions (boys' aPR = 3.3, 95 % CI 1.6-6.9; girls' aPR = 2.6, 95 % CI 1.5-4.5), and fewer social skills (aPR = 1.9, 95 % CI 1.3-2.9) than those who exercised at least 20 min every day of the week. Overweight/obese children, especially girls, were more likely than children of normal weight to have parent-reported negative emotions, suggesting an association between weight status and mental health. Lower levels of physical activity were associated with negative mental health outcomes, supporting the benefits of physical activity for all children.
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.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1410240
Cook, John T; Frank, Deborah A; Berkowitz, Carol; Black, Maureen M; Casey, Patrick H; Cutts, Diana B; Meyers, Alan F; Zaldivar, Nieves; Skalicky, Anne; Levenson, Suzette; Heeren, Tim; Nord, Mark
The U.S. Household Food Security Scale, developed with federal support for use in national surveys, is an effective research tool. This study uses these new measures to examine associations between food insecurity and health outcomes in young children. The purpose of this study was to determine whether household food insecurity is associated with adverse health outcomes in a sentinel population ages < or = 36 mo. We conducted a multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington DC, August 1998-December 2001. Caregivers of 11,539 children ages < or = 36 mo were interviewed at hospital clinics and emergency departments (ED) in central cities. Outcome measures included child's health status, hospitalization history, whether child was admitted to hospital on day of ED visit (for subsample interviewed in EDs), and a composite growth-risk variable. In this sample, 21.4% of households were food insecure (6.8% with hunger). In a logistic regression, after adjusting for confounders, food-insecure children had odds of "fair or poor" health nearly twice as great [adjusted odds ratio (AOR) = 1.90, 95% CI = 1.66-2.18], and odds of being hospitalized since birth almost a third larger (AOR = 1.31, 95% CI = 1.16-1.48) than food-secure children. A dose-response relation appeared between fair/poor health status and severity of food insecurity. Effect modification occurred between Food Stamps and food insecurity; Food Stamps attenuated (but did not eliminate) associations between food insecurity and fair/poor health. Food insecurity is associated with health problems for young, low-income children. Ensuring food security may reduce health problems, including the need for hospitalizations.
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
Fragoso, Zachary L; Holcombe, Kyla J; McCluney, Courtney L; Fisher, Gwenith G; McGonagle, Alyssa K; Friebe, Susan J
This study's purpose was twofold: first, to examine the relative importance of job demands and resources as predictors of burnout and engagement, and second, the relative importance of engagement and burnout related to health, depressive symptoms, work ability, organizational commitment, and turnover intentions in two samples of health care workers. Nurse leaders (n = 162) and licensed emergency medical technicians (EMTs; n = 102) completed surveys. In both samples, job demands predicted burnout more strongly than job resources, and job resources predicted engagement more strongly than job demands. Engagement held more weight than burnout for predicting commitment, and burnout held more weight for predicting health outcomes, depressive symptoms, and work ability. Results have implications for the design, evaluation, and effectiveness of workplace interventions to reduce burnout and improve engagement among health care workers. Actionable recommendations for increasing engagement and decreasing burnout in health care organizations are provided.
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...
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…
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…
Savinainen, Minna; Oksa, Panu
In Finland, workplace surveys are used to identify and assess health risks and problems caused by work and make suggestions for continuous improvement of the work environment. With the aid of the workplace survey, occupational health services can be tailored to a company. The aims of this study were to determine how occupational health professionals gather data via the workplace survey and the effect survey results have on companies. A total of 259 occupational health nurses and 108 occupational health physicians responded to the questionnaire: 84.2% were women and 15.8% were men. The mean age of the respondents was 48.8 years (range, 26 to 65 years). Usually occupational health nurses and foremen and sometimes occupational health physicians and occupational safety and health representatives initiate the workplace survey. More than 90% of the surveys were followed by action proposals, and about 50% of these were implemented. The proposals implemented most often concerned personal protective equipment and less often leadership. Survey respondents should have both the opportunity and the authority to affect resources, the work environment, work arrangements, and tools. Teamwork among occupational health and safety professionals, management, and employees is vital for cost-effectively solving today's complex problems at workplaces around the globe.
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.
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
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.
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
Colombia's 1990 Survey of Prevalence, Demography, and Health (EPDS) was intended to provide data on the total population and on the status of women's and children's health for use in planning and in formulating health and family planning policy. 7412 household interviews and 8647 individual interviews with women aged 15-49 years were completed. This document provides a brief description of the questionnaire, sample design, data processing, and survey results. More detailed works on each topic are expected to follow. After weighing, 74.8% of respondents were urban and 25.2% rural. 3.2% were illiterate, 36.6% had some primary education, 50.2% had secondary educations, and 9.9% had high higher educations. Among all respondents and respondents currently in union respectively, 98.2% and 997% knew some contraceptive method, 94.1% and 97.9% knew some source of family planning, 57.6% and 86.0% had ever used a method, and 39.9% and 66.1% were currently using a method. Among all respondents and respondents currently in union respectively, 52.2% and 78.9% had ever used a modern method and 33.0% and 54.6% were currently using a modern method. Among women in union, 14.1% currently used pills, 12.4% IUDs, 2.2% injectables, 1.7% vaginal methods, 2.9% condoms, 20.9% female sterilization, .5% vasectomy, 11.5% some tradition method, 6.1% periodic abstinence, 4.8% withdrawal, and .5% others. Equal proportions of rural and urban women were sterilized. The prevalence of female sterilization declined with education and increased with family size. Modern methods were used by 57.5% of urban and 47.7% of rural women, 44.0% of illiterate women, 51.8% of women with primary and 57.8% with secondary educations. Among women in union, 10.9% wanted a child soon, 19.7% wanted 1 eventually, 3.6% were undecided, 42.6% did not want 1, 21.4% were sterilized, and 1.2% were infertile. Among women giving birth in the past 5 years, the proportion having antitetanus vaccinations increased from 39% in 1986
Elliott, Marc N.; Zaslavsky, Alan M.; Hays, Ron D.; Lehrman, William G.; Rybowski, Lise; Edgman-Levitan, Susan; Cleary, Paul D.
Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs. PMID:25027409
Marshall, Andrea P; Roberts, Shelley; Baker, Mark J; Keijzers, Gerben; Young, Jessica; Stapelberg, N J Chris; Crilly, Julia
Objective The aim of the present study was to describe the research activities being undertaken by health service employees within one Australian health service and explore their experiences with undertaking research.Methods The present mixed-methods study was conducted across one health service in Queensland, Australia, and included a cross-sectional online survey and interviews with healthcare service employees. The anonymous survey was a self-administered online questionnaire, distributed to all 6121 employees at the health service via email, asking about research activity and engagement. Willing participants were also interviewed on their perceptions and experiences with research and capacity building.Results In all, 151 participants responded to the survey and 22 participated in interviews. Three-quarters of respondents reported actively participating in research over the past 6 years and several research outputs, such as publications, conference presentations and competitive grant funding, were displayed. Four concepts emerged from interview findings, namely collaborative partnerships, skilled mentorship, embedding research and organisational support, which represented the overall theme 'opportunities for a research-infused health service'.Conclusion Employees of the health service recognised the importance of research and had a range of research skills, knowledge and experience. They also identified several opportunities for building research capacity in this service.What is known about the topic? Building research capacity among healthcare professionals is important for enabling the conduct of high-quality research in healthcare institutions. However, building research capacity is complex and influenced by the uniqueness of organisational context. In order to successfully build research capacity among employees at any health service, current research activity, skills and experience, as well as staff perceptions around building research capacity in that
Lim, Sungwoo; Yi, Stella S.; De La Cruz, Nneka Lundy; Trinh-Shevrin, Chau
Evidence on ethnic enclave-health associations for Asian Americans is limited due to an inconsistent definition of ethnic enclave. The authors aimed to establish a robust criterion for defining Asian enclaves in New York City (NYC) and assessed the association between enclave residence and health outcomes among Asian American adults. Data came from 2009-12 NYC Community Health Surveys and 2008-12 American Community Survey. Asian enclave was defined as an area with high dissimilarity and isolation scores as well as high concentration of Asians. Five of 55 NYC community districts were identified as Asian enclaves. After controlling for confounding, enclave residence was associated with positive perception of general health with borderline significance (prevalence ratio = 1.06, 95% CI = 0.98, 1.15), but not with current smoking, hypertension, and diabetes. Ethnic enclave residence in urban areas may not produce a substantial impact on chronic health outcomes for Asian Americans beyond individual-level factors. PMID:26699378
Ishikawa, Yoshiki; Nishiuchi, Hiromu; Hayashi, Hana; Viswanath, Kasisomayajula
Background Considerable evidence suggests that communication inequality is one potential mechanism linking social determinants, particularly socioeconomic status, and health inequalities. This study aimed to examine how dimensions of health communication outcomes (health information seeking, self-efficacy, exposure, and trust) are patterned by socioeconomic status in Japan. Methods Data of a nationally representative cross-sectional survey of 2,455 people aged 15–75 years in Japan were used for secondary analysis. Measures included socio-demographic characteristics, subjective health, recent health information seeking, self-efficacy in seeking health information, and exposure to and trust in health information from different media. Results A total of 1,311 participants completed the questionnaire, giving a response rate of 53.6%. Multivariate logistic regression revealed that education and household income, but not employment, were significantly associated with health information seeking and self-efficacy. Socioeconomic status was not associated with exposure to and trust in health information from mass media, but was significantly associated with health information from healthcare providers and the Internet. Conclusion Health communication outcomes were patterned by socioeconomic status in Japan thus demonstrating the prevalence of health communication inequalities. Providing customized exposure to and enhancing the quality of health information by considering social determinants may contribute to addressing social disparities in health in Japan. PMID:22808229
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
Harrington, Kathleen F; Zhang, Bin; Magruder, Teresa; Bailey, William C; Gerald, Lynn B
Background: Health literacy has been associated with health disparities in many disease outcomes, including children's asthma. Parents are responsible for most of children's healthcare. Therefore, parents' health literacy may impact children's health outcomes, including asthma control. This study sought to determine the association between parent health literacy and children's asthma control among a cohort of predominately minority urban children aged between 6 and 12 years. Methods: This cross-sectional study assessed children with asthma and their parents at a single outpatient visit. English-speaking parents and their children, aged between 6 and 12 years with physician-diagnosed asthma, were eligible for this study. Healthcare providers assessed asthma control and severity, and parents completed demographic, health literacy, asthma control, and asthma knowledge measures. Children completed a pulmonary function test as part of the Asthma Control Questionnaire (ACQ) scoring. Results: A total of 281 parent-child dyads provided data, with the majority of parents being mothers and African American, with a high school level education or less. Lower parent health literacy was associated with worse asthma control as rated both by the provider (p=0.007) and the ACQ (p=0.013), despite only moderate concordance between ratings (ρ=0.408, p<0.0001). Lower parent health literacy also was associated with less asthma knowledge, which was associated with worse asthma control. Conclusions: Higher parent health literacy was associated with more parent asthma knowledge and better child asthma control. Pediatric providers should consider tailoring education or treatment plans or utilizing universal precautions for low health literacy.
Kuo, Dennis Z; Bird, T Mac; Tilford, J Mick
The objective of this study is to examine the association of family-centered care (FCC) with specific health care service outcomes for children with special health care needs (CSHCN). The study is a secondary analysis of the 2005-2006 National Survey of Children with Special Health Care Needs. Receipt of FCC was determined by five questions regarding how well health care providers addressed family concerns in the prior 12 months. We measured family burden by reports of delayed health care, unmet need, financial costs, and time devoted to care; health status, by stability of health care needs; and emergency department and outpatient service use. All statistical analyses used propensity score-based matching models to address selection bias. FCC was reported by 65.6% of respondents (N = 38,915). FCC was associated with less delayed health care (AOR: 0.56; 95% CI: 0.48, 0.66), fewer unmet service needs (AOR: 0.53; 95% CI: 0.47, 0.60), reduced odds of ≥1 h/week coordinating care (AOR: 0.83; 95% CI: 0.74, 0.93) and reductions in out of pocket costs (AOR: 0.88; 95% CI: 0.80, 0.96). FCC was associated with more stable health care needs (AOR: 1.11; 95% CI: 1.01, 1.21), reduced odds of emergency room visits (AOR: 0.90; 95% CI: 0.82, 0.99) and increased odds of doctor visits (AOR: 1.25; 95% CI: 1.14, 1.37). Our study demonstrates associations of positive health and family outcomes with FCC. Realizing the health care delivery benefits of FCC may require additional encounters to build key elements of trust and partnership.
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
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.
Gordon, Nancy; Lin, Teresa
Introduction The Kaiser Permanente Northern California (KPNC) Member Health Survey (MHS) is used to describe sociodemographic and health-related characteristics of the adult membership of this large, integrated health care delivery system to monitor trends over time, identify health disparities, and conduct research. Objective To provide an overview of the KPNC MHS and share findings that illustrate how survey statistics and data have been and can be used for research and programmatic purposes. Methods The MHS is a large-scale, institutional review board-approved survey of English-speaking KPNC adult members. The confidential survey has been conducted by mail triennially starting in 1993 with independent age-sex and geographically stratified random samples, with an option for online completion starting in 2005. The full survey sample and survey data are linkable at the individual level to Health Plan and geocoded data. Respondents are assigned weighting factors for their survey year and additional weighting factors for analysis of pooled survey data. Results Statistics from the 1999, 2002, 2005, 2008, and 2011 surveys show trends in sociodemographic and health-related characteristics and access to the Internet and e-mail for the adult membership aged 25 to 79 years and for 6 age-sex subgroups. Pooled data from the 2008 and 2011 surveys show many significant differences in these characteristics across the 5 largest race/ethnic groups in KPNC (non-Hispanic whites, blacks, Latinos, Filipinos, and Chinese). Conclusion The KPNC MHS has yielded unique insights and provides an opportunity for researchers and public health organizations outside of KPNC to leverage our survey-generated statistics and collaborate on epidemiologic and health services research studies. PMID:27548806
Monsen, Karen A; Fulkerson, Jayne A; Lytton, Amy B; Taft, Lila L; Schwichtenberg, Linda D; Martin, Karen S
To use aggregated data from health informatics systems to identify needs of maternal and child health (MCH) clients served by county public health agencies and to demonstrate outcomes of services provided. Participating agencies developed and implemented a formal standardized classification data comparison process using structured Omaha System data. An exploratory descriptive analysis of the data was performed. Summary reports of aggregated and analyzed data from records of clients served and discharged in 2005 were compared. Client problems and outcomes were found to be similar across agencies, with behavioral, psychosocial, environmental and physiological problems identified and addressed. Differential improvement was noted by problem, outcome measure, and agency; and areas for enhancing intervention strategies were prioritized. Problems with greatest improvement across agencies were Antepartum/postpartum and Family planning, and least improvement across agencies were Neglect and Substance use. Findings demonstrated that public health nurses address many serious health-related problems with low-income high-risk MCH clients. MCH client needs were found to be similar across agencies. Public health nurse home visiting services addressed important health issues with MCH clients, and statistically significant improvement in client health problems occurred consistently across agencies. The data comparison processes developed in this project were useful for MCH programs, and may be applicable to other program areas using structured client data for evaluation purposes. Using informatics tools and data facilitated needs assessment, program evaluation, and outcomes management processes for the agencies, and will continue to play an integral role in directing practice and improving client outcomes.
Schatz, Bruce R
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.
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
Sharma, Niraj; O'Hare, Kitty; Antonelli, Richard C; Sawicki, Gregory S
All youth must transition from pediatric to adult-centered medical care. This process is especially difficult for youth with special health care needs. Many youth do not receive the age-appropriate medical care they need and are at risk during this vulnerable time. Previous research has identified barriers that may prevent effective transition, and protocols have been developed to improve the process. Health outcomes related to successful transition have yet to be fully defined. Health care transition can also be influenced by education of providers, but there are gaps in medical education at the undergraduate, graduate, and postgraduate levels. Current changes in federal health policy allow improved health care coverage, provide some new financial incentives, and test new structures for transitional care, including the evolution of accountable care organizations (ACO). Future work must test how these systems changes will affect quality of care. Finally, transition protocols exist in various medical subspecialties; however, national survey results show no improvement in transition readiness, and there are no consistent measures of what constitutes transition success. In order to advance the field of transition, research must be done to integrate transition curricula at the undergraduate, graduate, and postgraduate levels; to provide advance financial incentives and pilot the ACO model in centers providing care to youth during transition; to define outcome measures of importance to transition; and to study the effectiveness of current transition tools on improving these outcomes.
MacDermid, Joy C; Walton, David M; Côté, Pierre; Santaguida, P. Lina; Gross, Anita; Carlesso, Lisa
Purpose: To determine the outcome measures practice patterns in the neck pain management of various health disciplines. Methods: A survey of 381 clinicians treating patients with neck pain was conducted. Results: Respondents were more commonly male (54%) and either chiropractors (44%) or physiotherapists (32%). The survey was international (24 countries with Canada having the largest response (44%)). The most common assessment was a single-item pain assessment (numeric or visual analog) used by 75% of respondents. Respondents sometimes or routinely used the Neck Disability Index (49%), the Patient Specific Functional Scale (28%), and the Disabilities of the Arm, Shoulder and Hand (32%). Work status was recorded in terms of time lost by more than 50% of respondents, but standardized measures of work limitations or functional capacity testing were rarely used. The majority of respondents never used fear of movement, psychological distress, quality of life, participation measures, or global ratings of change (< 10% routinely use). Use of impairment measurers was prevalent, but the type selected was variable. Quantitative sensory testing was used sometimes or routinely by 53% of respondents, whereas 26% never used it. Ratings of segmental joint mobility were commonly used to assess motion (44% routinely use), whereas 66% of respondents never used inclinometry. Neck muscle strength, postural alignment and upper extremity coordination were assessed sometimes or routinely by a majority of respondents (>56%). With the exception of numeric pain ratings and verbal reporting of work status, all outcomes measures were less frequently used by physicians. Years of practice did not affect practice patterns, but reimbursement did affect selection of some outcome measures. Conclusions: Few outcome measures are routinely used to assess patients with neck pain other than a numeric pain rating scale. A comparison of practice patterns to current evidence suggessts overutilization of
John, Juanette; Wright, Caradee Yael; Oosthuizen, Maria Aletta; Steyn, Maronel; Genthe, Bettina; le Roux, Wouter; Albers, Patricia; Oberholster, Paul; Pauw, Christiaan
Potential exposure to water and air pollution and associated health impacts of three low-income communities in the Upper Olifants River Catchment, South Africa, was investigated through a cross-sectional epidemiological study comprising a household survey. Water samples were collected and analysed for microbial indicators and pathogens. Ambient air-monitoring included some of the criteria pollutants, as well as mercury and manganese. Associations between environmental exposure and health outcomes were analysed by means of logistic regression. Despite poor water and air quality episodes, the communities' self-perceived health was good with relatively low prevalence of reported health outcomes. Hygiene practices with respect to water collection and storage were often poor, and most likely contributed to the regularly contaminated water storage containers. Community proximity to the polluted stream was associated with increased prevalence in adverse health outcomes. This paper reports on preliminary results and additional multivariate analyses are necessary to further understand study results.
Shave, Kassi; Fernandes, Ricardo M; Scott, Shannon D; Hartling, Lisa
Background With the rapid growth of technology and its improved accessibility globally, social media is gaining an increasingly important role in health care. Patients are frequently engaging with social media to access information, share content, and interact with others in online health communities. However, the use of social media as a stakeholder engagement strategy has been minimally explored, and effective methods for involving participants in research on the identification of patient-centered outcomes remain unknown. Objective The aim of this study was to evaluate the process of using social media to engage parents in identifying patient-centered outcomes, using acute respiratory infections in children as an example to gauge feasibility. Methods We conducted a process evaluation of a two-phase Web-based strategy to engage parents in research on patient-centered outcomes. In the first phase, we developed a website and study-specific Facebook and Twitter accounts to recruit parents to complete a Web-based survey identifying patient-centered outcomes. In the second phase, we used Facebook to host discussion with parents based on the survey results. The reach of social media as an engagement strategy and the characteristics of the population recruited were assessed. Results During the first phase, there were 5027 visits to the survey site, 110 participants completed the survey, 553 unique users visited the study website (675 visits), the Facebook page received 104 likes, and the Twitter account gained 52 followers over the 14-week study period. Most survey respondents identified Facebook (51.8%, 57/110) or a friend (45.5%, 50/110) as their source of referral. It was found that 70.0% (77/110) of respondents resided in Canada, in urban centers (92.7%, 102/110), and 88.2% (97/110) had a college or university degree or higher. The median year of birth was 1978 and 90.0% (99/110) were female. Most survey responses (88.2%, 97/110) were completed during the first month
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.
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…
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
Poots, Alan J.; Green, Stuart A.; Honeybourne, Emmi; Green, John; Woodcock, Thomas; Barnes, Ruth; Bell, Derek
Objective To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Design Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. Setting A psychological therapy service in Westminster, London, UK. Participants People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. Intervention(s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. Main Outcome Measure(s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. Results Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = −6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories. Conclusions QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome. PMID:24521701
Bailey, Donald B., Jr.; Raspa, Melissa; Olmsted, Murrey G.; Novak, Scott P.; Sam, Ann M.; Humphreys, Betsy P.; Nelson, Robin; Robinson, Nyle; Guillen, Chelsea
Few psychometrically valid scales exist to assess family outcomes and the helpfulness of early intervention. This article describes the development and psychometric properties of the Family Outcomes Survey-Revised. The revision was prompted by the need to (a) create a new format that would be easier for parents to understand, (b) revise and expand…
MORALES, LEO S.; LARA, MARIELENA; KINGTON, RAYNARD S.; VALDEZ, ROBERT O.; ESCARCE, JOSÉ J.
Evidence suggests that social and economic factors are important determinants of health. Yet, despite higher poverty rates, less education, and worse access to health care, health outcomes of many Hispanics living in the United States today are equal to, or better than, those of non-Hispanic whites. This paradox is described in the literature as the epidemiological paradox or Hispanic health paradox. In this paper, the authors selectively review data and research supporting the existence of the epidemiological paradox. They find substantial support for the existence of the epidemiological paradox, particularly among Mexican Americans. Census undercounts of Hispanics, misclassification of Hispanic deaths, and emigration of Hispanics do not fully account for the epidemiological paradox. Identifying protective factors underlying the epidemiological paradox, while improving access to care and the economic conditions among Hispanics, are important research and policy implications of this review. PMID:12407964
Morales, Leo S; Lara, Marielena; Kington, Raynard S; Valdez, Robert O; Escarce, José J
Evidence suggests that social and economic factors are important determinants of health. Yet, despite higher porverty rates, less education, and worse access to health care, health outcomes of many Hispanics living in the United States today are equal to, or better than, those of non-Hispanic whites. This paradox is described in the literature as the epidemiological paradox or Hispanic health paradox. In this paper, the authors selectively review data and research supporting the existence of the epidemiological paradox. They find substantial support for the existence of the epidemiological paradox, particularly among Mexican Americans. Census undercounts of Hispanics, misclassification of Hispanic deaths, and emigration of Hispanics do not fully account for the epidemiological paradox. Identifying protective factors underlying the epidemiological paradox, while improving access to care and the economic conditions among Hispanics, are important research and policy implications of this review.
Fendrick, A. Mark
Although medical innovation can reduce morbidity and mortality associated with diseases or their treatments, in most instances new interventions tend to increase the amount of resources expended on health care services. In this era of increasing cost consciousness, there is a perceived tension between the desire to improve health outcomes and the necessity to control the growth of health care costs. The dramatic changes in the organization, financing, and delivery of health care services, make it no longer acceptable to provide any and all services to every individual with only a remote probability of clinical benefit. An incentive structure which rewards the practice of cost-effective medical care is rapidly replacing the 'technological imperative' of decades past. As the expansion towards managed care continues, increasing scrutiny will be paid to the clinical and cost implications of our medical interventions.
Gaab, Jens; Kossowsky, Joe; Hasler, Sebastian; Krummenacher, Peter; Werner, Christoph; Gerger, Heike
Objective To examine whether patients’ trust in the health care professional is associated with health outcomes. Study selection We searched 4 major electronic databases for studies that reported quantitative data on the association between trust in the health care professional and health outcome. We screened the full-texts of 400 publications and included 47 studies in our meta-analysis. Data extraction and data synthesis We conducted random effects meta-analyses and meta-regressions and calculated correlation coefficients with corresponding 95% confidence intervals. Two interdependent researchers assessed the quality of the included studies using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results Overall, we found a small to moderate correlation between trust and health outcomes (r = 0.24, 95% CI: 0.19–0.29). Subgroup analyses revealed a moderate correlation between trust and self-rated subjective health outcomes (r = 0.30, 0.24–0.35). Correlations between trust and objective (r = -0.02, -0.08–0.03) as well as observer-rated outcomes (r = 0.10, -0.16–0.36) were non-significant. Exploratory analyses showed a large correlation between trust and patient satisfaction and somewhat smaller correlations with health behaviours, quality of life and symptom severity. Heterogeneity was small to moderate across the analyses. Conclusions From a clinical perspective, patients reported more beneficial health behaviours, less symptoms and higher quality of life and to be more satisfied with treatment when they had higher trust in their health care professional. There was evidence for upward bias in the summarized results. Prospective studies are required to deepen our understanding of the complex interplay between trust and health outcomes. PMID:28170443
Wright, Michelle L.; Starkweather, Angela R.; York, Timothy P.
It is well established that the environment contributes to health. However, few studies have evaluated environmental exposures in women that may influence future health of their offspring. Knowledge gained may inform nursing how to better advocate for patients and families; and provide individualized interventions and education. Therefore, a more comprehensive investigation of the maternal exposome to uncover mechanistic insight into complex disease in offspring is warranted. To advance understanding of biological mechanisms that contribute to high-risk birth outcomes and offspring predisposition to disease, it will be necessary to measure a range of exposures and biomarkers before and during pregnancy. PMID:27149232
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.
Karvinen, Kristina H; Carr, Lucas J
The purpose of this study was to examine the associations between God Locus of Health Control, health behaviors, and beliefs utilizing a cross-sectional online survey (N = 549). Results indicated that God Locus of Health Control was correlated with alcohol use, physical activity, perceived risk of chronic disease, and beliefs that poor health behaviors contribute to chronic disease (all p values < .05). Multiple regression analyses including covariates and other locus of control variables revealed that God Locus of Health Control was only an independent correlate of the belief that physical inactivity contributed to chronic disease. Insights from this study may be important for future faith-based health behavior change interventions.
Landale, Nancy S.; Oropesa, R. S.; Llanes, Daniel; Gorman, Bridget K.
Analysis of data from the Puerto Rican Maternal and Infant Health Study found that recent migrants to the U.S. mainland experienced fewer stressful life events and engaged in fewer negative health behaviors during pregnancy than U.S.-born Puerto Rican women. Recent migrants also exhibited better infant health outcomes than childhood migrants or…
Marshall, Grant N.; And Others
Relations between self-assessed health status and satisfaction with health care were examined using two waves of data obtained from participants in the Medical Outcomes Study. Using a multisample covariance modeling framework, separate models were examined for patients with significant symptoms of depression (N=417) and patients with chronic…
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…
Mäenpää, Tiina; Suominen, Tarja; Asikainen, Paula; Maass, Marianne; Rostila, Ilmari
The resulting regional healthcare information systems were expected to have effects and impacts on health care procedures, work practices and treatment outcomes. The aim is to find out how health information systems have been investigated, what has been investigated and what are the outcomes. A systematic review was carried out of the research on the regional health information systems or organizations. The literature search was conducted on four electronic Cinahl Medline, Medline/PubMed and Cochrane. The common type of study design was the survey research and case study, and the data collection was carried out via different methodologies. They found out different types of regional health information systems (RHIS). The systems were heterogeneous and were in different phases of these developments. The RHIS outcomes focused on the five main areas: flow of information, collaboration, process redesign, system usability and organization culture. The RHIS improved the clinical data access, timely information, and clinical data exchange and improvement in communication and coordination within a region between professionals but also there was inadequate access to patient relevant clinical data. There were differences in organization culture, vision and expectations of leadership and consistency of strategic plan. Nevertheless, there were widespread participation by both healthcare providers and patients.
Saloviita, Timo; Tolvanen, Asko
Seven final year cohorts of Finnish pre-service primary teachers (N = 384) were given an exit survey, which measured their estimated attainment of knowledge and experience in the 10 domains of professional activity considered critical for new teachers in the Interstate New Teacher Assessment and Support Consortium (INTASC) standards. The results…
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
Leider, Jonathon P; Shah, Gulzar; Rider, Nikki; Beck, Angela; Castrucci, Brian C; Harris, Jenine K; Sellers, Katie; Varda, Danielle; Ye, Jiali; Erwin, Paul C; Brownson, Ross C
Surveying governmental public health practitioners is a critical means of collecting data about public health organizations, their staff, and their partners. A greater focus on evidence-based practices, practice-based systems research, and evaluation has resulted in practitioners consistently receiving requests to participate in myriad surveys. This can result in a substantial survey burden for practitioners and declining response rates for researchers. This is potentially damaging to practitioners and researchers as well as the field of public health more broadly. We have examined recent developments in survey research, especially issues highly relevant for public health practice. We have also proposed a process by which researchers can engage with practitioners and practitioner groups on research questions of mutual interest.
Shah, Gulzar; Rider, Nikki; Beck, Angela; Castrucci, Brian C.; Harris, Jenine K.; Sellers, Katie; Varda, Danielle; Ye, Jiali; Erwin, Paul C.; Brownson, Ross C.
Surveying governmental public health practitioners is a critical means of collecting data about public health organizations, their staff, and their partners. A greater focus on evidence-based practices, practice-based systems research, and evaluation has resulted in practitioners consistently receiving requests to participate in myriad surveys. This can result in a substantial survey burden for practitioners and declining response rates for researchers. This is potentially damaging to practitioners and researchers as well as the field of public health more broadly. We have examined recent developments in survey research, especially issues highly relevant for public health practice. We have also proposed a process by which researchers can engage with practitioners and practitioner groups on research questions of mutual interest. PMID:27715307
Yasumura, Seiji; Hosoya, Mitsuaki; Yamashita, Shunichi; Kamiya, Kenji; Abe, Masafumi; Akashi, Makoto; Kodama, Kazunori; Ozasa, Kotaro
Background The accidents that occurred at the Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake on 11 March 2011 have resulted in long-term, ongoing anxiety among the residents of Fukushima, Japan. Soon after the disaster, Fukushima Prefecture launched the Fukushima Health Management Survey to investigate long-term low-dose radiation exposure caused by the accident. Fukushima Medical University took the lead in planning and implementing this survey. The primary purposes of this survey are to monitor the long-term health of residents, promote their future well-being, and confirm whether long-term low-dose radiation exposure has health effects. This report describes the rationale and implementation of the Fukushima Health Management Survey. Methods This cohort study enrolled all people living in Fukushima Prefecture after the earthquake and comprises a basic survey and 4 detailed surveys. The basic survey is to estimate levels of external radiation exposure among all 2.05 million residents. It should be noted that internal radiation levels were estimated by Fukushima Prefecture using whole-body counters. The detailed surveys comprise a thyroid ultrasound examination for all Fukushima children aged 18 years or younger, a comprehensive health check for all residents from the evacuation zones, an assessment of mental health and lifestyles of all residents from the evacuation zones, and recording of all pregnancies and births among all women in the prefecture who were pregnant on 11 March. All data have been entered into a database and will be used to support the residents and analyze the health effects of radiation. Conclusions The low response rate (<30%) to the basic survey complicates the estimation of health effects. There have been no cases of malignancy to date among 38 114 children who received thyroid ultrasound examinations. The importance of mental health care was revealed by the mental health and lifestyle survey and the pregnancy
Bliss, Kadi; Ogletree, Roberta J.; Liefer, Maureen
Readership surveys can help editors assess satisfaction with a journal as well as identify potential modifications to be made. The editorial staff of "The Health Educator" conducted an online readership survey in the summer of 20 11. After a five-week data solicitation and collection period, a total of 504 Eta Sigma Gamma (ESG) members responded.…
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
Meador, K J; Pennell, P B; Harden, C L; Gordon, J C; Tomson, T; Kaplan, P W; Holmes, G L; French, J A; Hauser, W A; Wells, P G; Cramer, J A
Most pregnant women with epilepsy require antiepileptic drug (AED) therapy. Present guidelines recommend optimizing treatment prior to conception, choosing the most effective AED for seizure type and syndrome, using monotherapy and lowest effective dose, and supplementing with folate. The Epilepsy Therapy Project established the international Health Outcomes in Pregnancy and Epilepsy (HOPE) forum to learn more about the impact of AEDs on the developing fetus, particularly the role of pregnancy registries in studying AED teratogenicity. The primary outcome of interest in these registries is the occurrence of major congenital malformations, with some data collected on minor malformations. Cognitive and behavioral outcomes are often beyond the timeframe for follow-up of these registries and require independent study. The HOPE consensus report describes the current state of knowledge and the limitations to interpretations of information from the various sources. Data regarding specific risks for both older and newer AEDs need to be analyzed carefully, considering study designs and confounding factors. There is a critical need for investigations to delineate the underlying mechanisms and explain the variance seen in outcomes across AEDs and within a single AED.
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.
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
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…
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.
Das, Ipsita; Jagger, Pamela; Yeatts, Karin
In sub-Saharan Africa, biomass fuels account for approximately 90% of household energy consumption. Limited evidence exists on the association between different biomass fuels and health outcomes. We report results from a cross-sectional sample of 655 households in Malawi. We calculated odds ratios between hypothesized determinants of household air pollution (HAP) exposure (fuel, stove type, and cooking location) and five categories of health outcomes (cardiopulmonary, respiratory, neurologic, eye health, and burns). Reliance on high- or low-quality firewood or crop residue (vs. charcoal) was associated with significantly higher odds of shortness of breath, difficulty breathing, chest pains, night phlegm, forgetfulness, dizziness, and dry irritated eyes. Use of high-quality firewood was associated with significantly lower odds of persistent phlegm. Cooks in rural areas (vs. urban areas) had significantly higher odds of experiencing shortness of breath, persistent cough, and phlegm, but significantly lower odds of phlegm, forgetfulness, and burns. With deforestation and population pressures increasing reliance on low-quality biomass fuels, prevalence of HAP-related cardiopulmonary and neurologic symptoms will likely increase among cooks. Short- to medium-term strategies are needed to secure access to high-quality biomass fuels given limited potential for scalable transitions to modern energy.
Donaldson, Michael S
While there have been many studies on health outcomes that have included measurements of plasma carotenoids, this data has not been reviewed and assembled into a useful form. In this review sixty-two studies of plasma carotenoids and health outcomes, mostly prospective cohort studies or population-based case-control studies, are analyzed together to establish a carotenoid health index. Five cutoff points are established across the percentiles of carotenoid concentrations in populations, from the tenth to ninetieth percentile. The cutoff points (mean ± standard error of the mean) are 1.11 ± 0.08, 1.47 ± 0.08, 1.89 ± 0.08, 2.52 ± 0.13, and 3.07 ± 0.20 µM. For all cause mortality there seems to be a low threshold effect with protection above every cutoff point but the lowest. But for metabolic syndrome and cancer outcomes there tends to be significant positive health outcomes only above the higher cutoff points, perhaps as a triage effect. Based on this data a carotenoid health index is proposed with risk categories as follows: very high risk: <1 µM, high risk: 1-1.5 µM, moderate risk: 1.5-2.5 µM, low risk: 2.5-4 µM, and very low risk: >4 µM. Over 95 percent of the USA population falls into the moderate or high risk category of the carotenoid health index.
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
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
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.
Bass, Loretta E; Warehime, M Nicole
We use categorical and logistic regression models to investigate the extent that family structure affects children’s health outcomes at age five (i.e., child’s type of health insurance coverage, the use of a routine medical doctor, and report of being in excellent health) using a sample of 4,898 children from the "Fragile Families and Child Well-Being Study." We find that children with married biological parents are most likely to have private health insurance compared with each of three other relationship statuses. With each additional child in the home, a child is less likely to have private insurance compared with no insurance and Medicaid insurance. Children with cohabiting biological parents are less likely to have a routine doctor compared with children of married biological parents, yet having additional children in the household is not associated with having a routine doctor. Children with biological parents who are not romantically involved and those with additional children in the household are less likely to be in excellent health, all else being equal.
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,…
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…
Keller, Michael J.
A random sample of Miami University undergraduate and graduate students were surveyed to determine their opinions about health care at the university. Most of the questions dealt with the university's student health service and satisfaction with the quality of medical treatment at the facility, perception of the staff's performance and interest in…
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…
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…
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
Schulz, Heiko; Zacher, Hannes; Lippke, Sonia
Occupational health researchers and practitioners have mainly focused on the individual and organizational levels, whereas the team level has been largely neglected. In this study, we define team health climate as employees' shared perceptions of the extent to which their team is concerned, cares, and communicates about health issues. Based on climate, signaling, and social exchange theories, we examined a multilevel model of team health climate and its relationships with five well-established health-related outcomes (i.e., subjective general health, psychosomatic complaints, mental health, work ability, and presenteeism). Results of multilevel analyses of data provided by 6,449 employees in 621 teams of a large organization showed that team health climate is positively related to subjective general health, mental health, and work ability, and negatively related to presenteeism, above and beyond the effects of team size, age, job tenure, job demands, job control, and employees' individual perceptions of health climate. Moreover, additional analyses showed that a positive team health climate buffered the negative relationship between employee age and work ability. Implications for future research on team health climate and suggestions for occupational health interventions in teams are discussed.
Schulz, Heiko; Zacher, Hannes; Lippke, Sonia
Occupational health researchers and practitioners have mainly focused on the individual and organizational levels, whereas the team level has been largely neglected. In this study, we define team health climate as employees’ shared perceptions of the extent to which their team is concerned, cares, and communicates about health issues. Based on climate, signaling, and social exchange theories, we examined a multilevel model of team health climate and its relationships with five well-established health-related outcomes (i.e., subjective general health, psychosomatic complaints, mental health, work ability, and presenteeism). Results of multilevel analyses of data provided by 6,449 employees in 621 teams of a large organization showed that team health climate is positively related to subjective general health, mental health, and work ability, and negatively related to presenteeism, above and beyond the effects of team size, age, job tenure, job demands, job control, and employees’ individual perceptions of health climate. Moreover, additional analyses showed that a positive team health climate buffered the negative relationship between employee age and work ability. Implications for future research on team health climate and suggestions for occupational health interventions in teams are discussed. PMID:28194126
Hannigan, B; Burnard, P; Edwards, D; Turnbull, J
Surveys of the leaders of the UK's post-qualifying education courses for community mental health nurses have taken place, on an annual basis, for over 10 years. In this paper, findings from the survey undertaken in the 1998--99 academic year are reported. These findings include: that most course leaders do not personally engage in clinical practice; that interprofessional education takes place at a minority of course centres, and that course philosophies and aims are characterised by an emphasis on both outcomes (in terms of, for example, skills acquisition, knowledge development and the ability to engage in reflective practice), and process (adult learning).
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.
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 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
The experience of poverty during childhood is a potent predictor of a variety of adverse health outcomes during middle and late adulthood. Children who live in poverty are more likely as adults than their peers to develop and die earlier from a range of diseases. These effects are especially strong for cardiovascular disease and type II diabetes. Most disturbingly, these effects appear in large part to be biologically embedded such that later improved life circumstances have only a modest ameliorative effect. Considering these findings and the relatively high rates of child poverty in nations such as Canada, UK, and USA, those concerned with improving the health of citizens should focus their attention on advocating for public policy that will reduce the incidence of child poverty.
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
Deola, Claudio; Patel, Ronak B
With urbanisation, cities are increasingly home to greater proportions of the world's population. As this transition has significant implications on human health, the epidemiology of diseases among relatively stable urban populations is growing. As humanitarian crises increasingly drive people to urban centers rather than traditional refugee camps, however, rapid and massive urban displacements will increase in frequency. This paper explores the idea that such urban displacements combine epidemiological features of forced migration, slum conditions and humanitarian disaster contexts. This paper highlights the lack of primary data and the consequent paucity of solid epidemiological literature in the aftermath of rapid massive urban displacements. A framework of health outcomes in urban displacement drawing from the above 3 phenomenon is presented and avenues for improved epidemiologic work described. PMID:28229003
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.
Deola, Claudio; Patel, Ronak B
With urbanisation, cities are increasingly home to greater proportions of the world's population. As this transition has significant implications on human health, the epidemiology of diseases among relatively stable urban populations is growing. As humanitarian crises increasingly drive people to urban centers rather than traditional refugee camps, however, rapid and massive urban displacements will increase in frequency. This paper explores the idea that such urban displacements combine epidemiological features of forced migration, slum conditions and humanitarian disaster contexts. This paper highlights the lack of primary data and the consequent paucity of solid epidemiological literature in the aftermath of rapid massive urban displacements. A framework of health outcomes in urban displacement drawing from the above 3 phenomenon is presented and avenues for improved epidemiologic work described.
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
Miller, D R; Jensen, J E
A survey of dual pricing practices among publishers of health-related journals identified 281 periodicals with an average price differential of over 100% between individual and institutional subscription rates. Both the practice itself and the amount of the differential are increasing, indicating that journal subscriptions of health sciences libraries increasingly provide the financial support necessary for the publication of health sciences journals. Dual pricing is also correlated with copyright royalties. The problems that dual pricing creates for health sciences libraries' budgets are due in part to uncritical purchasing by libraries. Increased consumerism on the part of health science librarians is recommended. PMID:7437588
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.
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
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…
To, T; Dell, S; Tassoudji, M; Wang, C
Data collected from the Canadian National Longitudinal Survey of Children and Youth (NLSCY) in 1994/95 and 1996/97 were used to measure longitudinal health outcomes among children with asthma. Over 10 000 children aged 1 to 11 years with complete data on asthma status in both years were included. Outcomes included hospitalizations and health services use (HSU). Current asthma was defined as children diagnosed with asthma by a physician and who took prescribed inhalants regularly, had wheezing or an attack in the previous year, or had their activities limited by asthma. Children having asthma significantly increased their odds of hospitalization (OR = 2.52; 95% CI: 1.71, 3.70) and health services use (OR = 3.80; 95% CI: 2.69, 5.37). Low-income adequacy (LIA) in 1994/ 95 significantly predicts hospitalization and HSU in 1996/97 (OR = 2.68; 95% CI: 1.29, 5.59 and OR = 0.67; 95% CI: 0.45, 0.99, respectively). Our results confirmed that both having current asthma and living in low-income families had a significant impact on the health status of children in Canada. Programs seeking to decrease the economic burden of pediatric hospitalizations need to focus on asthma and low-income populations.
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
Champlin, Sara; Mackert, Michael
Purpose . Create a screening measure of health literacy for use with the Health Information National Trends Survey (HINTS). Design . Participants completed a paper-based survey. Items from the survey were used to construct a health literacy screening measure. Setting . A population-based survey conducted in geographic areas of high and low minority frequency and in Central Appalachia. Subjects . Two thousand nine hundred four English-speaking participants were included in this study: 66% white, 93% completed high school, mean age = 52.53 years (SD = 16.24). Measures . A health literacy screening measure was created using four items included in the HINTS survey. Scores could range from 0 (no questions affirmative/correct) to 4 (all questions answered affirmatively/correctly). Analysis . Multiple regression analysis was used to determine whether demographic variables known to predict health literacy were indeed associated with the constructed health literacy screening measure. Results . The weighted average health literacy score was 2.63 (SD = 1.00). Those who were nonwhite (p = .0005), were older (p < .0005), or had not completed high school (p < .0001) tended to have lower health literacy screening measure scores. Conclusion . This study highlights the need to assess health literacy in national surveys, but also serves as evidence that screening measures can be created within existing datasets to give researchers the ability to consider the impact of health literacy.
Peters, Michele; Crocker, Helen; Jenkinson, Crispin; Doll, Helen; Fitzpatrick, Ray
Objectives To evaluate the feasibility of using patient-reported outcome measures (PROMs) for long-term conditions (LTCs) in primary care. Design A cohort postal survey conducted from September 2010 to April 2012. Setting Primary care practices (n=33) in London and the North-West of England. Participants 4484 patients with a diagnosis of asthma, chronic obstructive pulmonary disease, diabetes, epilepsy, heart failure or stroke were sent a survey at baseline. Main outcome The main outcome was to evaluate the feasibility of and the recruitment strategies for collecting PROMs data in LTCs by assessing the response rates for the baseline and follow-up surveys. Secondary outcomes were the evaluation of change scores of the EQ-5D index and visual analogue scale (VAS) between baseline and follow-up surveys. Results The baseline survey achieved a response rate of 38.4% (n=1721/4485) and at follow-up 71.5% (n=1136/1589). Response rates varied by LTC. Little change was found in health-related quality of life for the total sample (−0.001 for the EQ-5D index score and 0.12 for the EQ-5D VAS) between patients responding to both the baseline and follow-up surveys. Conclusions The response rate to the baseline survey was similar to that of other general practice surveys. Current UK policy aims to assess health service performance in LTCs by means of using PROMs. It thus would be desirable to improve response rates by making the invitation to self-reports of health-related quality of life more engaging for patients. Results on the EQ-5D score raise questions about optimal indicators for LTCs and appropriate timelines for assessment. PMID:24561495
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 refinery and near other industrial and mobile sources of pollution. The Richmond health survey aimed to assess local concerns and perceptions of neighborhood conditions, health problems, mobile and stationary hazards, access to health care, and other issues affecting residents of Richmond. Although respondents thought their neighborhoods were good places to live, they expressed concerns about neighborhood stressors and particular sources of pollution, and identified elevated asthma rates for children and long-time Richmond residents. The Richmond health survey offers a holistic, community-centered perspective to understanding local environmental health issues, and can inform future environmental health research and organizing efforts for community-university collaboratives.
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.
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
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.
Bentz, Willard K.; And Others
Based on a North Carolina feasibility study (1967-73 in Vance and Franklin Counties) which focused on development of a pattern for providing comprehensive mental health services to rural people, this booklet is the first in a series of nine and deals with methods of gathering preliminary information. Basically, this booklet presents information…
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
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
Background Relatively little knowledge is available to date about health literacy among the general population in Europe. It is important to gain insights into health literacy competences among the general population, as this might contribute to more effective health promotion and help clarify socio-economic disparities in health. This paper is part of the European Health Literacy Survey (HLS-EU). It aims to add to the body of theoretical knowledge about health literacy by measuring perceived difficulties with health information in various domains of health, looking at a number of competences. The definition and measure of health literacy is still topic of debate and hardly any instruments are available that are applicable for the general population. The objectives were to obtain an initial measure of health literacy in a sample of the general population in the Netherlands and to relate this measure to education, income, perceived social status, age, and sex. Methods The HLS-EU questionnaire was administered face-to-face in a sample of 925 Dutch adults, during July 2011. Perceived difficulties with the health literacy competences for accessing, understanding, appraising and applying information were measured within the domains of healthcare, disease prevention and health promotion. Multiple linear regression analyses were applied to explore the associations between health literacy competences and education, income, perceived social status, age, and sex. Results Perceived difficulties with health information and their association with demographic and socio-economic variables vary according to the competence and health domain addressed. Having a low level of education or a low perceived social status or being male were consistently found to be significantly related to relatively low health literacy scores, mainly for accessing and understanding health information. Conclusions Perceived difficulties with health information vary between competences and domains of
Detty, Amber M R
During the 2009-2010 school year, the Ohio Department of Health conducted a statewide oral health and body mass index (BMI) screening survey among 3rd grade children. This marked the fifth school-based survey regarding the oral health of Ohio children since 1987. At 50 %, the participation rate of the 2009-2010 oral health and BMI survey was at the lowest level ever experienced. This study aimed to identify the factors associated with participation rates in a school-based survey. A stratified, random sample of 377 schools was drawn from the list of 1,742 Ohio public elementary schools with third grade students. All third grade children in the sampled schools with parent or guardian consent received an oral health screening and height/weight measurement by trained health professionals. Participation rates at the school level were then combined with data on school characteristics and survey implementation. Predictors of school form return, participation, and refusal rates were assessed by generalized linear modeling (GLM). High student mobility and larger school size were associated with lower form return (p = 0.000 and p = 0.001, respectively) and lower participation rates (p = 0.000 and p = 0.005, respectively). Surveying in the fall or spring (as opposed to winter) significantly decreased form return (p = 0.001 and p = 0.016, respectively) and participation rates (p = 0.008 and p = 0.002, respectively), while being surveyed by internal staff (versus external screeners) significantly increased form return (p = 0.003) and participation rates (p = 0.001). Efforts to increase participation should focus more on schools with higher student mobility and larger size. Additionally, participation could be improved by using internal staff and surveying during winter.
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
Pantelopoulos, Alexandros; Bourbakis, Nikolaos
Wearable biosensor systems for health monitoring are an emerging trend and are expected to enable proactive personal health management and better treatment of various medical conditions. These systems, comprising various types of small physiological sensors, transmission modules and processing capabilities, promise to change the future of health care, by providing low-cost wearable unobtrusive solutions for continuous all-day and any-place health, mental and activity status monitoring. This paper presents a comprehensive survey on the research and development done so far on wearable biosensor systems for health-monitoring, by comparing a variety of current system implementations and approaches and identifying their technological shortcomings. A set of significant features, that best describe the functionality and the characteristics of wearable biosensor systems, has been selected to derive a thorough study. The aim of this survey is not to criticize, but to serve as a reference for current achievements and their maturity level and to provide direction for future research improvements.
Ports, Katie A; Reddy, Diane M; Barnack-Tavlaris, Jessica L
Research in primary care medicine demonstrates that health care providers' communication varies depending on their sex, and that these sex differences in communication can influence patients' health outcomes. The present study aimed to examine the extent to which sex differences in primary care providers' communication extend to the sensitive context of gynecological care for genital herpes and whether these potential sex differences in communication influence patients' herpes transmission prevention behaviors and herpes-related quality of life. Women (N = 123) from the United States recently diagnosed with genital herpes anonymously completed established measures in which they rated (a) their health care providers' communication, (b) their herpes transmission prevention behaviors, and (c) their herpes-related quality of life. The authors found significant sex differences in health care providers' communication; this finding supports that sex differences in primary care providers' communication extend to gynecological care for herpes. Specifically, patients with female health care providers indicated that their providers engaged in more patient-centered communication and were more satisfied with their providers' communication. However, health care providers' sex did not predict women's quality of life, a finding that suggests that health care providers' sex alone is of little importance in patients' health outcomes. Patient-centered communication was significantly associated with greater quality-of-life scores and may provide a promising avenue for intervention.
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
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
Cohen, Beth E.; Maguen, Shira; Bertenthal, Daniel; Shi, Ying; Jacoby, Vanessa; Seal, Karen H.
Background An increasing number of women serve in the military and are exposed to trauma during service that can lead to mental health problems. Understanding how these mental health problems affect reproductive and physical health outcomes will inform interventions to improve care for women veterans. Methods We analyzed national VA data from women Iraq and Afghanistan veterans who were new users of VA healthcare from 10/7/2001 through 12/31/2010 (N=71,504). We used ICD-9 codes to categorize veterans into 5 groups by mental health diagnoses (MH Dx), those with: no MH Dx, PTSD, depression, comorbid PTSD and depression, and MH Dx other than PTSD and depression. We determined the association between mental health category and reproductive and other physical health outcomes defined by ICD-9 codes. Categories included sexually transmitted infections, other infections (e.g. urinary tract infections), pain-related conditions (e.g. dysmenorrhea and dsypareunia), and other conditions (e.g. polycystic ovarian syndrome, infertility, sexual dysfunction). Models were adjusted for sociodemographics and military service factors. Results 31,481 (44%) received at least one mental health diagnosis. Women veterans with any mental health diagnosis had significantly higher prevalences of nearly all categories of reproductive and physical disease diagnoses (p <.0001 for adjusted prevalences). There was a trend of increasing prevalence of disease outcomes in women with PTSD, depression, and comorbid PTSD and depression (p for trend <.0001 for all outcomes). Conclusions Iraq and Afghanistan women veterans with mental health diagnoses had significantly greater prevalences of several important reproductive and physical health diagnoses. These results provide support for VA initiatives to address mental and physical health concerns and improve comprehensive care for women veterans. PMID:22944901
Walpole, Sarah; Taylor, Paul
Objective Health informatics has growing importance in clinical practice with successive General Medical Council recommendations. However, prior data suggest that undergraduate medical education largely neglects this area. An up-to-date, UK-wide view of health informatics training in medical schools is required. Design An online survey was developed using current guidance and recommendations of UK professional bodies. Participants and Setting Senior academic staff and health informatics educators at all 34 UK medical schools were invited to complete the survey. Main outcome measures Quantitative and qualitative data regarding health informatics in the undergraduate medical curriculum. Results A total of 26/34 (76%) of UK medical schools responded and 23 provided full information. Aspects most frequently mentioned were literature searching and research governance. Seventeen per cent of respondents felt there was little or no HI training, although clinical record keeping was addressed by all medical schools. Pedagogies used to teach health informatics were self-directed learning (78%) to lecture based (70%), seminars (70%), informal teaching in clinical settings (57%) and problem-based learning (22%). Health informatics was usually integrated vertically and horizontally across the curriculum (76%). Assessment and updates of the health informatics curriculum are limited (57 and 41%, respectively). Thirty-two per cent of respondents reported a low level of confidence among students to use health informatics as doctors. In the most up-to-date survey of health informatics teaching in UK medical schools, there are three major findings. First, the proportion of health informatics in the medical undergraduate curriculum is low. Second, there was variation in content, pedagogy and timing across medical schools. Third, health informatics is rarely assessed and course content is not regularly updated. Conclusions There is a role for national guidelines and further research in
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.
Guerrero, Erick G.; Aarons, Gregory; Grella, Christine; 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 2010–2011 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
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.
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…
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
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
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.
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)
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…
Song, Xiaowei; Mitnitski, Arnold; Cox, Jafna; Rockwood, Kenneth
Several machine learning techniques (multilayer and single layer perceptron, logistic regression, least square linear separation and support vector machines) are applied to calculate the risk of death from two biomedical data sets, one from patient care records, and another from a population survey. Each dataset contained multiple sources of information: history of related symptoms and other illnesses, physical examination findings, laboratory tests, medications (patient records dataset), health attitudes, and disabilities in activities of daily living (survey dataset). Each technique showed very good mortality prediction in the acute patients data sample (AUC up to 0.89) and fair prediction accuracy for six year mortality (AUC from 0.70 to 0.76) in individuals from epidemiological database surveys. The results suggest that the nature of data is of primary importance rather than the learning technique. However, the consistently superior performance of the artificial neural network (multi-layer perceptron) indicates that nonlinear relationships (which cannot be discerned by linear separation techniques) can provide additional improvement in correctly predicting health outcomes.
Verdes-Tennant, Emese; McEniry, Mary; Ispány, Márton
Data harmonization is a topic of growing importance to demographers, who increasingly conduct domestic or international comparative research. Many self-reported survey items cannot be directly compared across demographic groups or countries because these groups differ in how they use subjective response categories. Anchoring vignettes, already appearing in numerous surveys worldwide, promise to overcome this problem. However, many anchoring vignettes have not been formally evaluated for adherence to the key measurement assumptions of vignette equivalence and response consistency. This article tests these assumptions in some of the most widely fielded anchoring vignettes in the world: the health vignettes in the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE) and World Health Survey (WHS) (representing 10 countries; n = 52,388), as well as similar vignettes in the Health and Retirement Study (HRS) (n = 4,528). Findings are encouraging regarding adherence to response consistency, but reveal substantial violations of vignette equivalence both cross-nationally and across socioeconomic groups. That is, members of different sociocultural groups appear to interpret vignettes as depicting fundamentally different levels of health. The evaluated anchoring vignettes do not fulfill their promise of providing interpersonally comparable measures of health. Recommendations for improving future implementations of vignettes are discussed. PMID:26335547
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.
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…
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…
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…
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…
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…
The 2015 Health Physics Enrollments and Degrees Survey reports degrees granted between September 1, 2014 and August 31, 2015. Enrollment information refers to the fall term 2015. Twenty-two academic programs were included in the survey universe, with all 22 programs providing data. The enrollments and degrees information comprises students majoring in health physics or in an option program equivalent to a major. The report includes enrollment information on undergraduate students and graduate students and information by degree level for post-graduation plans.
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…
Donaldson, Michael S.
While there have been many studies on health outcomes that have included measurements of plasma carotenoids, this data has not been reviewed and assembled into a useful form. In this review sixty-two studies of plasma carotenoids and health outcomes, mostly prospective cohort studies or population-based case-control studies, are analyzed together to establish a carotenoid health index. Five cutoff points are established across the percentiles of carotenoid concentrations in populations, from the tenth to ninetieth percentile. The cutoff points (mean ± standard error of the mean) are 1.11 ± 0.08, 1.47 ± 0.08, 1.89 ± 0.08, 2.52 ± 0.13, and 3.07 ± 0.20 µM. For all cause mortality there seems to be a low threshold effect with protection above every cutoff point but the lowest. But for metabolic syndrome and cancer outcomes there tends to be significant positive health outcomes only above the higher cutoff points, perhaps as a triage effect. Based on this data a carotenoid health index is proposed with risk categories as follows: very high risk: <1 µM, high risk: 1-1.5 µM, moderate risk: 1.5-2.5 µM, low risk: 2.5-4 µM, and very low risk: >4 µM. Over 95 percent of the USA population falls into the moderate or high risk category of the carotenoid health index. PMID:22292108
Hansen, Daniel; Vedantam, Aditya; Briceño, Valentina; Lam, Sandi K; Luerssen, Thomas G; Jea, Andrew
OBJECTIVE The emphasis on health-related quality of life (HRQOL) outcomes is increasing, along with an emphasis on evidence-based medicine. However, there is a notable paucity of validated HRQOL instruments for the pediatric population. Furthermore, no standardization or consensus currently exists concerning which HRQOL outcome measures ought to be used in pediatric neurosurgery. The authors wished to identify HRQOL outcomes used in pediatric neurosurgery research over the past 10 years, their frequency, and usage trends. METHODS Three top pediatric neurosurgical journals were reviewed for the decade from 2005 to 2014 for clinical studies of pediatric neurosurgical procedures that report HRQOL outcomes. Similar studies in the peer-reviewed journal Pediatrics were also used as a benchmark. Publication year, level of evidence, and HRQOL outcomes were collected for each article. RESULTS A total of 31 HRQOL studies were published in the pediatric neurosurgical literature over the study period. By comparison, there were 55 such articles in Pediatrics. The number of publications using HRQOL instruments showed a significant positive trend over time for Pediatrics (B = 0.62, p = 0.02) but did not increase significantly over time for the 3 neurosurgical journals (B = 0.12, p = 0.5). The authors identified a total of 46 different HRQOL instruments used across all journals. Within the neurosurgical journals, the Hydrocephalus Outcome Questionnaire (HOQ) (24%) was the most frequently used, followed by the Health Utilities Index (HUI) (16%), the Pediatric Quality of Life Inventory (PedsQL) (12%), and the 36-Item Short Form Health Survey (SF-36) (12%). Of the 55 articles identified in Pediatrics, 22 (40%) used a version of the PedsQL. No neurosurgical study reached above Level 4 on the Oxford Centre for Evidence-Based Medicine (OCEBM) system. However, multiple studies from Pediatrics achieved OCEBM Level 3, several were categorized as Level 2, and one reached Level 1
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
Piccolo, Rebecca S; Araujo, Andre B; Pearce, Neil; McKinlay, John B
The Boston Area Community Health (BACH) Survey is a community-based, random sample, epidemiologic cohort of n = 5502 Boston (MA) residents. The baseline BACH Survey (2002-05) was designed to explore the mechanisms conferring increased health risks on minority populations with a particular focus on urologic signs/symptoms and type 2 diabetes. To this end, the cohort was designed to include adequate numbers of US racial/ethnic minorities (Black, Hispanic, White), both men and women, across a broad age of distribution. Follow-up surveys were conducted ∼5 (BACH II, 2008) and 7 (BACH III, 2010) years later, which allows for both within- and between-person comparisons over time. The BACH Survey's measures were designed to cover the following seven broad categories: socio-demographics, health care access/utilization, lifestyles, psychosocial factors, health status, physical measures and biochemical parameters. The breadth of measures has allowed BACH researchers to identify disparities and quantify contributions to social disparities in a number of health conditions including urologic conditions (e.g. nocturia, lower urinary tract symptoms, prostatitis), type 2 diabetes, obesity, bone mineral content and density, and physical function. BACH I data are available through the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repositories (www.niddkrepository.org). Further inquiries can be made through the New England Research Institutes Inc. website (www.neriscience.com/epidemiology).
Parkes, Alison; Kearns, Ade
Neighbourhoods may influence the health of individual residents in different ways: via the social and physical environment, as well as through facilities and services. Not all factors may be equally important for all population subgroups. A cross-sectional analysis of the Scottish Household Survey 2001 examined a range of neighbourhood factors for links with three health outcomes and two health-related behaviours. The results support the hypothesis that the neighbourhood has a multi-dimensional impact on health. There was also some evidence that the relationship between neighbourhood factors and health varied according to the population subgroup, although not in a consistent manner.
Wilde, Elizabeth Ty
The introduction of technology aimed at reducing the response times of emergency medical services has been one of the principal innovations in crisis care over the last several decades. These substantial investments have typically been justified by an assumed link between shorter response times and improved health outcomes. However, current medical research does not generally show a relationship between response time and mortality. In this study, we explain the discrepancy between conventional wisdom and mortality; existing medical research fails to account for the endogeneity of incident severity and response times. Analyzing detailed call-level information from the state of Utah's Bureau of Emergency Medical Services, we measure the impact of response time on mortality and hospital utilization using the distance of the incident from the nearest EMS agency headquarters as an instrument for response time. We find that response times significantly affect mortality and the likelihood of being admitted to the hospital, but not procedures or utilization within the hospital.
Philipson, Tomas; Linthicum, Mark T; Snider, Julia Thornton
As healthcare costs climb around the world, public and private payers alike are demanding evidence of a treatment's value to support approval and reimbursement decisions. Health economics and outcomes research, or HEOR, offers tools to answer questions about a treatment's value, as well as its real-world effects and cost-effectiveness. Given that nutrition interventions have to compete for space in budgets along with biopharmaceutical products and devices, nutrition is now increasingly coming to be evaluated through HEOR. This tutorial introduces the discipline of HEOR and motivates its relevance for nutrition. We first define HEOR and explain its role and relevance in relation to randomized controlled trials. Common HEOR study types--including burden of illness, effectiveness studies, cost-effectiveness analysis, and valuation studies--are presented, with applications to nutrition. Tips for critically reading HEOR studies are provided, along with suggestions on how to use HEOR to improve patient care. Directions for future research are discussed.
O'Connor, Kathleen; Vizcaino, Maricarmen; Benavides, Nora A
The purpose of this cross-sectional study was to investigate to what extent young adults with close ties to Mexico were at greater risk for self-reported negative mental health outcomes than comparison groups during drug-related armed conflict from 2008 through 2012, and the effect of type and number of traumatic events on mental health outcomes. Using the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist, 202 university students living in the El Paso-Ciudad Juárez border region were surveyed for symptoms of depression, anxiety, and posttraumatic stress. Students with close ties to Mexico reported symptoms of anxiety and posttraumatic stress at significantly higher rates compared with those without connection to Mexico, but there was no significant difference in rates of depression. Although more than a third of participants reported experiencing 5 or more traumatic events connected with the drug war, being confined to home had the most significant effect. Frequency of traumatic events reported by students as well as rates of anxiety and posttraumatic stress symptoms were higher among students with greater connection to Mexico. Rates of clinically-significant depressive symptoms among all students were higher than expected for U.S. adults but comparable with all U.S. college students. This study presents important new data on the mental health effects of Mexico's drug war.
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
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.
Hill, Tom R; Aspray, Terence J; Francis, Roger M
The aim of this review is to summarise the evidence linking vitamin D to bone health outcomes in older adults. A plethora of scientific evidence globally suggests that large proportions of people have vitamin D deficiency and are not meeting recommended intakes. Older adults are at particular risk of the consequences of vitamin D deficiency owing to a combination of physiological and behavioural factors. Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism. There seems to be inconsistent evidence for a protective role of vitamin D supplementation alone on bone mass. However, it is generally accepted that vitamin D (17·5 μg/d) in combination with Ca (1200 mg/d) reduces bone loss among older white subjects. Evidence for a benefit of vitamin D supplementation alone on reducing fracture risk is varied. According to a recent Agency for Healthcare Research and Quality review in the USA the evidence base shows mixed results for a beneficial effect of vitamin D on decreasing overall fracture risk. Limitations such as poor compliance with treatment, incomplete assessment of vitamin D status and large drop-out rates however, have been highlighted within some studies. In conclusion, it is generally accepted that vitamin D in combination with Ca reduces the risk of non-vertebral fractures particularly those in institutional care. The lack of data on vitamin D and bone health outcomes in certain population groups such as diverse racial groups warrants attention.
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
... Collection; Comment Request; Survey of ``Health Care Providers' Responses to Medical Device Labeling'' AGENCY... collection ``Health Care Providers' Responses to Medical Device Labeling.'' DATES: Submit either electronic... appropriate, and other forms of information technology. Survey of ``Health Care Providers' Responses...
Hanmer, Janel; Cherepanov, Dasha; Palta, Mari; Kaplan, Robert M.; Feeny, David; Fryback, Dennis
Importance Many cost-utility analyses rely on generic utility measures for estimates of disease impact. Commonly used generic preference-based indexes may generate different absolute estimates of disease burden despite sharing anchors of dead at 0 and full health at 1.0. Objective We compare the impact of 16 prevalent chronic health conditions using six utility-based indexes of health and a visual analog scale. Design Data were from the National Health Measurement Study (NHMS), a cross-sectional telephone survey of 3844 adults aged 35–89 in the United States. Main Outcome Measures The NHMS included the EuroQol-5D-3L, Health and Activities Limitation Index (HALex), Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3), preference-based scoring for the SF-36 (SF-6D), Quality of Well-being Scale, and visual analog scale. Respondents self-reported 16 chronic conditions. Survey-weighted regression analyses for each index with all health conditions, age, and gender were used to estimate health condition impact estimates in terms of quality-adjusted life-years (QALYs) lost over 10 years. All analyses were stratified by ages 35–69 and 70–89. Results There were significant differences between the indexes for estimates of the absolute impact of most conditions. On average, condition impacts were the smallest with the SF-6D and EQ-5D and the largest with the HALex and HUI3. Likewise, the estimated loss of QALYs varied across indexes. Condition impact estimates for EQ-5D, HUI2, HUI3, and SF-6D generally had strong Spearman correlations across conditions (i.e., > 0.69). Limitations This analysis uses cross-sectional data and lacks health condition severity information. Conclusions Health condition impact estimates vary substantially across the indexes. These results imply that it is difficult to standardize results across cost-utility analyses which use different utility measures. PMID:26314728
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.
Liu, Zhaorui; Huang, Yueqin; Lv, Ping; Zhang, Tingting; Wang, Hong; Li, Qiang; Yan, Jie; Yu, Yaqin; Kou, Changgui; Xu, Xiufeng; Lu, Jin; Wang, Zhizhong; Qiu, Hongyan; Xu, Yifeng; He, Yanling; Li, Tao; Guo, Wanjun; Tian, Hongjun; Xu, Guangming; Xu, Xiangdong; Ma, Yanjuan; Wang, Linhong; Wang, Limin; Yan, Yongping; Wang, Bo; Xiao, Shuiyuan; Zhou, Liang; Li, Lingjiang; Tan, Liwen; Chen, Hongguang; Ma, Chao
China Mental Health Survey (CMHS), which was carried out from July 2013 to March 2015, was the first national representative community survey of mental disorders and mental health services in China using computer-assisted personal interview (CAPI). Face-to-face interviews were finished in the homes of respondents who were selected from a nationally representative multi-stage disproportionate stratified sampling procedure. Sample selection was integrated with the National Chronic Disease and Risk Factor Surveillance Survey administered by the National Centre for Chronic and Non-communicable Disease Control and Prevention in 2013, which made it possible to obtain both physical and mental health information of Chinese community population. One-stage design of data collection was used in the CMHS to obtain the information of mental disorders, including mood disorders, anxiety disorders, and substance use disorders, while two-stage design was applied for schizophrenia and other psychotic disorders, and dementia. A total of 28,140 respondents finished the survey with 72.9% of the overall response rate. This paper describes the survey mode, fieldwork organization, procedures, and the sample design and weighting of the CMHS. Detailed information is presented on the establishment of a new payment scheme for interviewers, results of the quality control in both stages, and evaluations to the weighting.
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
The key health issues for women tend to be primarily associated with the female reproductive system. There are also other gender priorities and consequences associated with ageing, which require effective interventions. Acupuncture is used worldwide and its evidence base is increasing on both mechanisms of action and its effectiveness in clinical care. Although acupuncture may be a valuable addition to healthcare for some conditions, it is rarely fully integrated into mainstream Western medicine clinical practice. Inadequate design and poor reporting of clinical trials have been barriers. Additionally systematic reviews and meta-analyses have tended to be equivocal and have reported that there is insufficient evidence for its recommendation. Future research should focus on ensuring good trial design including cost effectiveness and qualitative data and using a more pragmatic stance which reflects acupuncture in clinical practice. Undoubtedly, effective interventions are always needed to ensure the best health outcomes and address preventable deaths, morbidities, and disabilities among women but integration will be compromised unless underpinned by good evidence. PMID:28271658
McCague, Anna-Binney; Cox-Ganser, Jean M.; Harney, Joshua M.; Alwis, K. Udeni; Blount, Benjamin C.; Cummings, Kristin J.; Edwards, Nicole; Kreiss, Kathleen
Background Health risks of using styrene to manufacture windblades for the green energy sector are unknown. Methods Using data collected from 355 (73%) current windblade workers and regression analysis, we investigated associations between health outcomes and styrene exposure estimates derived from urinary styrene metabolites. Results The median current styrene exposure was 53.6 mg/g creatinine (interquartile range: 19.5–94.4). Color blindness in men and women (standardized morbidity ratios 2.3 and 16.6, respectively) was not associated with exposure estimates, but was the type previously reported with styrene. Visual contrast sensitivity decreased and chest tightness increased (odds ratio 2.9) with increasing current exposure. Decreases in spirometric parameters and FeNO, and increases in the odds of wheeze and asthma-like symptoms (odds ratios 1.3 and 1.2, respectively) occurred with increasing cumulative exposure. Conclusions Despite styrene exposures below the recommended 400 mg/g creatinine, visual and respiratory effects indicate the need for additional preventative measures in this industry. PMID:26305283
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
Brisset, Camille; Leanza, Yvan; Rosenberg, Ellen; Vissandjée, Bilkis; Kirmayer, Laurence J; Muckle, Gina; Xenocostas, Spyridoula; Laforce, Hugues
Many migrants do not speak the official language of their host country. This linguistic gap has been found to be an important contributor to disparities in access to services and health outcomes. This study examined primary care mental health practitioners' experiences with linguistic diversity. 113 practitioners in Montreal completed a self-report survey assessing their experiences working with allophones. About 40% of practitioners frequently encountered difficulties working in mental health with allophone clients. Few resources were available, and calling on an interpreter was the most common practice. Interpreters were expected to play many roles, which went beyond basic language translation. There is a clear need for training of practitioners on how to work with different types of interpreters. Training should highlight the benefits and limitations of the different roles that interpreters can play in health care delivery and the differences in communication dynamics with each role.
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)
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…
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)
Abiola, Sara E; Gonzales, Richard; Blendon, Robert J; Benson, John
Public opinion can play an important role in shaping health policy alternatives and outcomes. However, little is known about how citizens in developing countries evaluate government performance in the health sector. Through a survey conducted in 2008 in twenty sub-Saharan African countries, we examined public priorities and perceptions of government efforts to improve health services. In sixteen of these countries, health was one of the top five priorities the public thought the government should address. A staggering proportion of citizens in most of the sampled countries reported having gone without medicines or medical treatment in the previous year, and going without health care was most strongly correlated with views on health services. By contrast, greater access to health care was associated with more positive impressions of government efforts to improve health services. Population health indicators, such as life expectancy and childhood mortality, were not correlated with citizens' evaluation of government efforts. Results suggest that improving access to health care will be a key factor in improving perceptions of government performance.
Watt, R G; Steele, J G; Treasure, E T; White, D A; Pitts, N B; Murray, J J
This is the final paper in a series reporting on the results of the 2009 Adult Dental Health Survey. Since 1968 national adult surveys have been repeated every decade with broadly similar methods providing a unique overview of trends in oral health over a 40-year period. This paper aims to explore the implications for dentists and oral health policy of the key results from the Adult Dental Health Survey 2009. Although repeat, cross-sectional, epidemiological surveys provide very valuable data on trends in disease patterns, they do not provide answers to test causal relationships and therefore cannot identify the causes for the significant improvements in oral health over the last 40 years. Evidence would indicate, however, that broad societal shifts in population norms and behaviours, combined with changes in clinical diagnostic criteria, treatment planning and clinical procedures are the main reasons for the changes that have taken place. Key implications of the survey results include the need to monitor, support and maintain the good state of oral health of the increasing proportion of younger adults with relatively simple treatment needs. A smaller number of young and middle aged adults but a significant proportion of older adults will have far more complex treatment needs requiring advanced restorative and periodontal care. Future oral health policy will need to address oral health inequalities, encourage skill mix and promote and facilitate the dental profession to deliver appropriate and high quality care relevant to the needs of their local population.
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.
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.
Bushnell, P Timothy; Colombi, Alberto; Caruso, Claire C; Tak, Sangwoo
There is evidence that work schedules may influence rates of unhealthy behaviors, suggesting that addressing work schedule challenges may improve health. Health Risk Assessment (HRA) survey responses were collected during 2000-2008 in a multinational chemical and coatings manufacturer. Responses of 26,442 were sufficiently complete for analysis. Rates of smoking, lack of exercise, moderate to high alcohol use, obesity (BMI > or = 30), and short sleep duration were compared by work schedule type (day, night, or rotating shift) and daily work hours (8, 10, or 12 h). Prevalence rate ratios (RRs) were calculated, adjusting for age group, sex, marital/living status, job tenure, and occupational group. The reference group was 8-h day shift employees. Overall prevalence rates were: sleep duration of 6 h or less per night 47%, smoking 17.3%, no exercise 22.0%, BMI > or = 30 28.3%, and moderate to heavy alcohol consumption 22.2%. Statistically significant RRs include the following: Short sleep duration: 10 h rotating shift (RR=1.6), 12 h day and 12 h rotating shifts (RR=1.3); Smoking: 12 h day and rotating shifts (RR=1.6), 10 and 12 h night and 8 h rotating shift (RR=1.4); No exercise: 8, 10, and 12 h rotating shifts (RR=1.2 to 1.3), 12 h day schedules (RR=1.3). Obesity (BMI > or = 30): 8 and 10 h night shifts (RR=1.3 and 1.4, respectively).
Patel, Vaishali N; Dhopeshwarkar, Rina V; Edwards, Alison; Barrón, Yolanda; Sparenborg, Jeffrey; Kaushal, Rainu
In order to characterize consumer support for electronic health information exchange (HIE) and personal health records (PHRs) in a community where HIE is underway, we conducted a survey of English speaking adults who visited primary care practices participating in a regional community-wide clinical data exchange, during August, 2008. Amongst the 117 respondents, a majority supported physicians' use of HIE (83%) or expressed interest in potentially using PHRs (76%). Consumers' comfort sending personal information electronically over the Internet and their perceptions regarding the potential benefits of HIE were independently associated with their support for HIE. Consumers' prior experience using the Internet to manage their healthcare, perceptions regarding the potential benefits of PHRs and college education were independently associated with potential PHR use. Bolstering consumer support for HIE and PHRs will require addressing privacy and security concerns, demonstrating clinical benefits, and reaching out to those who are less educated and computer literate.
Baugh, Christine M; Kroshus, Emily; Kiernan, Patrick T; Mendel, David; Meehan, William P
Concussion is increasingly recognized as a risk of participation in contact and collision sports. There have been few examinations of athletes' perceptions of their susceptibility to concussion or concussion-related health consequences. We examine college football players' perceptions of their risk of sustaining a concussion and concussion-related health consequences in their future, whether these perceptions change over time, and how concussion history is related to perceived future risk of concussion and concussion-related health consequences. A survey was administered to National Collegiate Athletic Association Division I Football Championship Series athletes on 10 teams in 2013 and to nine of those teams in 2014. Athletes answered questions assessing their perceptions of concussion and potential concussion-related health consequences. Approximately 40% of athletes believed there was a strong possibility that they would sustain a concussion in the future, while approximately one-in-four thought a concussion would make them miss a few games. About one-in-10 athletes predicted dementia, Alzheimer's disease, or chronic traumatic encephalopathy would develop from concussions. These beliefs were stronger among athletes who had sustained previous concussions. Across the two years studied, athletes' perceptions of the risk of concussion and missing a few games because of concussion decreased significantly. Overall, a substantial proportion of college football players believe they will have long-term health consequences as a result of sustaining sport-related concussions. The true incidence and prevalence of many of these outcomes are unknown. Further research is needed to determine whether athletes have an accurate perception of the risks of these outcomes developing.
Firestone, M; Smylie, J; Maracle, S; Spiller, M; O'Campo, P
Objective Population-based health information on urban Aboriginal populations in Canada is limited due to challenges with the identification of Aboriginal persons in existing health data sets. The main objective of the Our Health Counts (OHC) project was to work in partnership with Aboriginal stakeholders to generate a culturally relevant, representative baseline health data set for three urban Aboriginal communities in Ontario, Canada. Design Respondent-driven sampling (RDS). Setting Hamilton, Ontario, Canada. Participants The OHC study, in partnership with the De dwa da dehs ney >s Aboriginal Health Access Centre (DAHC), recruited 554 First Nations adults living in Hamilton using RDS. Results Among First Nations adults living in Hamilton, 78% earned less than $20 000 per year and 70% lived in the lowest income quartile neighbourhoods. Mobility and crowded living conditions were also highly prevalent. Common chronic diseases included arthritis, hypertension, diabetes and chronic obstructive pulmonary disease and rates of emergency room access were elevated. Conclusions RDS is an effective sampling method in urban Aboriginal contexts as it builds on existing social networks and successfully identified a population-based cohort. The findings illustrate striking disparities in health determinants and health outcomes between urban First Nations individuals and the general population which have important implications for health services delivery, programming and policy development. PMID:25011988
Benjamins, Maureen R; Whitman, Steven
Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23% of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57-3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28-0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers.
stress, coping behaviors , alcohol use, and sleep . The scores for each issue were trichotomized by risk level, as green, yellow, or orange/red. The...military efforts. The Naval Unit Behavioral Health Needs Assessment Survey (NUBHNAS) will undertake the surveillance of Navy and Marine Corps personnel in... Behavioral health issues, including depression and posttraumatic stress disorder (PTSD), are an ongoing problem for U.S. military forces. Rates of diagnosed
Phillips, David E; AbouZahr, Carla; Lopez, Alan D; Mikkelsen, Lene; de Savigny, Don; Lozano, Rafael; Wilmoth, John; Setel, Philip W
In this Series paper, we examine whether well functioning civil registration and vital statistics (CRVS) systems are associated with improved population health outcomes. We present a conceptual model connecting CRVS to wellbeing, and describe an ecological association between CRVS and health outcomes. The conceptual model posits that the legal identity that civil registration provides to individuals is key to access entitlements and services. Vital statistics produced by CRVS systems provide essential information for public health policy and prevention. These outcomes benefit individuals and societies, including improved health. We use marginal linear models and lag-lead analysis to measure ecological associations between a composite metric of CRVS performance and three health outcomes. Results are consistent with the conceptual model: improved CRVS performance coincides with improved health outcomes worldwide in a temporally consistent manner. Investment to strengthen CRVS systems is not only an important goal for individuals and societies, but also a development imperative that is good for health.
Wagner, Julie; Burke, Georgine; Kuoch, Theanvy; Scully, Mary; Armeli, Stephen; Rajan, Thiruchandurai V.
Objective Mental health problems among Southeast Asian refugees have been documented. However, longer term health consequences of mass violence as re-settled refugees age are less well described. This study investigated relationships among trauma symptoms, self-reported health outcomes, and barriers to healthcare among Cambodian and Vietnamese persons in Connecticut. Methods An internet phone directory was used to generate a list of names that was compared to 2000 census data to estimate the proportion of the population in each group. From these lists, 190 telephone listings were selected at random. Interviewers telephoned selected listings to screen for eligible participants and obtain an appointment for interview. Surveys were administered through face-to-face interviews during home visits conducted in Khmer or Vietnamese. The Harvard Trauma Questionnaire assessed trauma symptoms. Questions regarding the presence of physician diagnosed heart disease, hypertension, diabetes, and chronic pain were adapted as written from the Health Interview Survey. Healthcare access and occurrence were measured with questions regarding cost and access, patient-provider understanding, and interpretive services. Hierarchical modeling was used to account for respondent nesting within family. Analyses controlled for age, sex, and country of origin. Results Individuals who reported greater trauma symptoms were more likely to report heart disease by a factor of 1.82, hypertension by a factor of 1.41, and total count of diseases by a factor of 1.22, as well as lower levels of subjective health. Greater trauma symptoms were also associated with greater lack of understanding, cost and access problems, and the need for an interpreter. Conclusions Although the majority of Southeast Asian immigrants came to the United States as refugees approximately 20–30 years ago, there continues to be high levels of trauma symptoms among this population which are associated with increased risk for
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.
Johnson, Kiersten B; Jacob, Anila; Brown, Molly E
ABSTRACT 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
Davern, Michael; McAlpine, Donna; Beebe, Timothy J; Ziegenfuss, Jeanette; Rockwood, Todd; Call, Kathleen Thiede
Objective To examine the impact of response rate variation on survey estimates and costs in three health telephone surveys. Data Source Three telephone surveys of noninstitutionalized adults in Minnesota and Oklahoma conducted from 2003 to 2005. Study Design We examine differences in demographics and health measures by number of call attempts made before completion of the survey or whether the household initially refused to participate. We compare the point estimates we actually obtained with those we would have obtained with a less aggressive protocol and subsequent lower response rate. We also simulate what the effective sample sizes would have been if less aggressive protocols were followed. Principal Findings Unweighted bivariate analyses reveal many differences between early completers and those requiring more contacts and between those who initially refused to participate and those who did not. However, after making standard poststratification adjustments, no statistically significant differences were observed in the key health variables we examined between the early responders and the estimates derived from the full reporting sample. Conclusions Our findings demonstrate that for the surveys we examined, larger effective sample sizes (i.e., more statistical power) could have been achieved with the same amount of funding using less aggressive calling protocols. For some studies, money spent on aggressively pursuing high response rates could be better used to increase statistical power and/or to directly examine nonresponse bias. PMID:20579127
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)…
Franzini, Luisa; Fernandez-Esquer, Maria Eugenia
Several studies have suggested that the health of Mexican-Americans is better than expected given their low socioeconomic status. The healthy migrant hypothesis and the acculturation hypothesis, stating that the foreign-born and the less acculturated enjoy better health, have been proposed as possible complementary explanations. However, it is not clear which are the socioeconomic, cultural, and personal characteristics that favor good health and that differentiate foreign-born from US-born and unacculturated from acculturated Mexicans. In this paper, we compare, by nativity and acculturation level, the socioeconomic, cultural, and personal characteristics in a sample of low income mostly female Mexican-origin individuals living in Texas and investigate their contribution to differences in self-reported physical health, mental health, and self-rated health (SRH) status. Using a multistage probability sample, we completed 1745 interviews with Mexican-origin individuals. The survey instrument included the SF-12, demographic and socioeconomic information, and questions on social support, religiosity, fear of victimization, trust, perceived racism, and perceived opportunity. Nativity and use of the Spanish language were combined into a nativity/acculturation variable. We estimated multivariate regressions and ordered logit regressions to investigate the association of health outcomes to nativity/acculturation and socioeconomic, cultural, and personal characteristics. Overall, the distribution of strengths (more social support, trust, perceived personal opportunities and less perceived victimization) reflected a nativity-based income gradient and an education gradient reflecting language use. Health outcomes varied by nativity/acculturation after controlling for socioeconomic, cultural, and personal characteristics. Physical health differed by nativity, supporting the healthy migrant hypothesis, while nativity-based differences in mental health were explained by
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
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
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
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
Molitor, John; Papathomas, Michail; Jerrett, Michael; Richardson, Sylvia
Standard regression analyses are often plagued with problems encountered when one tries to make inference going beyond main effects using data sets that contain dozens of variables that are potentially correlated. This situation arises, for example, in epidemiology where surveys or study questionnaires consisting of a large number of questions yield a potentially unwieldy set of interrelated data from which teasing out the effect of multiple covariates is difficult. We propose a method that addresses these problems for categorical covariates by using, as its basic unit of inference, a profile formed from a sequence of covariate values. These covariate profiles are clustered into groups and associated via a regression model to a relevant outcome. The Bayesian clustering aspect of the proposed modeling framework has a number of advantages over traditional clustering approaches in that it allows the number of groups to vary, uncovers subgroups and examines their association with an outcome of interest, and fits the model as a unit, allowing an individual's outcome potentially to influence cluster membership. The method is demonstrated with an analysis of survey data obtained from the National Survey of Children's Health. The approach has been implemented using the standard Bayesian modeling software, WinBUGS, with code provided in the supplementary material available at Biostatistics online. Further, interpretation of partitions of the data is helped by a number of postprocessing tools that we have developed.
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
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.
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
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.
Dahlhamer, James M; Galinsky, Adena M; Joestl, Sarah S; Ward, Brian W
Objective-This report presents a set of quality analyses of sexual orientation data collected in the 2013 National Health Interview Survey (NHIS). NHIS sexual orientation estimates are compared with those from the National Survey of Family Growth (NSFG) and the National Health and Nutrition Examination Survey (NHANES). Selected health outcomes by sexual orientation are compared between NHIS and NSFG. Assessments of item nonresponse, item response times, and responses to follow-up questions to the sexual orientation question are also presented. Methods-NHIS is a multipurpose health survey conducted continuously throughout the year by the Centers for Disease Control and Prevention's National Center for Health Statistics. Analyses in this report were based on NHIS data collected in 2013 from 34,557 adults aged 18 and over. Sampling weights were used to produce national estimates that are representative of the civilian noninstitutionalized U.S. adult population. Data from the 2006-2010 NSFG and 2009-2012 NHANES were used for the comparisons. Results-Based on the 2013 NHIS data, 96.6% of adults identified as straight, 1.6% identified as gay/lesbian, and 0.7% identified as bisexual. The remaining 1.1% of adults identified as ''something else,'' stated ''I don't know the answer,'' or refused to answer. Responses to follow-up questions suggest that the sexual orientation question is producing little classification error. In addition, largely similar patterns of association between sexual orientation and health were observed for NHIS and NSFG. Analyses of item nonresponse rates revealed few data quality issues, although item response times suggest possible shortcutting of the question and comprehension problems for select respondents.
Yusoff, Fadhli; Saari, Riyanti; Naidu, Balkish M; Ahmad, Noor Ani; Omar, Azahadi; Aris, Tahir
The National School-Based Health Survey 2012 was a nationwide school health survey of students in Standard 4 to Form 5 (10-17 years of age), who were schooling in government schools in Malaysia during the period of data collection. The survey comprised 3 subsurveys: the Global School Health Survey (GSHS), the Mental Health Survey, and the National School-Based Nutrition Survey. The aim of the survey was to provide data on the health status of adolescents in Malaysia toward strengthening the adolescent health program in the country. The design of the survey was created to fulfill the requirements of the 3 subsurveys. A 2-stage stratified sampling method was adopted in the sampling. The methods for data collection were via questionnaire and physical examination. The National School-Based Health Survey 2012 adopted an appropriate methodology for a school-based survey to ensure valid and reliable findings.
Lynch, Wendy D; Sherman, Bruce W
When corporate health researchers examine the effects of health on business outcomes or the effect of health interventions on health and business outcomes, results will necessarily be confounded by the corporate environment(s) in which they are studied. In this research setting, most studies control for factors traditionally identified in public health, such as demographics and health status. Nevertheless, often overlooked is the extent to which company policies can also independently impact health care cost, work attendance, and productivity outcomes. With changes in employment and benefits practices resulting from health care reform, including incentives and plan design options, consideration of these largely neglected variables in research design has become increasingly important. This commentary summarizes existing knowledge regarding the implications of policy variations in research outcomes and provides a framework for incorporating them into future employer-based research.
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”.
Poulsen, Roger L.
This survey was conducted to provide informational inputs for planning and establishing a community health education system in southwest New Mexico. Information was gathered concerning the opinions of typical area residents regarding needed health-medical care facilities, personnel training needs, services, personnel requisite to their well-being,…
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…
Keough, John J.; And Others
This report is a summary of the results of a questionnaire survey of locally developed health education materials. This guide has been prepared to assist school districts in the planning and initiation or expansion of local health programs. It reports on the current status of locally developed programs in the county. Hopefully, this information…
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;…
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
Tamrat, Tigest; Kachnowski, Stan
Mobile health (mHealth) encompasses the use of mobile telecommunication and multimedia into increasingly mobile and wireless health care delivery systems and has the potential to improve tens of thousands of lives each year. The ubiquity and penetration of mobile phones presents the opportunity to leverage mHealth for maternal and newborn care, particularly in under-resourced health ecosystems. Moreover, the slow progress and funding constraints in attaining the Millennium Development Goals for child and maternal health encourage harnessing innovative measures, such as mHealth, to address these public health priorities. This literature review provides a schematic overview of the outcomes, barriers, and strategies of integrating mHealth to improve prenatal and neonatal health outcomes. Six electronic databases were methodically searched using predetermined search terms. Retrieved articles were then categorized according to themes identified in previous studies. A total of 34 articles and reports contributed to the findings with information about the use and limitations of mHealth for prenatal and neonatal healthcare access and delivery. Health systems have implemented mHealth programs to facilitate emergency medical responses, point-of-care support, health promotion and data collection. However, the policy infrastructure for funding, coordinating and guiding the sustainable adoption of prenatal and neonatal mHealth services remains under-developed. The integration of mobile health for prenatal and newborn health services has demonstrated positive outcomes, but the sustainability and scalability of operations requires further feedback from and evaluation of ongoing programs.
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
Barton, Christopher; Reeve, Joanne; Adams, Ann; McIntyre, Ellen
This study was undertaken to provide a snapshot of the academic primary health-care workforce in Australia and to provide some insight into research capacity in academic primary health care following changes to funding for this sector. A convenience sample of individuals self-identifying as working within academic primary health care (n=405) completed an anonymous online survey. Respondents were identified from several academic primary health-care mailing lists. The survey explored workforce demographics, clarity of career pathways, career trajectories and enablers/barriers to 'getting in' and 'getting on'. A mix of early career (41%), mid-career (25%) and senior academics (35%) responded. Early career academics tended to be female and younger than mid-career and senior academics, who tended to be male and working in 'balanced' (teaching and research) roles and listing medicine as their disciplinary background. Almost three-quarters (74%) indicated career pathways were either 'completely' or 'somewhat unclear', irrespective of gender and disciplinary backgrounds. Just over half (51%) had a permanent position. Males were more likely to have permanent positions, as were those with a medical background. Less than half (43%) reported having a mentor, and of the 57% without a mentor, more than two-thirds (69%) would like one. These results suggest a lack of clarity in career paths, uncertainty in employment and a large number of temporary (contract) or casual positions represent barriers to sustainable careers in academic primary health care, especially for women who are from non-medicine backgrounds. Professional development or a mentoring program for primary health-care academics was desired and may address some of the issues identified by survey respondents.
Kenning, Cassandra; Coventry, Peter A; Gibbons, Chris; Bee, Penny; Fisher, Louise; Bower, Peter
Background. There is a need to better understand the mechanisms which lead to poor outcomes in patients with multimorbidity, especially those factors that might be amenable to intervention. Objective. This research aims to explore what factors predict self-management behaviour and health outcomes in patients with multimorbidity in primary care in the UK. Methods. A prospective study design was used. Questionnaires were mailed out to 1460 patients with multimorbidity. Patients were asked to complete a range of self-report measures including measures of multimorbidity, measures of their experience of multimorbidity and service delivery and outcomes (three measures of self-management: behaviours, Self-monitoring and Insight and medication adherence; and a measure of self-reported health). Results. In total, 36% (n = 499) of patients responded to the baseline survey and 80% of those respondents completed follow-up. Self-management behaviour at 4 months was predicted by illness perceptions around the consequences of individual conditions. Self-monitoring and Insight at 4 months was predicted by patient experience of ‘Hassles’ in health services. Self-reported medication adherence at 4 months was predicted by health status, Self-monitoring and Insight and ‘Hassles’ in health services. Perceived health status at 4 months was predicted by age and patient experience of multimorbidity. Conclusions. This research shows that different factors, particularly around patients’ experiences of health care and control over their treatment, impact on various types of self-management. Patient experience of multimorbidity was not a critical predictor of self-management but did predict health status in the short term. The findings can help to develop and target interventions that might improve outcomes in patients with multimorbidity. PMID:25715962
The Brazil Demographic and Health Survey (DHS) was conducted by the Society for the Welfare of the Family in Brazil within the framework of the DHS Program of the Institute for Resource Development of Westinghouse. The survey is national in scope, covering 95% of the population. Data were collected in 8519 households and complete interviews were conducted with 5892 women aged 15-44. Fieldwork for the survey took place between May and August, 1986. The summary statistics presented here were taken from the Brazil First Country Report, with exceptions as noted. The summary statistics include: population characteristics, fertility patterns, fertility preferences, current contraceptive use, contraception knowledge, nuptiality and exposure-to-conception status, postpartum variables, infant mortality, disease prevention and treatment, and nutritional status.
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.
Adewumi-Gunn, Teniope A; Ponce, Esmeralda; Flint, Nourbese; Robbins, Wendie
Black hair-salon workers face serious health hazards from the product they use on clients and other health hazards at their work. Currently there is a significant research gap in understanding the prevalence of workplace related exposures and health outcomes. The primary objective of this study was to gather preliminary data on workplace exposures and health outcomes of hair care workers in South Los Angeles. We conducted 22 surveys of salon workers at 16 salons. The results suggest the need for proper health and safety training within the salon worker community, specifically around chemical hair services. The results also suggest ergonomic workstation assessments and recommendations would be beneficial to reduce musculoskeletal disorders. Willingness of stylists to learn more about workplace hazards and how to mitigate their risks was high. Our findings indicate the need for a larger community based participatory research study on the workplace exposures of Black salon workers.
Warren, Jared S.; Nelson, Philip L.; Mondragon, Sasha A.; Baldwin, Scott A.; Burlingame, Gary M.
Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome…
Short, Vanessa L; Ivory-Walls, Tameka; Smith, Larry; Loustalot, Fleetwood
Assessment of cardiovascular disease (CVD) morbidity and mortality in subnational areas is limited. A model for regional CVD surveillance is needed, particularly among vulnerable populations underrepresented in current monitoring systems. The Mississippi Delta Cardiovascular Health Examination Survey (CHES) is a population-based, cross-sectional study on a representative sample of adults living in the 18-county Mississippi Delta region, a rural, impoverished area with high rates of poor health outcomes and marked health disparities. The primary objectives of Delta CHES are to (1) determine the prevalence and distribution of CVD and CVD risk factors using self-reported and directly measured health metrics and (2) to assess environmental perceptions and existing policies that support or deter healthy choices. An address-based sampling frame is used for household enumeration and participant recruitment and an in-home data collection model is used to collect survey data, anthropometric measures, and blood samples from participants. Data from all sources will be merged into one analytic dataset and sample weights developed to ensure data are representative of the Mississippi Delta region adult population. Information gathered will be used to assess the burden of CVD and guide the development, implementation, and evaluation of cardiovascular health promotion and risk factor control strategies.
Context: Numerous software and data storage systems are employed by local health departments (LHDs) to manage clinical and nonclinical data needs. Leveraging electronic systems may yield improvements in public health practice. However, information is lacking regarding current usage patterns among LHDs. Objective: To analyze clinical and nonclinical data storage and software types by LHDs. Design: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County and City Health Officials. Participants: A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). Main Outcome Measures: Outcome measures included LHD's primary clinical service data system, nonclinical data system(s) used, and plans to adopt electronic clinical data system (if not already in use). Predictors of interest included jurisdiction size and governance type, and other informatics capacities within the LHD. Bivariate analyses were performed using χ2 and t tests. Results: Up to 38.4% of LHDs reported using an electronic health record (EHR). Usage was common especially among LHDs that provide primary care and/or dental services. LHDs serving smaller populations and those with state-level governance were both less likely to use an EHR. Paper records were a common data storage approach for both clinical data (28.9%) and nonclinical data (59.4%). Among LHDs without an EHR, 84.7% reported implementation plans. Conclusions: Our findings suggest that LHDs are increasingly using EHRs as a clinical data storage solution and that more LHDs are likely to adopt EHRs in the foreseeable future. Yet use of paper records remains common. Correlates of electronic system usage emerged across a range of factors. Program- or system-specific needs may be barriers or facilitators to EHR adoption. Policy makers can tailor resources to address barriers specific to LHD size, governance, service
Gee, Susan B.; Croucher, Matthew J.; Beveridge, John
The Health of the Nation Outcome Scales (HoNOS) family of measures is routinely used in mental health services in the New Zealand, Australia, and the United Kingdom. However, the psychometric properties of the HoNOS65+ for elderly people have not been extensively evaluated. The aim of the present study was to examine the validity, reliability, and…
Silvey, Kerry; Stock, Jacquie; Hasegawa, Lianne E; Au, Sylvia Mann
Third party payers, funding agencies, and lawmakers often require clinicians and public health agencies to justify programs and services by documenting results. This article describes two assessment tools--"Defining Genetics Services Framework" and "Genetics Services Outcomes Menu," created to assist public health professionals, clinicians, family advocates, and researchers to plan, evaluate, and demonstrate the effectiveness of genetics services. The tools were developed by a work group of the Western States Genetics Services Collaborative (WSGSC) consisting of public health genetics and newborn screening professionals, family representatives, a medical geneticist, and genetic counselors from Alaska, California, Hawaii, Idaho, Oregon, and Washington. The work group created both tools by an iterative process of combining their ideas with findings from a literature and World Wide Web review. The Defining Genetics Services Framework reflects the diversity of work group members. Three over-lapping areas of genetics services from public health core functions to population screening to clinical genetics services are depicted. The Genetics Services Outcomes Menu lists sample long-term outcomes of genetics services. Menu outcomes are classified under impact areas of Knowledge and Information; Financing; Screening and Identification; Diagnosis, Treatment, and Management; and Population Health. The WSGSC incorporated aspects of both tools into their Regional Genetics Plan.
assessment of "outcome". Stroke , 13, 873-876. 63. Ferguson, G. H., Hildman, T., & Nichols, B. (1987). The effect of nursing care planning systems on patient...Outcome assessment. (1987). New England Journal of Medicine, 317(4), 251-252. 177. Partridge, C. J. (1982). The outcome of physiotherapy and its...measurement. Physiotherapy , 68(11), 362-363. 178. Penckofer, S. H., & Holm, K. (1984). Early appraisal of coronary revascularization on quality of life
This study investigated the prevalence of preterm birth and low-birth-weight in Macao. It also evaluated the effects of maternal perceived stress and health-related quality of life on these 2 birth outcomes. A quantitative study using a prospective longitudinal design was undertaken in an antenatal clinic in Macao. A community-based sample (N = 581) of pregnant women in their second trimester was recruited; birth outcome data were collected from medical records. Perceived stress was measured using the Perceived Stress Scale, whereas health-related quality of life was measured using the standard SF-12 Health Survey. The prevalence rates of preterm birth and low-birth-weight were found to be 6.4% and 7.1%, respectively. Two multiple logistic regression analyses revealed that participants with past adverse obstetric complications and higher perceived stress levels were more likely to have premature infants. Also, those participants with higher perceived stress levels and poorer health-related quality of life in the physical health domain were more likely to have low-birth-weight infants. Preliminary information was provided on risk factors associated with adverse birth outcomes; this could help nurses to design appropriate risk-specific interventions for preventing preterm birth and low-birth-weight.
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
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.
Kim, Su Hyun
Diabetes education is a critical element of care for people with diabetes. However, the associations between diabetes education and self-care or health outcomes have not been clearly demonstrated at a national level. The aims of this study were to examine the associations of attendance of diabetes education classes with health behaviours and glycaemic control, and to understand whether these associations were moderated by level of educational attainment. Data were analysed for 456 adults from the 2012 Korea National Health and Nutrition Examination Survey V, collected from January 2010 to December 2012. No significant differences were observed between patients who had attended diabetes education classes and those who had never attended for factors such as smoking, drinking, exercise, nutrition therapy or glycaemic control. There was a significant interaction effect between receiving diabetes education and level of educational attainment on obtaining optimal glycaemic control. Attending diabetes education was positively associated with optimal glycaemic control among patients with more than a high school education but was negatively associated with it among those with less than middle school education. Diabetes education programmes need to be tailored to the needs and cognitive capacities of the target population.
Mascarenhas, Ana Karina; Altman, Donald
In preparation to update the Dental Public Health specialty competencies, the Expert Panel determined that a needs assessment be conducted. A nine item open and close ended survey developed by the Expert Panel was used to collect data on the Diplomates current work environment, the utility of the current set of Dental Public Health competencies, and to identify any gaps in the current competencies. In 2015, the survey was administered to all active Diplomates of the American Board of Dental Public Health. One hundred and nine Diplomates responded. Diplomates overwhelmingly reported that each of the ten current competencies were still relevant for Dental Public Health specialists in the 21(st) Century, but needed to be updated to be more contemporary. Domains suggested to achieve this were interprofessional care, cultural competency, health literacy, and evidence-based dentistry.
Kolena, B; Petrovičová, I; Šidlovská, M; Pilka, T; Neuschlová, M; Valentová, I; Rybanský, L'; Trnovec, T
We studied occupational exposure to phthalates from first-morning-void urine sample of hairdressing apprentices by HPLC-MS/MS analyses and association with health status. Metabolites of mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono ethyl phthalate (MEP), mono-n-butyl phthalate (MnBP) and mono-iso-butyl phthalate (MiBP) were detected in all urine samples, followed by metabolites mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono(2-etylhexyl) phthalate (MEHP) occurring in 97.06% and 86.76% of samples, respectively. Positive associations for females were observed between MnBP and fat-free mass index (FFMI) and age; negative associations were found between MEHP, MEOHP, MEHHP, sum of MEHP, MEHHP, MEOHP and vital capacity and also between MEHP and forced vital capacity (FVC of predicted value (PV)). Lengths of exposure were associated to MnBP, MEHHP, and MEP. We also documented positive associations between anthropometry (body mass index, waist-to-height ratio (WHtR), FFMI, fat mass index) and pulmonary function FVC% of PV for females and negative associations between WHtR, waist-to-hip ratio, FFMI and ratio of forced expiratory volume in 1 s (FEV1) to FVC (FEV1/FVC). We assume that factors of occupational environment of hairdressing apprentices are affected by phthalates and resulted in negative outcomes in breathing mechanism and influence of body composition. Adipose tissue could play role as confounding factor in urine excretion of phthalates because of their lipid solubility and accumulation.
Musyimi, Christine W; Mutiso, Victoria; Ndetei, David M; Henderson, David C; Bunders, Joske
Task-shifting in mental health such as engaging Traditional Health Practitioners (THPs) in appropriate management of mental disorders is crucial in reducing global mental health challenges. This study aims to determine the outcomes of using evidence-based mental health Global Action Programme Intervention guide (mhGAP-IG) to provide psychosocial interventions among depressed patients seeking care from THPs. THPs were trained to deliver psychosocial interventions to their patients screening positive for mild to severe depression on Beck's Depression Inventory (BDI). Assessments were conducted at 0, 6 and 12 weeks and Analysis of Variance (ANOVA) performed to determine the change in depression scores over the three time period. BDI mean score was 26.52 before intervention and reduced significantly at 6 (13%) and 12 (35%) weeks after intervention. 58 and 78% of patients showed reduction in symptoms of depression at 6 and 12 weeks. It is therefore crucial to engage THPs in the care of patients with depression and the need for inclusion of training packages; and other mental disorders in order to establish and maintain collaboration between THPs and conventional health workers and promote evidence-based care among marginalized populations. Moreover, further research on randomized control trials of mhGAP-IG intervention versus usual care is required.
Nancarrow, Susan A
For over a decade, organizations have attempted to include the measurement and reporting of health outcome data in contractual agreements between funders and health service providers, but few have succeeded. This research explores the utility of collecting health outcomes data that could be included in funding contracts for an Australian Community Care Organisation (CCO). An action-research methodology was used to trial the implementation of outcome measurement in six diverse projects within the CCO using a taxonomy of interventions based on the International Classification of Function. The findings from the six projects are presented as vignettes to illustrate the issues around the routine collection of health outcomes in each case. Data collection and analyses were structured around Donabedian’s structure–process–outcome triad. Health outcomes are commonly defined as a change in health status that is attributable to an intervention. This definition assumes that a change in health status can be defined and measured objectively; the intervention can be defined; the change in health status is attributable to the intervention; and that the health outcomes data are accessible. This study found flaws with all of these assumptions that seriously undermine the ability of community-based organizations to introduce routine health outcome measurement. Challenges were identified across all stages of the Donabedian triad, including poor adherence to minimum dataset requirements; difficulties standardizing processes or defining interventions; low rates of use of outcome tools; lack of value of the tools to the service provider; difficulties defining or identifying the end point of an intervention; technical and ethical barriers to accessing data; a lack of standardized processes; and time lags for the collection of data. In no case was the use of outcome measures sustained by any of the teams, although some quality-assurance measures were introduced as a result of the
Narrowing the gaps in health outcomes, including those between men and women, has been a pronounced goal on the agenda of the Finnish health authorities since the mid-1980s. But still there is a huge gap in favour of women when it comes to life expectancy at birth. People's health information behaviour, that is how people seek, obtain, evaluate, categorize and use relevant health-related information to perform desired health behaviours, is a critical prerequisite to appropriate and consistent performances of these behaviours. With respect to gender, it has been noted that men often are unwilling and lack the motivation to engage with health-related information. The purpose of this study was to investigate how gender affects health information behaviour in the Finnish population aged 18-65 years. The survey data were collected via a questionnaire which was posted to a representative cross section consisting of 1500 Finnish citizens. The statistical analysis consists of ANOVA F-tests and Fisher's exact tests. The results show that women were more interested in and reported much more active seeking of health-related information, paid more attention to potential worldwide pandemics and were much more attentive as to how the goods they purchase in everyday life affect their health than men did. Women also reported receiving far more informal health-related information from close family members, other kin and friends/workmates than men did. Thus, to succeed in public health promotion and interventions the measures taken should be much more sensitive to the gender gap in health information behaviour.
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…
Ridley, Jane; Wilson, Barbara; Harwood, Lori; Laschinger, Heather K
Nephrology, like others areas of health care, is confronting a nursing shortage. Unless action is taken to address nursing shortages, patient care may be negatively affected (American Nephrology Nurses' Association, 2007). Previous studies have been conducted on magnet hospital traits, quality of nursing worklife, empowerment, job satisfaction, burnout, health outcomes, and their influence on nursing retention in Canada. However, there is little research in this area specific to nephrology nursing. This descriptive study examined whether magnet hospital traits, empowerment, and organizational support contribute to Canadian nephrology nurses' job satisfaction, health outcomes, and perceived quality of patient care. A randomly selected sample of 300 nurse members of the Canadian Association of Nephrology Nurses and Technologists (CANNT) was asked to complete a survey consisting of four instruments: The Nursing Work Index (Lake, 2002), the Conditions of Work Effectiveness Questionnaire II (Laschinger, Finegan, Shamian, & Wilk, 2001), the Pressure Management Indicator (Williams & Cooper, 1998), and the Maslach Burnout Inventory (Maslach, Jackson, & Leiter, 1996). There was a 48.1% response rate. Results demonstrated that some aspects of the Canadian nephrology nursing environment were rated quite favourably (e.g., high standards of care are expected; good working relationships with peers), but areas requiring improvement were evident (e.g., assignments that foster continuity of care). Overall, the nurses felt empowered. The results of the Pressure Management Indicator and Maslach Burnout Inventory indicated that nephrology nurses are generally coping well, but that some of them are struggling. Strategies that improve work environments could promote the recruitment and retention of nephrology nurses. Further research in this area is warranted.
Johnsen, Tone Langjordet; Indahl, Aage; Eriksen, Hege Randi; Ihlebæk, Camilla; Tveito, Torill Helene
Purpose Investigate the relative effect of response outcome expectancies, work conditions, and number of subjective health complaints (SHC) on anxiety and depression in Norwegian employees. Learned response outcome expectancies are important contributors to health. Individual differences in the expectancy to cope with workplace and general life demands may be important for how work conditions influence health. Method A survey was conducted among 1746 municipal employees (mean age 44.1, SD = 11.5, 81.5 % female), as part of a randomized controlled trial. This cross-sectional study used baseline data. Multiple logistic regression analysis was performed. Outcome variables were anxiety and depression; response outcome expectancies, work conditions, and number of SHC were independent variables. Results A high number of SHC was a significant factor in explaining anxiety (OR 1.26), depression (OR 1.22) and comorbid anxiety and depression (OR 1.31). A high degree of no and/or negative response outcome expectancies was a significant factor in explaining depression (OR 1.19) and comorbid anxiety and depression (OR 1.28). The variance accounted for in the full models was 14 % for anxiety, 23 % for depression, and 41 % for comorbid anxiety and depression. Conclusion A high number of SHC, and a high degree of no and/or negative response outcome expectancies were associated with anxiety and depression. The strongest association was found for number of SHC. However, previous studies indicate that it may not be possible to prevent the occurrence of SHC. We suggest that workplace interventions targeting anxiety and depression could focus on influencing and altering employees' response outcome expectancies.
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
Kristoffersen, Agnete Egilsdatter; Alræk, Terje; Stub, Trine; Hamre, Harald Johan; Björkman, Lars; Musial, Frauke
Background: Many patients have complex health complaints they attribute to dental amalgam. There is some evidence of symptom relief after removal of amalgam. Objective: The aims of this study were to assess the total symptom load in patients with all their amalgam fillings removed, and to investigate the self-reported improvement of health with regard to precautions taken under amalgam removal and time since removal. Methods: The survey was distributed to all members (n=999) of the Norwegian Dental patients association in 2011. The study participants returned the questionnaires anonymously by means of a pre-stamped envelope. The questionnaire asked for sociodemographic data, subjectively perceived health status, complaints persisting after amalgam removal and self-reported changes in symptoms after amalgam removal. Results: A total of 324 participants were included in the study. The majority of the participants reported improved health after amalgam removal, even though the mean degree of severity of complaints was still high. Exhaustion and musculoskeletal complaints were most severe, and reflects the fact that 38% of the participants reported poor to very poor current health. With regard to amalgam removal, associations between improved health, number of precautions applied, and time since removal were found. Conclusion: Most of the participants in this study reported improvement of health after amalgam removal even though they still suffered a high complaint load. Since absolute symptom load is a robust predictor for general health outcome and socioeconomic burden for society, a possible intervention, which enables patients to further improve their health status is desirable. PMID:28217190
Davern, Michael; Quinn, Brian C; Kenney, Genevieve M; Blewett, Lynn A
Objective To introduce the American Community Survey (ACS) and its measure of health insurance coverage to researchers and policy makers. Data Sources/Study Setting We compare the survey designs for the ACS and Current Population Survey (CPS) that measure insurance coverage. Study Design We describe the ACS and how it will be useful to health policy researchers. Principal Findings Relative to the CPS, the ACS will provide more precise state and substate estimates of health insurance coverage at a point-in-time. Yet the ACS lacks the historical data and detailed state-specific coverage categories seen in the CPS. Conclusions The ACS will be a critical new resource for researchers. To use the new data to the best advantage, careful research will be needed to understand its strengths and weaknesses. PMID:19040425
This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children.
Earnshaw, Valerie; Lewis, Jessica B.; Kershaw, Trace S.; Magriples, Urania; Stasko, Emily; Rising, Sharon Schindler; Cassells, Andrea; Cunningham, Shayna; Bernstein, Peter; Tobin, Jonathan N.
Objectives. We compared an evidence-based model of group prenatal care to traditional individual prenatal care on birth, neonatal, and reproductive health outcomes. Methods. We performed a multisite cluster randomized controlled trial in 14 health centers in New York City (2008–2012). We analyzed 1148 pregnant women aged 14 to 21 years, at less than 24 weeks of gestation, and not at high obstetrical risk. We assessed outcomes via medical records and surveys. Results. In intention-to-treat analyses, women at intervention sites were significantly less likely to have infants small for gestational age (< 10th percentile; 11.0% vs 15.8%; odds ratio = 0.66; 95% confidence interval = 0.44, 0.99). In as-treated analyses, women with more group visits had better outcomes, including small for gestational age, gestational age, birth weight, days in neonatal intensive care unit, rapid repeat pregnancy, condom use, and unprotected sex (P = .030 to < .001). There were no associated risks. Conclusions. CenteringPregnancy Plus group prenatal care resulted in more favorable birth, neonatal, and reproductive outcomes. Successful translation of clinical innovations to enhance care, improve outcomes, and reduce cost requires strategies that facilitate patient adherence and support organizational change. PMID:26691105
The Indonesia Demographic and Health Survey (DHS) was conducted by the Central Bureau of Statistics, State Ministry of Population/National Family Planning Coordinating Board, and Ministry of Health, Jakarta, Indonesia, within the framework of the DHS Program of Macro International. Data from the DHS were collected from 34,255 households and complete interviews were conducted with 28,810 women aged 15-49. The interviews took place between September 1, 1997 and December 31, 1997. The summary statistics presented were taken from the Indonesia country report with exception as noted. Included in this article are table and charts presenting valuable data on Indonesia general characteristics of the population, fertility, contraceptive use, and knowledge about contraception, marital and contraceptive status, infant mortality, and health.
Leamy, M.; Clarke, E.; Le Boutillier, C.; Bird, V.; Choudhury, R.; MacPherson, R.; Pesola, F.; Sabas, K.; Williams, J.; Williams, P.; Slade, M.
Background There is consensus about the importance of ‘recovery’ in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched. Aims To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England. Method In six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR). Results Team leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31–0.85, P<0.001). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians. Conclusions Compared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery. PMID:27340113
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.
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
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
Wellings, K.; Cleland, J.
The increasingly widespread adoption of the term sexual health reflects a move away from the medicalisation of this specialty. The focus has shifted from clinical practice to lifestyle and behaviour; from clinician to client, and from treatment to prevention. This article discusses these themes, identifying their implications for sexual health research. Recent times have seen, for example, a growing number of studies combining biological and behavioural measures conducted by interdisciplinary teams able to combine biomedical measurements of morbidity with insights into the subjective interpretations of symptoms and consequences. Considerable progress has been made, too, in mounting community based studies, and much has been achieved in gaining compliance and refining sampling methods. Integrated sexual health services, encompassing more than contraceptive or prophylactic service provision, have provided the impetus to investigation of the costs and benefits of coordinated family planning and genitourinary medicine services. Despite its broader focus, there remain opportunities for sexual health research to expand its remit. Studies to date may have focused too narrowly on pathological, to the neglect of health enhancing, consequences of sexual behaviour. Key Words: surveys; sexual health PMID:11463921
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.
Sarfaty, Mona; Bloodhart, Brittany; Ewart, Gary; Thurston, George D; Balmes, John R; Guidotti, Tee L; Maibach, Edward W
The American Thoracic Society (ATS), in collaboration with George Mason University, surveyed a random sample of ATS members to assess their perceptions of, clinical experiences with, and preferred policy responses to climate change. An e-mail containing an invitation from the ATS President and a link to an online survey was sent to 5,500 randomly selected U.S. members; up to four reminder e-mails were sent to nonrespondents. Responses were received from members in 49 states and the District of Columbia (n = 915); the response rate was 17%. Geographic distribution of respondents mirrored that of the sample. Survey estimates' confidence intervals were ±3.5% or smaller. Results indicate that a large majority of ATS members have concluded that climate change is happening (89%), that it is driven by human activity (68%), and that it is relevant to patient care ("a great deal"/"a moderate amount") (65%). A majority of respondents indicated they were already observing health impacts of climate change among their patients, most commonly as increases in chronic disease severity from air pollution (77%), allergic symptoms from exposure to plants or mold (58%), and severe weather injuries (57%). A larger majority anticipated seeing these climate-related health impacts in the next 2 decades. Respondents indicated that physicians and physician organizations should play an active role in educating patients, the public, and policy makers on the human health effects of climate change. Overall, ATS members are observing that human health is already adversely affected by climate change and support responses to address this situation.
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.
Spleen, Angela M.; Lengerich, Eugene J.; Camacho, Fabian T.; Vanderpool, Robin C.
Background Previous research suggests that certain populations, including rural residents, exhibit health care avoidant behaviors more frequently than other groups. Additionally, health care avoidance is related to sociodemographics, attitudes, social expectations, ability to pay for care, and prior experiences with providers. However, previous studies have been limited to specific geographic areas, particular health conditions, or by analytic methods. Methods The 2008 Health Information Trends Survey (HINTS) was used to estimate the magnitude of health care avoidance nationally and, while controlling for confounding factors, identify groups of people in the US who are more likely to avoid health care. Chi-square procedures tested the statistical significance (P < .05) of bivariate relationships. Multivariable analysis was conducted through a weighted multiple logistic regression with backward selection. Results For 6,714 respondents, bivariate analyses revealed differences (P < .05) in health care avoidance for multiple factors. However, multiple regression reduced the set of significant factors (P < .05) to rural residence (OR=1.69), male sex (OR=1.24), younger age (18-34 years OR=2.34; 35-49 years OR=2.10), lack of health insurance (OR=1.43), lack of confidence in personal health care (OR=2.24), lack of regular provider (OR=1.49), little trust in physicians (OR=1.34), and poor provider rapport (OR=0.94). Conclusion The results of the current study will help public health practitioners develop programs and initiatives targeted and tailored to specific groups, particularly rural populations, which seek to address avoidant behavior, thereby reducing the likelihood of adverse health outcomes. PMID:24383487
Price, James H.; Murnan, Judy; Dake, Joseph A.; Dimmig, Jaime; Hayes, Mary
This study assessed mail survey return rates published in seven general health education journals for the 13-year period, 1990-2002: "American Journal of Health Behavior," "American Journal of Health Education," "American Journal of Health Promotion," "Health Education & Behavior," "Health Education Research," "Journal of American College Health,"…
von Treuer, Kathryn; Fuller-Tyszkiewicz, Matthew; Little, Glenn
Shift workers have a higher rate of negative health outcomes than day shift workers. Few studies however, have examined the role of difference in workplace environment between shifts itself on such health measures. This study investigated variation in organizational climate across different types of shift work and health outcomes in nurses. Participants (n = 142) were nursing staff from a metropolitan Melbourne hospital. Demographic items elicited the type of shift worked, while the Work Environment Scale and the General Health Questionnaire measured organizational climate and health respectively. Analysis supported the hypotheses that different organizational climates occurred across different shifts, and that different organizational climate factors predicted poor health outcomes. Shift work alone was not found to predict health outcomes. Specifically, permanent night shift workers had significantly lower coworker cohesion scores compared with rotating day and evening shift workers and significantly higher managerial control scores compared with day shift workers. Further, coworker cohesion and involvement were found to be significant predictors of somatic problems. These findings suggest that differences in organizational climate between shifts accounts for the variation in health outcomes associated with shift work. Therefore, increased workplace cohesion and involvement, and decreased work pressure, may mitigate the negative health outcomes of shift workers.
Narayana, Arvind; Katz, Nathaniel; Shillington, Alicia C; Stephenson, Judith J; Harshaw, Qing; Frye, Carla B; Portenoy, Russell K
The National Breakthrough Pain Study is a large observational study that assessed breakthrough pain (BTP) in a population of commercially insured community-dwelling patients with opioid-treated chronic pain. Eligible patients were identified from an administrative claims database, and consenting patients were asked to complete a structured telephone interview and several validated questionnaires. Questionnaires assessed pain interference with function (Brief Pain Inventory-Short Form), health status (Short Form 12 [SF-12] Health Survey), disability (Sheehan Disability Scale), work performance (World Health Organization Health and Work Performance Questionnaire), and mood (Generalized Anxiety Disorder-7 Screener [GAD-7] and Patient Health Questionnaire-2 [PHQ-2]). Of 2198 patients interviewed, 1278 patients had persistent pain controlled with opioid therapy; 1023 (80%) of these patients reported BTP. Patients had a median of 2.0 episodes of BTP per day (range, 1-50) and a median duration of BTP of 45 minutes (range, 1-720). Compared with patients without BTP, patients with BTP had more pain-related interference in function (Brief Pain Inventory, mean ± SD: 34.2 ± 15.6 vs 25.0 ± 15.7 [P < 0.001]), worse physical health (SF-12 physical component score: 29.9 ± 9.6 vs 35.1 ± 10.4 [P < 0.001]) and mental health (SF-12 mental component score: 47.4 ± 11.3 vs 49.3 ± 10.4 [P < 0.001]), more disability (Sheehan Disability Scale global impairment score: 15.1 ± 9.1 vs 10.6 ± 8.5; World Health Organization Health and Work Performance Questionnaire absolute absenteeism: 12.4 ± 59.9 vs 7.7 ± 44.9 hours [both P < 0.001]), and worse mood (GAD-7 score: 7.4 ± 5.9 vs 5.9 ± 5.4; PHQ-2 anhedonia score: 1.2 ± 1.1 vs 0.9 ± 1.0 [both P < 0.001]). In this population of community-dwelling patients with opioid-treated chronic pain, BTP was highly prevalent and associated with negative outcomes. This burden of illness suggests the need for specific treatment plans.
Livingood, W C; Woodhouse, L D; Godin, S W
OBJECTIVES. The goal of this study was to provide insight concerning the potential of credentialing public health workers through an exploratory examination of public health leaders' perceptions. METHODS. Qualitative and quantitative procedures were used. Credentialing issues were identified through the literature and through open-ended interviews with leaders and experts. A 74-item Likert-type survey was used to quantify perceptions. Key informants and survey participants were identified through pertinent organizations. RESULTS. The public health leaders leaned toward consensus on some benefits of and concerns about credentialing. There was no consensus related to a specific form of desired credentialing, although national certification was supported by a plurality. State licensing and an emphasis on the master's in public health (MPH) degree were opposed by large margins. Public health leadership survey results were similar to results of a survey of credentialing experts. CONCLUSIONS. The lack of consensus and the vehemence of some opposing positions indicate that movements toward credentialing should proceed cautiously. However, many of the response patterns indicate that the issue merits further exploration. PMID:7762707
Barden-O'Fallon, Janine; Angeles, Gustavo; Tsui, Amy
Accurate knowledge of the characteristics of the health labour force that can affect health care production is of critical importance to health planners and policymakers. This study uses health facility survey data to examine characteristics of the primary health care labour force in Nicaragua, Tanzania and Bangladesh. The characteristics examined are those that are likely to affect service provision, including urban/rural distribution, demographic characteristics, and experience and in-service training, for three types of providers (physicians, nurses and auxiliary nurses). The profiles suggest a pattern of urban/rural imbalances in Nicaragua and Tanzania. The Bangladesh facility survey did not include hospitals, thereby making concrete conclusions on the supply and distribution of providers difficult to make. Multivariate logistic regressions are used to assess the relationship between the urban/rural placement of providers by health need, population demand and facility characteristics. Health need, as measured by child mortality rates, does not have a significant association with the placement of providers in either country, unlike population size and annual growth rates. The mean number of years providers have worked at a facility is significantly associated with a decreased likelihood of rural placement for the three types of providers in Nicaragua. The mean age and percentage of female providers at each facility has a negative association with the placement of rural providers in Tanzania. The use of health facility data to profile the health care labour force is also discussed.
Malta, Deborah Carvalho; Stopa, Sheila Rizzato; Pereira, Cimar Azeredo; Szwarcwald, Célia Landmann; Oliveira, Martha; Reis, Arthur Chioro Dos
This study aims to present the percentages of the Brazilian population holding health insurance plans, itemized by social-demographic characteristics, based on the data of the National Health Survey carried out in 2013, and to compare this information with the administrative data of the National Supplementary Health Agency for the same year. Data from the National Health Survey, and from the Beneficiaries Information System of the National Health Agency for the year 2013, were used. The percentage of people having a health plan was described according to stratification for: all of Brazil, urban/rural, Brazilian official Regions, Brazilian States and state capitals, gender, age group, level of schooling, position in the workforce, ethnic classification, and self-assessed state of health. Results include the following: The percentage of people saying they had some health plan in Brazil was 27.9% (CI 95%: 27.1-28.8). A significant difference was found relating to level of schooling - the percentage being highest for those who stated they had complete secondary education (68.8% CI 95%: 67.2-70.4) and for those who said they were currently in work (32.5% CI 95%: 31.5-33.5). The increase in health plan coverage in the Brazilian population reflects the improvement of the suply of employment and the growth in the country's economy.
George, Melissa W; Trumpeter, Nevelyn N; Wilson, Dawn K; McDaniel, Heather L; Schiele, Bryn; Prinz, Ron; Weist, Mark D
The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program.
George, Melissa W.; Trumpeter, Nevelyn N.; Wilson, Dawn K.; McDaniel, Heather L.; Schiele, Bryn; Prinz, Ron; Weist, Mark D.
The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program. PMID:24297005
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.
Mustanski, Brian; Van Wagenen, Aimee; Birkett, Michelle; Eyster, Sandra; Corliss, Heather L
We studied sexual orientation disparities in health outcomes among US adolescents by pooling multiple Youth Risk Behavior Survey (YRBS) data sets from 2005 and 2007 for 14 jurisdictions. Here we describe the methodology for pooling and analyzing these data sets. Sexual orientation-related items assessed sexual orientation identity, gender of sexual contacts, sexual attractions, and harassment regarding sexual orientation. Wording of items varied across jurisdictions, so we created parallel variables and composite sexual minority variables. We used a variety of statistical approaches to address issues with the analysis of pooled data and to meet the aims of individual articles, which focused on a range of health outcomes and behaviors related to cancer, substance use, sexual health, mental health, violence, and injury.
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…
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.
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.
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…
Boyd, R D; Corley, M J
This article presents findings from an outcome survey of the effects of early intensive behavioral intervention (EIBI) for young children with autism in a community setting. Results from both individual case reviews and parent questionnaires are presented, with the data failing to support any instances of'recovery' while still yielding a high degree of parental satisfaction with the treatment. Moreover, a follow-up inquiry into the type of services each child was receiving in his or her post-EIBI setting documents continued dependence on extensive educational and related developmental services, suggesting that the promise of future treatment sparing did not materialize. Limitations of the survey in evaluating community-based EIBI services are discussed along with the need for further research designed to document the effectiveness of services provided to young children with ASD in the community.
Rowland, M L; Forthofer, R N
There is a potential for nonresponse bias in most population studies using health examinations. This is true of the Mexican American portion of the Hispanic Health and Nutrition Examination Survey (HHANES), conducted by the National Center for Health Statistics, in which unit nonresponse to the examination accounted for 24 percent of the sample. Even though the full effect of nonresponse can never be really known, ancillary information from the interview sample can be used in an attempt to adjust for bias in estimates. Two techniques for nonresponse bias adjustment are presented and illustrated using health status level and hypertension status from published studies based on the HHANES of 1982-84. The first approach uses conditional probabilities and the second approach uses direct standardization. The examples examine whether or not an adjustment for socioeconomic status, sex, and age--variables related to both response status and the conditions under study--changes the prevalence estimates of (a) Mexican Americans who report poor, fair, or good health status and (b) hypertension among Mexican Americans. PMID:8497577
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
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…
... HUMAN SERVICES National Institutes of Health Proposed Collection; Comment Request; Survey of Health Care... Collection: Title: The Survey of Health Care Professionals' Awareness and Perceptions of the National Cancer... Response: Yearly. Affected Public: Individual adults. Type of Respondents: Health care providers...
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
Elliott, John O; Charyton, Christine; Lu, Bo; Moore, J Layne
Epidemiology literature demonstrates socioeconomic status as an important variable for outcomes in persons with epilepsy. However, no previous studies have analyzed the association between poverty and epilepsy in the United States. Forty-one percent (246/604) of persons with a history of epilepsy (PWHE) in the 2005 California Health Interview Survey (n=43,020) had an annual income <200% Federal Poverty Level (FPL), adjusted lifetime prevalence rate 0.5% [98.33% CI 0.4-0.7]. Four groups are presented in the analyses: (1) those with a history of epilepsy <200% FPL, (2) those with a history of epilepsy > or =200% FPL, (3) those not reporting a history of epilepsy <200% FPL and (4) those not reporting a history of epilepsy > or =200% FPL. PWHE in poverty reported significantly higher amounts of serious psychological distress, based on the validated Kessler 6 (K6) scale, than both non-epilepsy populations. After adjusting for demographics and other comorbid conditions, logistic regression analyses show PWHE in poverty are significantly more likely to report fair or poor self-rated health status when compared to the PWHE not in poverty and both non-epilepsy populations. PWHE in poverty are also more likely to report > or =14 generally unhealthy days and > or =14 physically unhealthy days in the past 30 days compared to the PWHE not in poverty and both non-epilepsy populations. Psychological well-being needs to be incorporated into any comprehensive treatment strategy for managing epilepsy.
Cutts, Emily; Kavikondala, Sushma; Salcedo, Alejandra; D'Souza, Karan; Hernandez-Torre, Martin; Anderson, Claire; Tiwari, Agnes; Ho, Kendall; Last, Jason
Background Social media is an asset that higher education students can use for an array of purposes. Studies have shown the merits of social media use in educational settings; however, its adoption in health science education has been slow, and the contributing reasons remain unclear. Objective This multidisciplinary study aimed to examine health science students’ opinions on the use of social media in health science education and identify factors that may discourage its use. Methods Data were collected from the Universitas 21 “Use of social media in health education” survey, distributed electronically among the health science staff and students from 8 universities in 7 countries. The 1640 student respondents were grouped as users or nonusers based on their reported frequency of social media use in their education. Results Of the 1640 respondents, 1343 (81.89%) use social media in their education. Only 462 of the 1320 (35.00%) respondents have received specific social media training, and of those who have not, the majority (64.9%, 608/936) would like the opportunity. Users and nonusers reported the same 3 factors as the top barriers to their use of social media: uncertainty on policies, concerns about professionalism, and lack of support from the department. Nonusers reported all the barriers more frequently and almost half of nonusers reported not knowing how to incorporate social media into their learning. Among users, more than one fifth (20.5%, 50/243) of students who use social media “almost always” reported sharing clinical images without explicit permission. Conclusions Our global, interdisciplinary study demonstrates that a significant number of students across all health science disciplines self-reported sharing clinical images inappropriately, and thus request the need for policies and training specific to social media use in health science education. PMID:28052842
McConnell, Scott; McEvoy, Mary; Carta, Judith J.; Greenwood, Charles R.; Kaminski, Ruth; Good, Roland H., III; Shinn, Mark
This monograph reports on a national mail survey to validate a set of general growth outcomes for children, including those with disabilities, between birth and age 8. The survey was part of a 5-year project to create a comprehensive measurement system to track the developmental progress of individual children with disabilities in this age range…
The past few decades have witnessed a dramatic increase in consumers seeking health information online. However, the quality of such information remains questionable, and the trustworthiness of online health information has become a hot topic, whereas little attention has been paid to how consumers evaluate online health information credibility. This study builds on theoretical perspectives of trust such as personal-capital-based, social-capital-based, and transfer-based, and it examines various correlates of consumer trust in online health information. The author analyzed the 2007 Health Information National Trends Survey data (N = 7,674). Results showed that consumer trust in online health information did not correlate with personal capital such as income, education, and health status. Social capital indicated by visiting social networking Web sites was not associated with trust in online health information either. Nevertheless, trust in online health information transferred from traditional mass media and government health agencies to the Internet, and it varied by such information features as easiness to locate and to understand. Age appeared to be a key factor in understanding the correlates of trust in online health information. Theoretical and empirical implications of the results are discussed.
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
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
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.
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).
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
Clithero, Amy; Ross, Simone Jacquelyn; Middleton, Lyn; Reeve, Carole; Neusy, Andre-Jacques
Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement. PMID:28289678
Clithero, Amy; Ross, Simone Jacquelyn; Middleton, Lyn; Reeve, Carole; Neusy, Andre-Jacques
Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement.
National Survey of Drug Use and Health OR odds ratio RUCA Rural Urban Community Area SAMHSA Substance Abuse and Mental Health Services...Survey of Drug Use and Health (NSDUH), an annual survey of the general U.S. population carried out by the Substance Abuse and Mental Health...from the National Survey of Drug Use and Health (NSDUH), a large annual cross- sectional survey of behavioral health status and service use in the
Weston, R L; Hopwood, B; Harding, J; Sizmur, S; Ross, J D C
Patient experience of and satisfaction with health-care services is increasingly being used to evaluate and guide health-care provision. A recent systematic review failed to identify a validated method of measuring patient satisfaction in sexually transmitted infection (STI) clinics. The aim of this study was to design and validate a specific STI clinic patient satisfaction survey that could be used as a patient-derived outcome measure. Key themes of importance to patients were identified from a recent systematic review of STI clinic patient satisfaction surveys. Semi-structured interviews were performed with patients attending a sexual health clinic to further refine these themes, and then used to compile a patient questionnaire. Cognitive testing was used to provide face validity for the questionnaire design, layout and wording. The questionnaire was further reviewed and revised by the research team prior to being piloted over a five-week period. Five key patient themes were incorporated into the questionnaire and the pilot phase included responses from 936 patients. The completion rate for individual items and the whole questionnaire (95% [885/936]) was high. Internal consistency and validity also scored highly.
Hall, William J.; Lee, Kent M.; Merino, Yesenia M.; Thomas, Tainayah W.; Payne, B. Keith; Eng, Eugenia; Day, Steven H.; Coyne-Beasley, Tamera
Background. In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition. Objectives. We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals’ implicit attitudes about racial/ethnic groups and health care outcomes. Search Methods. To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique. Selection Criteria. We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English. Data Collection and Analysis. We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings. We summarized study design characteristics, and categorized and then synthesized substantive findings. Main Results. Almost all studies used cross-sectional designs, convenience sampling, US participants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias
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.
Lebrun-Harris, Lydie A; Baggett, Travis P; Jenkins, Darlene M; Sripipatana, Alek; Sharma, Ravi; Hayashi, A Seiji; Daly, Charles A; Ngo-Metzger, Quyen
Objective To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts. Data Sources/Study Setting Nationally representative data from the 2009 Health Center Patient Survey. Study Design Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients' health care experiences. Data Collection Computer-assisted personal interviews were conducted with health center patients. Principal Findings Homeless patients had worse health status—lifetime burden of chronic conditions, mental health problems, and substance use problems—compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24–3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37–2.92). Conclusions There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use. PMID:23134588
Arria, Amelia M.; Caldeira, Kimberly M.; Bugbee, Brittany A.; Vincent, Kathryn B.; O’Grady, Kevin E.
Background Several studies have linked marijuana use with a variety of health outcomes among young adults. Information about marijuana’s long-term health effects is critically needed. Methods Data are from a ten-year study of 1,253 young adults originally recruited as first-year college students and assessed annually thereafter. Six trajectories of marijuana use during college (Non-Use, Low-Stable, Early-Decline, College-Peak, Late-Increase, Chronic) were previously derived using latent variable growth mixture modeling. Nine health outcomes assessed in Year 10 (modal age 27) were regressed on a group membership variable for the six group trajectories, holding constant demographics, baseline health status, and alcohol and tobacco trajectory group membership. Results Marijuana trajectory groups differed significantly on seven of the nine outcomes (functional impairment due to injury, illness, or emotional problems; psychological distress; subjective well-being; and mental and physical health service utilization; all ps<.001), but not on general health rating or body mass index. Non-Users fared better than the Late-Increase and Chronic groups on most physical and mental health outcomes. The declining groups (Early-Decline, College-Peak) fared better than the Chronic group on mental health outcomes. The Late-Increase group fared significantly worse than the stable groups (Non-Use, Low-Stable, Chronic) on both physical and mental health outcomes. Conclusions Even occasional or time-limited marijuana use might have adverse effects on physical and mental health, perhaps enduring after several years of moderation or abstinence. Reducing marijuana use frequency might mitigate such effects. Individuals who escalate their marijuana use in their early twenties might be at especially high risk for adverse outcomes. PMID:26778758
There is a dearth of knowledge about the health outcomes of resilience during adolescence, making the study of health-related outcomes of resilience important. The purpose of this study was to develop a theory-based just-identified model and to test the direct and indirect effects of resilience on hope, well-being, and health-promoting lifestyle in middle adolescents. The study used a correlational design. The final sample consisted of 311 middle adolescents, aged 15 to 17, who were recruited from a public high school. Participants responded to instrument packets in classroom settings. The structural equation model was tested with the LISREL 8.80 software program. All seven hypotheses were supported at a statistically significant level (p < .001). The results supported the theoretical propositions and the previous empirical findings that were used to create the theoretical model of health-related outcomes of resilience. Alternate models of outcomes of resilience need to be tested on adolescents.
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.
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
Robinson, Jeffrey C; Abbott, Cheryl; Meadows, Christina A; Roach, Robert C; Honigman, Benjamin; Bull, Todd M
Robinson, Jeffrey C., Cheryl Abbott, Christina A. Meadows, Robert C. Roach, Benjamin Honigman, and Todd M. Bull. Long-term health outcomes in high-altitude pulmonary hypertension. High Alt Med Biol. 18:61-66, 2017.
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
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.
sexual violence defined as violence within one’s personal (dating or marital) relationships. The common thread through these negative health outcomes is...personal sexual violence . This research also seeks to establish the best training practices for educating young troops about health issues that impact
sexual violence defined as violence within one’s personal (dating or marital) relationships. The common thread through these negative health outcomes is...personal sexual violence . This research also seeks to establish the best training practices for educating young troops about health issues that impact
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…
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
Background: Although health information is of great interest and plays an important role in almost all media, there are very few studies on the actual work of health journalists. Methods: A quantitative online survey with qualitative elements on the definition and use of storytelling in health journalism was carried out among members of various professional journalists' associations (n=86). Results: The results suggest that health journalists understand storytelling especially as a term used when an article has a dramatic construction, and the story is about real people. As reasons for using storytelling, health journalists primarily name the understandable and clear presentation of medical issues. They see better chances for identification and establishing a relationship to the readers' lives. Of particular importance seems to be that narrative elements do not distort the facts and protect the privacy rights of persons mentioned in case reports.
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
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…
Roberts, Sean D.; Stroud, Daniel; Hoag, Matthew J.; Combs, Katie M.
A lack of clarity exists regarding how different clients respond to outdoor behavioral health care (OBH). In this study, specific client and treatment characteristics were assessed for 186 young adults completing an OBH therapeutic wilderness program. Clinical outcomes were measured with the Outcome Questionnaire-45.2. Hierarchical linear modeling…
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…
The full benefits of connected health cannot be achieved unless everyone in the United States who wants to participate and the organizations that support health and deliver healthcare have adequate access to high-speed Internet service. Access depends both on the availability of broadband service and the resources needed to obtain and maintain service.
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.
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
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).
Sokka, Tuulikki; Krishnan, Eswar
Three National Health and Nutrition Examination Surveys were conducted in the United States between 1971 and 1994 to provide data on the nutritional and health status of the population and on specific target conditions. This article describes features of the surveys and provides examples of research on musculoskeletal disorders that used the survey data.
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
McVeigh, Katharine H.; Newton-Dame, Remle; Chan, Pui Ying; Thorpe, Lorna E.; Schreibstein, Lauren; Tatem, Kathleen S.; Chernov, Claudia; Lurie-Moroni, Elizabeth; Perlman, Sharon E.
Introduction: Electronic health records (EHRs) offer potential for population health surveillance but EHR-based surveillance measures require validation prior to use. We assessed the validity of obesity, smoking, depression, and influenza vaccination indicators from a new EHR surveillance system, the New York City (NYC) Macroscope. This report is the second in a 3-part series describing the development and validation of the NYC Macroscope. The first report describes in detail the infrastructure underlying the NYC Macroscope; design decisions that were made to maximize data quality; characteristics of the population sampled; completeness of data collected; and lessons learned from doing this work. This second report, which addresses concerns related to sampling bias and data quality, describes the methods used to evaluate the validity and robustness of NYC Macroscope prevalence estimates; presents validation results for estimates of obesity, smoking, depression and influenza vaccination; and discusses the implications of our findings for NYC and for other jurisdictions embarking on similar work. The third report applies the same validation methods described in this report to metabolic outcomes, including the prevalence, treatment and control of diabetes, hypertension and hyperlipidemia. Methods: NYC Macroscope prevalence estimates, overall and stratified by sex and age group, were compared to reference survey estimates for adult New Yorkers who reported visiting a doctor in the past year. Agreement was evaluated against 5 a priori criteria. Sensitivity and specificity were assessed by examining individual EHR records in a subsample of 48 survey participants. Results: Among adult New Yorkers in care, the NYC Macroscope prevalence estimate for smoking (15.2%) fell between estimates from NYC HANES (17.7 %) and CHS (14.9%) and met all 5 a priori criteria. The NYC Macroscope obesity prevalence estimate (27.8%) also fell between the NYC HANES (31.3%) and CHS (24
Jozkowski, Kristen N; Sanders, Stephanie A
Previous research has linked women's history of experiencing sexual assault with negative health outcomes; however, much of this research is over a decade old. Furthermore, little research has examined the relationship between sexual assault and women's sexuality. In the current study the authors aimed to assess the relation of experiencing sexual assault to women's health and sexuality and the relation of repeat victimization by multiple different perpetrators to such outcomes. Data were collected from a convenience sample of 2,915 women using an online questionnaire. Nearly half (n = 1,394, 47.8%) indicated having experienced forced or coercive sex. Women who had experienced forced or coercive sex were more likely to report negative health outcomes (Adj. OR = 1.56; 95% CI: 1.35-1.82, p < .001) and some negative sexual outcomes compared to women without a history of forced or coercive sex. Similarly, women who experienced repeat victimizations by multiple different perpetrators were even more likely to report negative health outcomes (Adj. OR = 1.43; 95% CI: 1.28-1.59, p < .001) as well as some negative sexual outcomes. Healthcare providers should be aware of the relation of sexual assault to health and sexuality and continue to address health and sexuality issues associated with sexual assault for their patients.
Wilkinson, Joanne E.; Saper, Robert B.; Rosen, Amy K.; Welles, Seth L.; Culpepper, Larry
Background and Objectives Prayer for health (PFH) is common; in 2002, 35% of US adults prayed for their health. We examined the relationship of PFH and primary care visits, with a special focus on African American women, using data from the 2002 National Health Interview Survey (NHIS). Methods We used chi-square analyses to compare the demographic (age group, gender, race, region, marital status, educational level, ethnicity) and health-related covariates (alcohol use, smoking status, and selected medical conditions) between individuals who did and did not pray for their health in the past year. Univariate associations between PFH and visit to primary care provider (PCP), with Mantel-Haenszel adjustment for confounding, were determined. Multivariate regression was used to determine independent factors associated with PFH and PCP visit, with SUDAAN to adjust for the clustered survey design. Results Subjects who prayed were more likely to be female, older than 58, Black, Southern, separated, divorced or widowed, and nondrinkers. Subjects who prayed were also more likely to have seen a PCP within the past year. Black women who prayed were also more likely to see a PCP. Conclusions These findings suggest that people who pray for their health do so in addition to, not instead of, seeking primary care. This finding is maintained but with a smaller effect size, in Black women. PMID:18830839
Amed-Salazar, Eustorgio José
Objective: To analyze the self-reported perceived health related to socio-demographic characteristics, social health inequalities and social capital in Colombia. Methods: This study is a cross-sectional design; data was obtained from the National Health Survey of Colombia 2007. Independent variables: socio-demographic characteristics; component variables: social health inequality and social capital. Dependent variable: self-reported health. Analysis of the relationship used logistic regression through OR and its confidence interval. Results: The determinant factors for a negative health perceptions are related to being a female (OR: 0.49 [0.47 to 0.52]), and in both genders being older than 37 years of age (OR: 0.72 [0.61 to 0.85]), living without a partner, black ethnicity, indigenous women (0.80 [0.69 to 0.94] and low economic incomes. Discussion: The relationship between social determinants and social capital in the perception of health shows inequities and indirectly reflects the level of health. Given the policies and the model of health, requires a rational adjustment of the goals, programs, and national and regional strategies with the object of improving the demand and quality of services. PMID:24970954
Rockers, Peter C; Kruk, Margaret E; Laugesen, Miriam J
In low- and middle-income countries, health care systems are an important means by which individuals interact with their government. As such, aspects of health systems in these countries may be associated with public trust in government. Greater trust in government may in turn improve governance and government effectiveness. We identify health system and non-health system factors hypothesized to be associated with trust in government and fit several multilevel regression models to cross-national data from 51,300 respondents in thirty-eight low- and middle-income countries participating in the World Health Surveys. We find that health system performance factors are associated with trust in government while controlling for a range of non-health system covariates. Taken together, higher technical quality of health services, more responsive service delivery, fair treatment, better health outcomes, and financial risk protection accounted for a 13 percentage point increase in the probability of having trust in government. Health system performance and good governance may be more inter-related than previously thought. This finding is particularly important for low-income and fragile states, where health systems and governments tend to be weakest. Future research efforts should focus on determining the causal mechanisms that underlie the observed associations between health system performance and trust in government.
van der Pol, Marjon; Ruggeri, Matteo
The aim of this study is to examine whether individuals' risk attitude for life years differ from their risk attitude for quality of life. The study also investigates two different framing effects, an order and sequence effect, and the interaction between risk attitude and time preferences. The results showed that individuals tended to be risk averse with respect to the gamble involving risk of immediate death and risk seeking with respect to the other health gambles. Varying the order of the questions or the sequence of full health and ill-health did not seem to systematically bias the estimates.
Fiorillo, John; Lansky, David; Hendryx, Michael; Knickman, James
Background Interest in monitoring the quality of health care in the United States has increased in recent years. However, the policy objectives associated with collecting this information are constrained by the limited availability of timely and relevant data at a reasonable cost. Online data-collection technologies hold the promise of gathering data directly and inexpensively from large, representative samples of patients and consumers. These new information technologies also permit efficient, real-time assessment in such areas as health status, access to care, and other aspects of the care experience that impact health outcomes. Objective This study investigates the feasibility, validity, and generalizability of consumer online surveys to measure key aspects of health care quality in the United States. Methods Surveys about the health and health care experiences of a general adult population and of adults with diabetes were administered online and by telephone. The online survey drew from a sample frame of nearly 1 million consumers and used a single e-mail notification. The random-digit-dial methodology included 6 follow-up calls. Results from the online sample were compared to the telephone sample and to national benchmark data. Results Survey responses about quality of care collected using online and telephone methods were commensurate once they were weighted to represent the demographic distribution of the 2000 United States Census. Expected variations in health and health care quality across demographic and socioeconomic groups were largely observed, as were hypothesized associations among quality indicators and other variables. Fewer individuals were required to be contacted to achieve target sample sizes using online versus telephone methods. Neither method yielded representative cohorts of nonwhite individuals. Conclusions Conclusions about the level and variations in health care quality in the United States are similar using data collected in this study
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.
Lopez-Escamez, Jose A; Gamiz, Maria J; Fernandez-Perez, Antonio; Gomez-Fiñana, Manuel
A prospective cohort study was designed to evaluate the long-term outcome and health-related quality of life (HRQoL) in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV) treated by the particle repositioning maneuver (PRM) in the outpatient clinic of a general community hospital. Fifty individuals with PC-BPPV were included, and 45 (90%) completed the study. The diagnosis was based on the history of short episodes of vertigo and a positional nystagmus during the Dix-Hallpike test (DHT). All patients were treated by a single PRM, and relapses were evaluated by DHT at 30, 180 and 360 days post-treatment; a new PRM was performed if the DHT was positive. The main outcome measures were: percentage of patients with a negative DHT after treatment, scores obtained on the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S) before and 30, 180 and 360 days post-treatment. The DHT was found negative in 80% (40/50) of individuals at 30 days. Ten, seven and five patients presented a positive DHT at 30, 180 and 360 days, respectively. Persistent BPPV was observed in 5% (2/50) of patients at 360 days, despite repeated PRM. Relapses (DH+ after successful PRM) were observed in 7.5% (3/50) at 180 days and 360 days. Both questionnaires showed a reliability Cronbach's alpha >0.7. The average standardized score for each SF-36 scale was compared with the reference population normative data, showing differences with norms for all scales except for vitality. After PRM, patients improved their scores with both instruments, indicating a restoration of HRQoL at 30 days. Physical dimension scores of the SF-36 improved from day 30 to 360. DHI-S scores were statistically better after PRM (P < 0.001). Our results show that the effectiveness of PRM is 88% after 1 year of follow-up. Patients with BPPV experienced a decrease in HRQoL, which was restored after PRM. Although relapses were observed in 7.5% of
Lorgelly, Paula; Yamabhai, Inthira
Abstract Public health programmes tend to be complex and may combine social strategies with aspects of empowerment, capacity building and knowledge across sectors. The nature of the programmes means that some effects are likely to occur outside the healthcare sector; this breadth impacts on the choice of health and non‐health outcomes to measure and value in an economic evaluation. Employing conventional outcome measures in evaluations of public health has been questioned. There are concerns that such measures are too narrow, overlook important dimensions of programme effect and, thus, lead to such interventions being undervalued. This issue is of particular importance for low‐income and middle‐income countries, which face considerable budget constraints, yet deliver a large proportion of health activities within public health programmes. The need to develop outcome measures, which include broader measures of quality of life, has given impetus to the development of a variety of new, holistic approaches, including Sen's capability framework and measures of subjective wellbeing. Despite their promise, these approaches have not yet been widely applied, perhaps because they present significant methodological challenges. This paper outlines the methodological challenges for the identification and measurement of broader outcomes of public health interventions in economic evaluation in low‐income and middle‐income countries. PMID:26804360
Greco, Giulia; Lorgelly, Paula; Yamabhai, Inthira
Public health programmes tend to be complex and may combine social strategies with aspects of empowerment, capacity building and knowledge across sectors. The nature of the programmes means that some effects are likely to occur outside the healthcare sector; this breadth impacts on the choice of health and non-health outcomes to measure and value in an economic evaluation. Employing conventional outcome measures in evaluations of public health has been questioned. There are concerns that such measures are too narrow, overlook important dimensions of programme effect and, thus, lead to such interventions being undervalued. This issue is of particular importance for low-income and middle-income countries, which face considerable budget constraints, yet deliver a large proportion of health activities within public health programmes. The need to develop outcome measures, which include broader measures of quality of life, has given impetus to the development of a variety of new, holistic approaches, including Sen's capability framework and measures of subjective wellbeing. Despite their promise, these approaches have not yet been widely applied, perhaps because they present significant methodological challenges. This paper outlines the methodological challenges for the identification and measurement of broader outcomes of public health interventions in economic evaluation in low-income and middle-income countries.
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
Bayles, Brett R.; Brauman, Kate A.; Adkins, Joshua N.; Allan, Brian F.; Ellis, Alicia M.; Goldberg, Tony L.; Golden, Christopher D.; Grigsby-Toussaint, Diana S.; Myers, Samuel S.; Osofsky, Steven A.; Ricketts, Taylor H.; Ristaino, Jean B.
Global environmental change, driven in large part by human activities, profoundly impacts the structure and functioning of Earth’s ecosystems (Millennium Ecosystem Assessment 2005). We are beginning to push beyond planetary boundaries (Steffan et al. 2015), and the consequences for human health remain largely unknown (Myers et al. 2013). Growing evidence suggests that ecological transformations can dramatically affect human health in ways that are both obvious and obscure (Myers and Patz 2009; Myers et al. 2013). The framework of ecosystem services, designed to evaluate the benefits that people derive from ecosystem products and processes, provides a compelling framework for integrating the many factors that influence the human health response to global change, as well as for integrating health impacts into broader analyses of the impacts of this change
Nodhturft, V; Schneider, J M; Hebert, P; Bradham, D D; Bryant, M; Phillips, M; Russo, K; Goettelman, D; Aldahondo, A; Clark, V; Wagener, S
Chronic disease has become pandemic in the United States, and estimates are that it will affect 148 million people by the year 2030. Patients with chronic illnesses cost the health care system over three times more than individuals without chronic conditions. The US Department of Veterans' Affairs (VA) Sunshine HealthCare Network, composed of VA health care facilities in Florida and Puerto Rico, recognized that the needs of its increasing number of veterans with chronic diseases were unmet by traditional medical interventions. The Network implemented a chronic disease self-management pilot program to evaluate its value for the veteran population. Results of the pilot indicate that this program will make a positive, lasting change in the health status and quality of life for veterans with chronic disease.
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...
Desai, P.; Minassian, D; Reidy, A.
AIMS—A national survey of over 100 hospitals in the UK was carried out to collect routine clinical information on the outcomes of cataract surgery. The clinical outcomes of interest were: visual acuity at time of discharge from postoperative hospital follow up, visual acuity at time of final refraction; complications related to surgery occurring during the operation, within 48 hours of surgery, and within 3 months of surgery. In addition, information on age and comorbidity was obtained. This article reports on the findings of the experience of approximately 18 000 patients who had cataract surgery in the hospital eye service of the NHS. RESULTS—Of those with no ocular comorbidity, 85% achieved a visual acuity of 6/12 or better on discharge from postoperative hospital follow up, while 65% of patients with a serious co-existing eye disease achieved this level of acuity at this time. At final refraction, 92% of patients without ocular comorbidity and 77% of patients with ocular comorbidity achieved 6/12 or better visual acuity. The following main risk indicators were associated with visual outcomes and complications related to surgery: age, other eye diseases, diabetes and stroke, type of surgical procedure, and grade of surgeon. CONCLUSIONS—The acceptability of these findings could fruitfully be the subject of discussion within the ophthalmic community and hopefully issues arising out of the study can lead to research, especially in-depth studies of the outcomes of cataract surgery in those patients with co-existing serious eye conditions. PMID:10574810
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
Walker, Rebekah J; Smalls, Brittany L; Campbell, Jennifer A; Strom Williams, Joni L; Egede, Leonard E
Social determinants of health include the social and economic conditions that influence health status. Research into the impact of social determinants on individuals with type 2 diabetes has largely focused on the prevention of or risk of developing diabetes. No review exists summarizing the impact of social determinants of health outcomes in patients with type 2 diabetes. This systematic review examined whether social determinants of health have an impact on health outcomes in type 2 diabetes. Medline was searched for articles that (a) were published in English (b) targeted adults, ages 18 + years, (c) had a study population which was diagnosed with type 2 diabetes, (d) the study was done in the United States, and (e) the study measured at least one of the outcome measures-glycemic control, cholesterol (LDL), blood pressure, quality of life or cost. Using a reproducible strategy, 2,110 articles were identified, and 61 were reviewed based on inclusion criteria. Twelve were categorized as Economic Stability and Education, 17 were categorized as Social and Community Context, 28 were categorized as Health and Health Care, and three were categorized as Neighborhood and Built Environment. Based on the studies reviewed, social determinants have an impact on glycemic control, LDL, and blood pressure to varying degrees. The impact on cost and quality of life was not often measured, but when quality of life was investigated, it did show significance. More research is needed to better characterize the direct impact of social determinants of health on health outcomes in diabetes.
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
Belfield, Clive R; Kelly, Inas Rashad
This paper looks at health outcomes, health behaviors, and health screening with respect to participation in Early Childhood Care and Education. With information on health status at multiple periods in time, we are able to look at whether healthier children select into early childhood education (as measured by center-based preschool care and Head Start), as well as whether early childhood education has immediate and near-term effects on a range of health status measures. There is some evidence that child obesity is ameliorated by participation in center-based preschool or Head Start and this finding is supported by clear evidence of improved nutrition and increased levels of health screening. Effects on other health outcomes such as asthma, ear infections, and respiratory problems may be partially masked by unobserved heterogeneity.
Montresor, A; Urbani, C; Camara, B; Bha, A B; Albonico, M; Savioli, L
The Sectorial Adjustment Education Program implemented in Guinea by the Ministry of Pre-University Education in 1995 includes health-related measures. An important part is the fight against parasitosis and in particular against intestinal helminth infection which has been shown to impair cognitive function in school children. In order to obtain data for this purpose, a survey was carried out in 7 subprefectures across the country. A total of 1,649 children were examined to determine the prevalence in each school of macroscopic hematuria-related schistosomiasis and of various intestinal helminthiasis in stools. In 1468 of these children blood tests were also made to measure hemoglobin levels and detect malarial hematozoons. Overall prevalence rates were 60.0% for soil-transmitted nematodes, 9.1% for urinary schistosomiasis, 57.6% for blood plasmodium, and 57.0% for anemia. Hemoglobin levels were lower in children presenting plasmodium, multiple parasitic infection, and high ankylostoma burdens. Prevalence rates varied widely between regions indicating differences in therapeutic measures. In two villages more than 200 children not attending school who had been informed by school children were treated. This word-of-mouth effect shows that school health programs are also useful to reach children outside the school health system.
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
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.
Guan, Vivienne X; Kent, Katherine
Introduction Dietary phytochemicals are found in plant-based foods such as fruits, vegetables and grains and may be categorised in a nested hierarchical manner with many hundred individual phytochemicals identified to date. To associate phytochemical intakes with positive health outcomes, a fundamental step is to accurately estimate the dietary phytochemical intake from foods reported. The purpose of this systematic review protocol is to describe the process to be undertaken to summarise the evidence for food-based dietary phytochemical intakes and health outcomes for adults. Methods and analysis The review will be undertaken following the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions using the Review Manager software. Phytochemical subclasses (phenolic acids, flavanols, etc) will be used to search for relevant studies using the Web of Science and Scopus scientific databases. The retrieved studies will be screened based on inclusion of natural whole food items and health outcomes. Phytochemical studies related to cardiovascular disease, cancer, overweight, glucose tolerance, digestive, reproductive, macular and bone health and mental disorders, fatigue and immunity will be examined based on prior scoping. The evidence will be aggregated by the food types and health outcomes. Comparison of differences in the outcomes for randomised controlled trials and observational studies will be undertaken. The strength of the review lies in its focus on whole food items and health conditions rather than one type of phytochemical related to one single health condition. Subgroup and sensitivity analyses will be conducted where an adequate number of publications are found per phytochemical subclass. Dissemination By comparing the outcomes from experimental and observational studies, the review will determine whether the overall conclusions related to the phytochemical subclasses are the same between study types for the identified health
Wilson, Arthur; Daar, Abdallah S
Many global health issues, almost by definition, do not recognize state borders and therefore require bi-lateral, or more often multi-lateral international solutions. These latter solutions are articulated in international instruments (declarations, conventions, treaties, constitutions of international bodies, etc). However, the gap between formal adoption of such instruments by signatory states and substantive implementation of the articulated solutions can be very wide. This paper surveys a selection of international legal instruments, including those where the sought after positive outcomes have been achieved, and those that have been ineffective, with little or no real progress being made. The paper looks for commonalities, both in the nature of the problems and the forms of the international legal instruments, to seek answers as to why some instruments ultimately succeeded where others failed. It also provides some guidance to law/ treaty makers to help ensure that they frame future instruments in such a way as to maximize the probability that those instruments will have a substantive positive impact on global health and health rights.
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.
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
Cook, John T; Black, Maureen; Chilton, Mariana; Cutts, Diana; Ettinger de Cuba, Stephanie; Heeren, Timothy C; Rose-Jacobs, Ruth; Sandel, Megan; Casey, Patrick H; Coleman, Sharon; Weiss, Ingrid; Frank, Deborah A
This review addresses epidemiological, public health, and social policy implications of categorizing young children and their adult female caregivers in the United States as food secure when they live in households with "marginal food security," as indicated by the U.S. Household Food Security Survey Module. Existing literature shows that households in the US with marginal food security are more like food-insecure households than food-secure households. Similarities include socio-demographic characteristics, psychosocial profiles, and patterns of disease and health risk. Building on existing knowledge, we present new research on associations of marginal food security with health and developmental risks in young children (<48 mo) and health in their female caregivers. Marginal food security is positively associated with adverse health outcomes compared with food security, but the strength of the associations is weaker than that for food insecurity as usually defined in the US. Nonoverlapping CIs, when comparing odds of marginally food-secure children's fair/poor health and developmental risk and caregivers' depressive symptoms and fair/poor health with those in food-secure and -insecure families, indicate associations of marginal food security significantly and distinctly intermediate between those of food security and food insecurity. Evidence from reviewed research and the new research presented indicates that households with marginal food security should not be classified as food secure, as is the current practice, but should be reported in a separate discrete category. These findings highlight the potential underestimation of the prevalence of adverse health outcomes associated with exposure to lack of enough food for an active, healthy life in the US and indicate an even greater need for preventive action and policies to limit and reduce exposure among children and mothers.
Stanton, Sarah C E; Campbell, Lorne
Two literatures have explored some of the effects intimate relationships can have on physical and mental health outcomes. Research investigating health through the lens of attachment theory has demonstrated that more anxiously attached individuals in particular consistently report poorer health. Separate research on perceived social support (e.g., partner or spousal support) suggests that higher support has salutary influences on various health outcomes. Little to no research, however, has explored the interaction of attachment anxiety and perceived social support on health outcomes. The present study examined the attachment-health link and the moderating role of perceived social support in a community sample of married couples. Results revealed that more anxious persons reported poorer overall physical and mental health, more bodily pain, more medical symptoms, and impaired daily functioning, even after controlling for age, relationship length, neuroticism, and marital quality. Additionally, perceived social support interacted with attachment anxiety to influence health; more anxious individuals' health was poorer even when perceived social support was high, whereas less anxious individuals' health benefited from high support. Possible mechanisms underlying these findings and the importance of considering attachment anxiety in future studies of poor health in adulthood are discussed.
Pratt, Christina; 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 that
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...
Forsberg, Helena Hvitfeldt; Essén, Anna; Ernestam, Sofia
Background: Value-based health care is increasingly used for developing health care services by relating patient outcomes to costs. A hierarchical value scorecard for creating outcome measurements has been suggested: the 3-tier model. The objective of this study was to test the model against the patient's view of value in a chronic care setting. Methods: Semistructured interviews with 22 persons with rheumatoid arthritis were conducted, transcribed, and analyzed using qualitative content analysis. Themes were extracted, and the model was critically applied and revised. Results: The study validates existing dimensions in the model but suggests adding information, social health, predictability, and continuity to make it more useful and representative of patients' preferences. Conclusion: Although the model aims to focus on outcomes relevant to patients, it lacks dimensions important to individuals with rheumatoid arthritis. The data illustrate difficulties in finding patients' preferred outcomes and imply tactics for arriving at meaningful measurements. PMID:27749717
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.
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
Gorst, Sarah L.; Gargon, Elizabeth; Clarke, Mike; Smith, Valerie; Williamson, Paula R.
Background The COMET (Core Outcome Measures in Effectiveness Trials) Initiative promotes the development and application of core outcome sets (COS), including relevant studies in an online database. In order to keep the database current, an annual search of the literature is undertaken. This study aimed to update a previous systematic review, in order to identify any further studies where a COS has been developed. Furthermore, no prioritization for COS development has previously been undertaken, therefore this study also aimed to identify COS relevant to the world’s most prevalent health conditions. Methods The methods used in this updated review followed the same approach used in the original review and the previous update. A survey was also sent to the corresponding authors of COS identified for inclusion in this review, to ascertain what lessons they had learnt from developing their COS. Additionally, the COMET database was searched to identify COS that might be relevant to the conditions with the highest global prevalence. Results Twenty-five reports relating to 22 new studies were eligible for inclusion in the review. Further improvements were identified in relation to the description of the scope of the COS, use of the Delphi technique, and the inclusion of patient participants within the development process. Additionally, 33 published and ongoing COS were identified for 13 of the world’s most prevalent conditions. Conclusion The development of a reporting guideline and minimum standards should contribute towards future improvements in development and reporting of COS. This study has also described a first approach to identifying gaps in existing COS, and to priority setting in this area. Important gaps have been identified, on the basis of global burden of disease, and the development and application of COS in these areas should be considered a priority. PMID:27973622
Mishra, Vinod; Vaessen, Martin; Boerma, J. Ties; Arnold, Fred; Way, Ann; Barrere, Bernard; Cross, Anne; Hong, Rathavuth; Sangha, Jasbir
OBJECTIVES: To describe the methods used in the Demographic and Health Surveys (DHS) to collect nationally representative data on the prevalence of human immunodeficiency virus (HIV) and assess the value of such data to country HIV surveillance systems. METHODS: During 2001-04, national samples of adult women and men in Burkina Faso, Cameroon, Dominican Republic, Ghana, Mali, Kenya, United Republic of Tanzania and Zambia were tested for HIV. Dried blood spot samples were collected for HIV testing, following internationally accepted ethical standards. The results for each country are presented by age, sex, and urban versus rural residence. To estimate the effects of non-response, HIV prevalence among non-responding males and females was predicted using multivariate statistical models for those who were tested, with a common set of predictor variables. RESULTS: Rates of HIV testing varied from 70% among Kenyan men to 92% among women in Burkina Faso and Cameroon. Despite large differences in HIV prevalence between the surveys (1-16%), fairly consistent patterns of HIV infection were observed by age, sex and urban versus rural residence, with considerably higher rates in urban areas and in women, especially at younger ages. Analysis of non-response bias indicates that although predicted HIV prevalence tended to be higher in non-tested males and females than in those tested, the overall effects of non-response on the observed national estimates of HIV prevalence are insignificant. CONCLUSIONS: Population-based surveys can provide reliable, direct estimates of national and regional HIV seroprevalence among men and women irrespective of pregnancy status. Survey data greatly enhance surveillance systems and the accuracy of national estimates in generalized epidemics. PMID:16878227
Paine, Sarah-Jane; Harris, Ricci; Cormack, Donna; Stanley, James
Study Objectives: Research on the relationship between racial discrimination and sleep is limited. The aims of this study were to: (1) examine the independent relationship between ethnicity, sex, age, socioeconomic position, experience of racial discrimination and self-reported sleep disturbances, and (2) determine the statistical contribution of experience of racial discrimination to ethnic disparities in sleep disturbances. Methods: The study used data from the 2002/03 New Zealand Health Survey, a nationally-representative, population-based survey of New Zealand adults (≥ 15 years). The sample included 4,108 self-identified Māori (indigenous New Zealanders) and 6,261 European adults. Outcome variables were difficulty falling asleep, frequent nocturnal awakenings, and early morning awakenings. Experiences of racial discrimination across five domains were used to assess overall racial discrimination “ever” and the level of exposure to racial discrimination. Socioeconomic position was measured using neighborhood deprivation, education, and equivalized household income. Results: Māori had a higher prevalence of each sleep disturbance item than Europeans. Reported experiences of racial discrimination were independently associated with each sleep disturbance item, adjusted for ethnicity, sex, age group, and socioeconomic position. Sequential logistic regression models showed that racial discrimination and socioeconomic position explained most of the disparity in difficulty falling asleep and frequent nocturnal awakening between Māori and Europeans; however, ethnic differences in early morning awakenings remained. Conclusions: Racial discrimination may play an important role in ethnic disparities in sleep disturbances in New Zealand. Activities to improve the sleep health of non-dominant ethnic groups should consider the potentially multifarious ways in which racial discrimination can disturb sleep. Citation: Paine SJ, Harris R, Cormack D, Stanley J. Racial
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
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
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.
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…
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.