Torrance, G W; Furlong, W; Feeny, D; Boyle, M
Multi-attribute utility theory, an extension of conventional utility theory, can be applied to model preference scores for health states defined by multi-attribute health status classification systems. The type of preference independence among the attributes determines the type of preference function required: additive, multiplicative or multilinear. In addition, the type of measurement instrument used determines the type of preference score obtained: value or utility. Multi-attribute utility theory has been applied to 2 recently developed multi-attribute health status classification systems, the Health Utilities Index (HUI) Mark II and Mark III systems. Results are presented for the Mark II system, and ongoing research is described for the Mark III system. The theory is also discussed in the context of other well known multi-attribute systems. The HUI system is an efficient method of determining a general public-based utility score for a specified health outcome or for the health status of an individual. In clinical populations, the scores can be used to provide a single summary measure of health-related quality of life. In cost-utility analyses, the scores can be used as quality weights for calculating quality-adjusted life years. In general populations, the measure can be used as quality weights for determining population health expectancy.
Horsman, John; Furlong, William; Feeny, David; Torrance, George
This is a review of the Health Utilities Index (HUI) multi-attribute health-status classification systems, and single- and multi-attribute utility scoring systems. HUI refers to both HUI Mark 2 (HUI2) and HUI Mark 3 (HUI3) instruments. The classification systems provide compact but comprehensive frameworks within which to describe health status. The multi-attribute utility functions provide all the information required to calculate single-summary scores of health-related quality of life (HRQL) for each health state defined by the classification systems. The use of HUI in clinical studies for a wide variety of conditions in a large number of countries is illustrated. HUI provides comprehensive, reliable, responsive and valid measures of health status and HRQL for subjects in clinical studies. Utility scores of overall HRQL for patients are also used in cost-utility and cost-effectiveness analyses. Population norm data are available from numerous large general population surveys. The widespread use of HUI facilitates the interpretation of results and permits comparisons of disease and treatment outcomes, and comparisons of long-term sequelae at the local, national and international levels.
Gencer, Baris; Rodondi, Nicolas; Auer, Reto; Nanchen, David; Räber, Lorenz; Klingenberg, Roland; Pletscher, Mark; Jüni, Peter; Windecker, Stephan; Matter, Christian M; Lüscher, Thomas F; Mach, François; Perneger, Thomas V; Girardin, François R
Background Acute coronary syndromes (ACS) have been associated with lower health utilities (HUs) compared with the general population. Given the prognostic improvements after ACS with the implementation of coronary angiography (eg, percutaneous coronary intervention (PCI)), contemporary HU values derived from patient-reported outcomes are needed. Methods We analysed data of 1882 patients with ACS 1 year after coronary angiography in a Swiss prospective cohort. We used the EuroQol five-dimensional questionnaire (EQ-5D) and visual analogue scale (VAS) to derive HU indexes. We estimated the effects of clinical factors on HU using a linear regression model and compared the observed HU with the average values of individuals of the same sex and age in the general population. Results Mean EQ-5D HU 1-year after coronary angiography for ACS was 0.82 (±0.16) and mean VAS was 0.77 (±0.18); 40.9% of participants exhibited the highest utility values. Compared with population controls, the mean EQ-5D HU was similar (expected mean 0.82, p=0.58) in patients with ACS, but the mean VAS was slightly lower (expected mean 0.79, p<0.001). Patients with ACS who are younger than 60 years had lower HU than the general population (<0.001). In patients with ACS, significant differences were found according to the gender, education and employment status, diabetes, obesity, heart failure, recurrent ischaemic or incident bleeding event and participation in cardiac rehabilitation (p<0.01). Conclusions At 1 year, patients with ACS with coronary angiography had HU indexes similar to a control population. Subgroup analyses based on patients' characteristics and further disease-specific instruments could provide better sensitivity for detecting smaller variations in health-related quality of life. PMID:27252878
Butler, James; Fryer, Craig S.; Reed, Ernestine A.; Thomas, Stephen B.
Background: Insufficient attention has been paid to the process of conducting the Centers for Disease Control and Prevention's School Health Index (SHI) to promote collaboration between universities and urban school districts when developing adolescent health promotion initiatives. This article provides an overview of the real-world contextual…
King, Kristi McClary
A Coordinated School Health Program maximizes a school's positive interaction among health education, physical education, health services, nutrition services, counseling/psychological/social services, health school environment, health promotion for staff, and family and community involvement. The purpose of this semester project is for…
Do visual analogue scale (VAS) derived standard gamble (SG) utilities agree with Health Utilities Index utilities? A comparison of patient and community preferences for health status in rheumatoid arthritis patients
Rashidi, Amir Adel; Anis, Aslam H; Marra, Carlo A
Background Assessment of Health Related Quality of Life (HRQL) has become increasingly important and various direct and indirect methods and instruments have been devised to measure it. In direct methods such as Visual Analog Scale (VAS) and Standard Gamble (SG), respondent both assesses and values health states therefore the final score reflects patient's preferences. In indirect methods such as multi-attribute health status classification systems, the patient provides the assessment of a health state and then a multi-attribute utility function is used for evaluation of the health state. Because these functions have been estimated using valuations of general population, the final score reflects community's preferences. The objective of this study is to assess the agreement between community preferences derived from the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) systems, and patient preferences. Methods Visual analog scale (VAS) and HUI scores were obtained from a sample of 320 rheumatoid arthritis patients. VAS scores were adjusted for end-aversion bias and transformed to standard gamble (SG) utility scores using 8 different power conversion formulas reported in other studies. Individual level agreement between SG utilities and HUI2 and HUI3 utilities was assessed using the intraclass correlation coefficient (ICC). Group level agreement was assessed by comparing group means using the paired t-test. Results After examining all 8 different SG estimates, the ICC (95% confidence interval) between SG and HUI2 utilities ranged from 0.45 (0.36 to 0.54) to 0.55 (0.47 to 0.62). The ICC between SG and HUI3 utilities ranged from 0.45 (0.35 to 0.53) to 0.57 (0.49 to 0.64). The mean differences between SG and HUI2 utilities ranged from 0.10 (0.08 to 0.12) to 0.22 (0.20 to 0.24). The mean differences between SG and HUI3 utilities ranged from 0.18 (0.16 to 0.2) to 0.28 (0.26 to 0.3). Conclusion At the individual level, patient and community preferences show moderate
Mo, Frank; Choi, Bernard C K; Li, Felix C K; Merrick, Joav
Quality of life is an important indicator in assessing the burden of disease, especially for chronic conditions. The Health Utilities Index (HUI) is a recently developed system for measuring the overall health status and health-related quality of life (HRQL) of individuals, clinical groups, and general populations. Using the HUI (constructed based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort) to measure the HRQL for chronic disease patients and to detect possible associations between HUI system and various chronic conditions, this study provides information to improve the management of chronic diseases. This study is of interest to data analysts, policy makers, and public health practitioners involved in descriptive clinical studies, clinical trials, program evaluation, population health planning, and assessments. Based on the Canadian Community Health Survey (CCHS) for 2000-01, the HUI was used to measure the quality of life for individuals living with various chronic conditions (Alzheimer/other dementia, effects of stroke, urinary incontinence, arthritis/rheumatism, bowel disorder, cataracts, back problems, stomach/intestinal ulcers, emphysema/COPD, chronic bronchitis, epilepsy, heart disease, diabetes, migraine headaches, glaucoma, asthma, fibromyalgia, cancers, high blood pressure, multiple sclerosis, thyroid condition, and other remaining chronic diseases). Logistic Regression Model was employed to estimate the associations between the overall HUI scores and various chronic conditions. The HUI scores ranged from 0.00 (corresponding to a state close to death) to 1.00 (corresponding to perfect health); negative scores reflect health states considered worse than death. The mean HUI score by sex and age group indicated the typical quality of life for persons with various chronic conditions. Logistic Regression results showed a strong relationship between low HUI scores (< or = 0.5 and 0.06-1.0) and
Sundaram, Murali; Smith, Michael J; Revicki, Dennis A; Miller, Lesley-Ann; Madhavan, Suresh; Hobbs, Gerry
Preference-based measures of health (PBMH) provide 'preference' or 'utility' weights that enable the calculation of QALYs for the economic evaluations of interventions. The Diabetes Utility Index (DUI) was developed as a brief, self-administered, diabetes mellitus-specific PBMH that can efficiently estimate patient-derived health state utilities. To describe the development of the valuation function for the DUI, and to report the validation results of the valuation function. Multi-Attribute Utility Theory (MAUT) was used as the framework to develop a valuation function for the DUI. Twenty of 768 possible health states of the DUI classified as anchor states, single-attribute level states including corner states, and marker states were selected and described for preference elicitation interviews. Visual analogue scale and standard gamble (SG) exercises were used to measure preferences from individuals with diabetes recruited from primary care and community settings in and around Morgantown, WV, USA for the 20 health states defined by combinations of DUI attributes and severity levels. Data collected in the interviews were used to develop a valuation function that calculates utilities for the DUI health states and calculates attribute-level utilities. A validation survey of the valuation function was conducted in collaboration with the West Virginia University (WVU) Diabetes Institute. A total of 100 individuals with diabetes were interviewed and their preferences for various DUI health states measured. From data generated in the interviews, a DUI valuation function was developed on a scale where 1.00 = perfect health (PH) and 0.00 = the all worse 'pits' state, and adjusted to yield utilities on the conventional scale 1.00 = PH and 0.00 = dead. A total of 396 patients with diabetes who received care at WVU clinics completed a DUI mail validation survey (response rate = 33%). Clinical data consisting of International Classification of Diseases, 9th edition, diagnosis
Park, Jong Heon
Objectives The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. Methods We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. Results In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. Conclusions Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit. PMID:28173689
Jackson, C N; Manning, M R
This study explores the relationship between burnout and health care utilization of 238 employed adults. Burnout was measured by the Maslach Burnout Inventory and health care utilization by insurance company records regarding these employees' health care costs and number of times they accessed health care services over a one year period. ANOVAs were conducted using Golembiewski and Munzenrider's approach to define the burnout phase. Significant differences in health care costs were found.
One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894
Núñez, Alicia; Chi, Chunhuei
One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly.
Ohio State Univ., Columbus. Center on Education and Training for Employment.
This competency index lists the competencies included in the 62 units of the Tech Prep Competency Profiles within the Health Technologies Cluster. The unit topics are as follows: employability skills; professionalism; teamwork; computer literacy; documentation; infection control and risk management; medical terminology; anatomy, physiology, and…
Bhargava, Alok; Guntupalli, Aravinda M; Lokshin, Michael
This paper models the proximate determinants of height, weight and haemoglobin concentration of over 25,000 Indian children using data from the National Family Health Survey-3. The effects of public and private health care service utilization, food consumption patterns and maternal health status on child health were investigated in a multidisciplinary framework. Methodological issues such as potential endogeneity of explanatory variables and the appropriateness of combining height and weight as the body mass index were tackled. The results from models for children's heights and weight showed beneficial effects of child vaccinations against DPT, polio and measles, and negative effects of not utilizing government health facilities. The models for children's haemoglobin concentration indicated beneficial effects of food consumption patterns and treatment against intestinal parasites. The results provide several insights for improving child health in India.
Poxson, David J; Mont, Frank W; Schubert, Martin F; Kim, Jong Kyu; Cho, Jaehee; Schubert, E Fred
Optical interference filters utilizing tunable refractive index layers are shown to have higher spectral fidelity as compared to conventional filters consisting of non-tunable refractive index layers. To demonstrate this increase in spectral fidelity, we design and compare a variety of optical interference filters employing both tunable and non-tunable refractive index layers. Additionally, a five-layer optical interference filter utilizing tunable refractive index layers is designed and fabricated for use with a Xenon lamp to replicate the Air Mass 0 solar irradiance spectrum and is shown to have excellent spectral fidelity.
Peay, Wayne J.; And Others
Describes MEDOC, an index to U.S. government documents in health sciences produced at the Eccles Health Sciences Library at the University of Utah. Both the development of the index from an in-house catalog into a subscription service, and the application of computer technologies in its production are discussed. (CLB)
Some policy makers have proposed using the customer bill to measure a utility`s success at implementing a least-cost plan, including its demand-side management program. Use of a bill index results in imperfect incentives and unfair comparisons, and should be rejected as a performance index. Customers care about more than their bills - they also care about the quantity and quality of energy services received. Thus, a low per-customer bill is not necessarily a good indicator of utility performance. Basing regulatory rewards on relative bills sends inappropriate signals to utilities - rewarding uneconomical activity, such as the discouragement of efficient electricity consumption. Not only are there perverse incentives associated with the use of bills as indicators of performance, but the creation of comparable indices for a target firm and peer utilities is an administrative (and analytical) nightmare.
The Construction and Utility of Three Indexes of Intellectual Achievement: An Intellectual-Development (ID) Index; A Socio-Intellectual-Status (SIS) Index; A Differential-Intellectual-Development (DID) Index. U.S. Children and Youths, 6-17 Years. Vital and Health Statistics. Data Evaluation and Methods Research. Series 2-Number 74.
Dupuy, Harold J.; Gruvaeus, Gunnar
Although the Intellectual Development (ID) index was constructed using standard psychometric procedures, the derivation of the other two indexes, Socio Intellectual Status (SIS) and Differential Intellectual Development (DID), by criterion scaling should have applications in diverse areas of scale or index construction. The ID is basically…
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
Greiner, Wolfgang; Klose, Kristina
Measuring health-related quality of life is an important aspect in economic evaluation of health programmes. The development of utility-based (preference-based) measures is advanced by the discipline of health economics. Different preference measures are applied for valuing health states to produce a weighted health state index. Those preference weights should be derived from a general population sample in case of resource allocation on a collective level (as in current valuation studies of the EuroQol group).
Utility and applicability of the "Childhood Obesity Risk Evaluation" (CORE)-index in predicting obesity in childhood and adolescence in Greece from early life: the "National Action Plan for Public Health".
Manios, Yannis; Vlachopapadopoulou, Elpis; Moschonis, George; Karachaliou, Feneli; Psaltopoulou, Theodora; Koutsouki, Dimitra; Bogdanis, Gregory; Carayanni, Vilelmine; Hatzakis, Angelos; Michalacos, Stefanos
Early identification of infants being at high risk to become obese at their later childhood or adolescence can be of vital importance in any obesity prevention initiative. The aim of the present study was to examine the utility and applicability of the "Childhood Obesity Risk Evaluation (CORE)" index as a screening tool for the early prediction of obesity in childhood and adolescence. Anthropometric, socio-demographic data were collected cross-sectionally and retrospectively from a representative sample of 5946 children, and adolescents and were combined for calculating the CORE-index score. Logistic regression analyses were performed to examine the associations of the CORE-index score with obesity by gender and age group, and cut-off point analysis was also applied to identify the optimal value of the CORE-index score that differentiates obese from non-obese children. Mean CORE-index score in the total sample was 3.06 (sd 1.92) units (range 0-11 units). Each unit increase in the CORE-index score was found to be associated with a 30 % (95 % C.I. 1.24-1.36) increased likelihood for obesity in childhood or adolescence, while the optimal cut-off value of the CORE-index score that predicted obesity with the highest possible sensitivity and specificity was found to be 3.5.
While social networks have been examined in the context of many economic choices and outcomes, this study is the first to investigate the effects of social networks on health service utilization decisions. Networks can affect utilization decisions in many ways. They can provide information on institutional details of the health care system, and can reduce the search costs of locating an appropriate health care provider. Networks can even alter the demand for services by affecting the perceived efficacy or desirability of the available services. Using health service utilization decisions to study networks has two main advantages over work that studies other public programs. First, because health care in Canada is universal, there are no questions of eligibility. Second, by studying the different measures of utilization, it is possible to observe how the network effects vary across measures that reflect visits primarily instigated by the patient, to measures that reflect visits instigated by both patients and their physician. Using data from three cycles of the Canadian National Population Health Survey, this work exploits regional and language group variation to identify network effects. Strong and robust evidence of networks effects is found on the decision to utilize services reflecting initial contact with the health care system. As well, this work presents novel evidence that utilization of health services by immigrants increases with the number of doctors that speak their language in their neighborhood.
Center for Information and Research on Civic Learning and Engagement (CIRCLE), 2009
Since 2006, the National Conference on Citizenship (NCoC), in partnership with the Civic Indicators Working Group, has published annual reports called "America's Civic Health Index." These reports have informed Americans about leading indicators of the nation's civic health and motivated citizens, leaders and policymakers to strengthen…
Goyal, Ashima; Mittal, Neeti; Mittal, Parteek; Gauba, K
Reliable and safe provision of sedation and general anesthesia is dependent on continuous vigilance of patient's sedation depth. Failure to do so may result in unintended oversedation or undersedation. It is a common practice to observe sedation depth by applying subjective sedation scales and in case of general anesthesia, practitioner is dependent on vital sign assessment. The Bispectral Index System (BIS) is a recently introduced objective, quantitative, easy to use, and free from observer bias, and clinically useful tool to assess sedation depth and it precludes the need to stimulate the patient to assess his sedation level. The present article is an attempt to orient the readers towards utility and validity of BIS for sedation and general anesthesia in pediatric dentistry. In this article, we attempt to make the readers understand the principle of BIS, its variation across sedation continuum, its validity across different age groups and for a variety of sedative drugs.
Health Information Technology (HIT) adoption by clinicians, including nurses, will lead to reduction in healthcare costs and clinical errors and improve health outcomes. Understanding the importance of technology adoption, the current study utilized the Technology Readiness Index to explore technology perceptions of nursing students. Our analysis identifies factors that may influence perceptions of technology, including decreased optimism for students with clinical experience and increased discomfort of US born students. Our study provides insight to inform training programs to further meet the increasing demands of skilled nursing staff.
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
Doke, Prakash Prabhakarrao
Background: Health administrators require status of health of different administrative units under them. Use of large number of indicators may create confusion and uncertainty about health status. Availability of a comprehensive index is certainly useful. Objective: To evolve one comprehensive health index for a district as unit and measure district wise disparity. Materials and Methods: Ten indicators from categories of health outcomes, health system, determinants of health, and utilization of services were considered. Data for districts in Maharashtra State were obtained from different sources.For each indicator the best performing district was given score of 100 and other districts were given marks proportionately. Results: The comprehensive index for the state was 0.52. The district scoring lowest value of 0.36 was a tribal district and scoring highest value of 0.66 was a nontribal district. Conclusion: Computing such index of districts for monitoring and allocation of resources may be useful managerial tool. PMID:27890979
Adekanmbi, Victor T; Adedokun, Sulaimon T; Taylor-Phillips, Sian; Uthman, Olalekan A; Clarke, Aileen
Health service utilization is an important component of child health promotion. Evidence shows that two-thirds of child deaths in low and middle income countries could be prevented if current interventions were adequately utilized. Aim of this study was to identify determinants of variation in health services utilization for children in communities in Nigeria. Multivariable negative binomial regression model attempting to explain observed variability in health services usage in Nigerian communities was applied to the 2013 Nigeria Demographic and Health Survey data. We included the index of maternal deprivation, gender of child, community environmental factor index, and maternal health seeking behaviour, multiple childhood deprivation index and ethnicity diversity index as the independent variables. The outcome variable was under-fives' hospital attendance rates for acute illness. Of the 7577 children from 896 communities in Nigeria that were sick 1936 (25.6%) were taken to the health care facilities for treatment. The final model revealed that both multiple childhood deprivation (incidence rate ratio [IRR]=1.23, 95% confidence interval [CI] 1.12 to 1.35) and children living in communities with a high ethnic diversity were associated with higher rate of health service use. Maternal health seeking behaviour was associated with a significantly lower rate of health care service use. There are significant variations in health services utilization for sick children across Nigeria communities which appear to be more strongly determined by childhood deprivation factors and maternal health seeking behaviour than by health system functions.
De Luca, Giuliana; Ponzo, Michela; Andrés, Antonio Rodríguez
Healthcare utilization studies show how well documented disparities between migrants and non-migrants. Reducing such disparities is a major goal in European countries. However, healthcare utilization among Italian immigrants is under-studied. The objective of this study is to explore differences in healthcare use between immigrant and native Italians. Cross-sectional study using the latest available (2004/2005) Italian Health Conditions Survey. We estimated separate hurdle binomial negative regression models for GP, specialist, and telephone consultations and a logit model for emergency room (ER) use. We used logistic regression and zero-truncated negative binomial regression to model the zero (contact decision) and count processes (frequency decisions) respectively. Adjusting for risk factors, immigrants are significantly less likely to use healthcare services with 2.4 and 2.7 % lower utilization probability for specialist and telephone consultations, respectively. First- and second-generation immigrants' probability for specialist and telephone contact is significantly lower than natives'. Immigrants, ceteris paribus, have a much higher probability of using ERs than natives (0.7 %). First-generation immigrants show a higher probability of visiting ERs (1 %). GP visits show no significant difference. In conclusion Italian immigrants are much less likely to use specialist healthcare and medical telephone consultations than natives but more likely to use ERs. Hence, we report an over-use of ERs and under-utilization of preventive care among immigrants. We recommend improved health policies for immigrants: promotion of better information dissemination among them, simplification of organizational procedures, better communications between providers and immigrants, and an increased supply of health services for the most disadvantaged populations.
Fryback, Dennis G.; Palta, Mari; Cherepanov, Dasha; Bolt, Daniel; Kim, Jee-Seon
Background Five health-related quality-of-life (HRQoL) indexes—EQ-5D, HUI2, HUI3, QWB-SA, and SF-6D—are each used to assign community-based utility scores to health states, although these scores differ. Objective The authors transform these indexes to a common scale to understand their interrelationships. Methods Data were from the National Health Measurement Study, a telephone survey of 3844 US adults. The 5 indexes were analyzed using item response theory analysis to estimate scores on an underlying construct of summary health, θ. Unidimensionality was evaluated using nonlinear principal components analysis. Index scores were plotted against the estimated scores on the common underlying construct. In addition, scores on the Health and Activities Limitation Index (HALex), the Centers for Disease Control and Prevention Healthy Days questions, and self-rated health on a 5-category scale ranging from excellent to poor were plotted. Results SF-6D and QWB-SA are nearly linear across the range of θ, but with a shallow slope; EQ-5D, HUI2, and HUI3 are linear with steep slope from low θ (poor health) into mid-range of θ, then approximately linear with a less steep slope for higher θ (health just below to well above average) although the inflection points differ by index. Conclusion Simple linear functions may serve as crosswalks among these indexes only for lower health states albeit with low precision. Ceiling effects make crosswalks among most of the indexes ill specified above a certain level of health. Although each index measures generic health on a utility scale, these indexes are not identical but are relatively simply, if imprecisely, related. PMID:19843961
Vest, Joshua R
Health information exchange (HIE) makes previously inaccessible data available to clinicians, resulting in more complete information. This study tested the hypotheses that HIE information access reduced emergency room visits and inpatient hospitalizations for ambulatory care sensitive conditions among medically indigent adults. HIE access was quantified by how frequently system users' accessed patients' data. Encounter counts were modeled using zero inflated binomial regression. HIE was not accessed for 43% of individuals. Patient factors associated with accessed data included: prior utilization, chronic conditions, and age. Higher levels of information access were significantly associated with increased counts of all encounter types. Results indicate system users were more likely to access HIE for patients for whom the information might be considered most beneficial. Ultimately, these results imply that HIE information access did not transform care in the ways many would expect. Expectations in utilization reductions, however logical, may have to be reevaluated or postponed.
Perkowski, Patryk; Rodberg, Leonard
Health systems implement cost sharing to help reduce health care expenditure and utilization by discouraging the use of unnecessary health care services. We examine cost sharing in 28 countries in the Organisation for Economic Co-operation and Development from 1999 through 2009 in the areas of medical care, hospital care, and pharmaceuticals. We investigate associations between cost sharing, health care expenditures, and health care utilization and find no significant association between cost sharing and health care expenditures or utilization in these countries.
Flood, Emuella M; Cock, Erwin De; Mörk, Ann-Christin; Revicki, Dennis A
Background The Asthma Symptom Utility Index (ASUI) is a preference-based outcome measure used in US clinical trials and cost-effectiveness studies for asthma. This study evaluated ASUI preference weights in Europe to determine whether the multi-attribute utility function, based on preferences from a US population, is generalizable across countries. Methods Data were collected from ninety asthma patients from Italy, France, and the United Kingdom using the Asthma Control Questionnaire, the Asthma Quality of Life Questionnaire, and the ASUI. Subjects rated their preferences for 10 asthma health states using a visual analogue scale (VAS) and a standard gamble (SG) interview. Results All multi-symptom states showed statistically significant differences (p < 0.001) between countries in mean VAS scores. Mean SG utility scores between the US and France and the US and Italy demonstrated statistically significant differences (p < 0.001) for three states: severe wheeze; moderate cough and wheeze; and moderate cough and dyspnea. Because of these differences, the multi-attribute utility functions derived within countries were somewhat different. Despite these differences, country-specific algorithms captured a similar rank ordering of patients by disease severity, were strongly correlated (r = 0.971 to 0.995), and demonstrated similar relationships with symptom and AQLQ scores. Conclusion Results of this study suggest that the ASUI may be a complementary patient-reported outcome for clinical studies and may be useful for applications in cost-effectiveness studies comparing different asthma treatments. PMID:16911790
Schonbrun, Yael Chatav; Whisman, Mark A.
Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for…
Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Weinehall, Lars; Ng, Nawi
Background A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). Design A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas. PMID:25095780
Millions of people cannot access essential medicines they need for deadly diseases like malaria, tuberculosis (TB) and HIV/AIDS. There is good information on the need for drugs for these diseases but until now, no global estimate of the impact drugs are having on this burden. This paper presents a model measuring companies' key malaria, TB and HIV/AIDS drugs' consequences for global health (global-health-impact.org). It aggregates drugs' impacts in several ways-by disease, country and originator-company. The methodology can be extended across diseases as well as drugs to provide a more extensive picture of the impact companies' drugs are having on the global burden of disease. The study suggests that key malaria, TB and HIV/AIDS drugs are, together, ameliorating about 37% of the global burden of these diseases and Sanofi, Novartis, and Pfizer's drugs are having the largest effect on this burden. Moreover, drug impacts vary widely across countries. This index provides important information for policy makers, pharmaceutical companies, countries, and other stake-holders that can help increase access to essential medicines.
Elrashidi, Muhamad Y; Jacobson, Debra J; St Sauver, Jennifer; Fan, Chun; Lynch, Brian A; Rutten, Lila J Finney; Ebbert, Jon O
The obesity epidemic is a significant public health issue with adverse impact on health and costs. Applying a life-course perspective to obesity may advance our understanding of the influence of obesity over time on patterns of healthcare utilization in young and middle-aged United States (US) adults.We identified baseline body mass index (BMI) and BMI trajectories, and assessed their association with outpatient visits, emergency department (ED) visits, and hospitalizations in a well-defined population of young and middle-aged US adults.Using the Rochester Epidemiology Project resources, we conducted a retrospective cohort study of adults (N = 23,254) aged 18 to 44 years, with at least 3 BMI measurements, residing in Olmsted County, MN from January 1, 2005 through December 31, 2012.We observed that 27.5% of the population was obese. Four BMI trajectories were identified. Compared to under/normal weight, obese class III adults had higher risk of outpatient visits (adjusted rate ratio [RR], 1.86; 95% confidence intervals [CIs], 1.67-2,08), ED visits (adjusted RR, 3.02; 95% CI, 2.74-3.34), and hospitalizations (adjusted RR, 1.67; 95% CI, 1.59-1.75). BMI trajectory was positively associated with ED visits after adjustment for age, sex, race, and Charlson Comorbidity Index (P < 0.001 for trend).Among young and middle-aged US adults, baseline BMI is positively associated with outpatient visits, ED visits, and hospitalizations, while BMI trajectory is positively associated with ED visits. These findings extend our understanding of the longitudinal influence of obesity on healthcare utilization in early to mid-adulthood.
von Schacky, Clemens
Recent large trials with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the cardiovascular field did not demonstrate a beneficial effect in terms of reductions of clinical endpoints like total mortality, sudden cardiac arrest or other major adverse cardiac events. Pertinent guidelines do not uniformly recommend EPA + DHA for cardiac patients. In contrast, in epidemiologic findings, higher blood levels of EPA + DHA were consistently associated with a lower risk for the endpoints mentioned. Because of low biological and analytical variability, a standardized analytical procedure, a large database and for other reasons, blood levels of EPA + DHA are frequently assessed in erythrocytes, using the HS-Omega-3 Index® methodology. A low Omega-3 Index fulfills the current criteria for a novel cardiovascular risk factor. Neutral results of intervention trials can be explained by issues of bioavailability and trial design that surfaced after the trials were initiated. In the future, incorporating the Omega-3 Index into trial designs by recruiting participants with a low Omega-3 Index and treating them within a pre-specified target range (e.g., 8%–11%), will make more efficient trials possible and provide clearer answers to the questions asked than previously possible. PMID:24566438
Uzun Jacobson, Evin; Inglesby, Tom; Khan, Ali S; Rajotte, James C; Burhans, Robert L; Slemp, Catherine C; Links, Jonathan M
The importance of health security in the United States has been highlighted by recent emergencies such as the H1N1 influenza pandemic, Superstorm Sandy, and the Boston Marathon bombing. The nation's health security remains a high priority today, with federal, state, territorial, tribal, and local governments, as well as nongovernment organizations and the private sector, engaging in activities that prevent, protect, mitigate, respond to, and recover from health threats. The Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (OPHPR), led an effort to create an annual measure of health security preparedness at the national level. The collaborative released the National Health Security Preparedness Index (NHSPI(™)) in December 2013 and provided composite results for the 50 states and for the nation as a whole. The Index results represent current levels of health security preparedness in a consistent format and provide actionable information to drive decision making for continuous improvement of the nation's health security. The overall 2013 National Index result was 7.2 on the reported base-10 scale, with areas of greater strength in the domains of health surveillance, incident and information management, and countermeasure management. The strength of the Index relies on the interdependencies of the many elements in health security preparedness, making the sum greater than its parts. Moving forward, additional health security-related disciplines and measures will be included alongside continued validation efforts.
... cost indexes? 591.220 Section 591.220 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ALLOWANCES AND DIFFERENTIALS Cost-of-Living Allowance and Post Differential-Nonforeign Areas Cost-Of-Living Allowances § 591.220 How does OPM calculate energy utility cost indexes? (a)...
Childhood mental disorders affect between 13%-20% of children in the United States (US) annually and impact the child, family, and community. Literature suggests associations exist between environmental and children’s mental health such as air pollution with autism and ADHD...
Chen, Gao; Dai, Limin; Ji, Lanzhu; Deng, Hongbing; Hao, Zhanqing; Wang, Qingli
Ecosystem health assessment is one of the main researches and urgent tasks of ecosystem science in 21st century. An operational definition on ecosystem health and an all-sided, simple, easy operational and standard index system, which are the foundation of assessment on ecosystem health, are necessary in obtaining a simple and applicable assessment theory and method of ecosystem health. Taking the Korean pine and broadleaved mixed forest ecosystem as an example, an originally creative idea on ecosystem health was put forward in this paper based on the idea of mode ecosystem set and the idea of forest ecosystem health, together with its assessment. This creative idea can help understand what ecosystem health is. Finally, a formula was deduced based on a new effective health assessment method--health distance (HD), which is the first time to be brought forward in China. At the same time, aiming at it's characteristics by status understanding and material health questions, a health index system of Korean pine and broadleaved mixed forest ecosystem was put forward in this paper, which is a compound ecosystem based on the compound properties of nature, economy and society. It is concrete enough to measure sub-index, so it is the foundation to assess ecosystem health of Korean pine and broadleaved mixed forest in next researches.
Background A more comprehensive estimate of environmental quality would improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) for all counties in the U.S. was developed. Methods The EQI was developed in four parts: domain identification; data source acquisition; variable construction; and data reduction. Five environmental domains (air, water, land, built and sociodemographic) were recognized. Within each domain, data sources were identified; each was temporally (years 2000–2005) and geographically (county) restricted. Variables were constructed for each domain and assessed for missingness, collinearity, and normality. Domain-specific data reduction was accomplished using principal components analysis (PCA), resulting in domain-specific indices. Domain-specific indices were then combined into an overall EQI using PCA. In each PCA procedure, the first principal component was retained. Both domain-specific indices and overall EQI were stratified by four rural–urban continuum codes (RUCC). Higher values for each index were set to correspond to areas with poorer environmental quality. Results Concentrations of included variables differed across rural–urban strata, as did within-domain variable loadings, and domain index loadings for the EQI. In general, higher values of the air and sociodemographic indices were found in the more metropolitan areas and the most thinly populated areas have the lowest values of each of the domain indices. The less-urbanized counties (RUCC 3) demonstrated the greatest heterogeneity and range of EQI scores (−4.76, 3.57) while the thinly populated strata (RUCC 4) contained counties with the most positive scores (EQI score ranges from −5.86, 2.52). Conclusion The EQI holds promise for improving our characterization of the overall environment for public health. The EQI describes the non-residential ambient county-level conditions to which residents are
Rappazzo, Kristen; Messer, Lynne C.
Objectives. An environmental quality index (EQI) for all counties in the United States is under development to explore the relationship between environmental insults and human health. The EQI is potentially useful for investigators researching health disparities to account for other concurrent environmental conditions. This article focused on the identification and assessment of data sources used in developing the EQI. Data source strengths, limitations, and utility were addressed. Methods. Five domains were identified that contribute to environmental quality: air, water, land, built, and sociodemographic environments. An inventory of possible data sources was created. Data sources were evaluated for appropriate spatial and temporal coverage and data quality. Results. The overall data inventory identified multiple data sources for each domain. From the inventory (187 sources, 617 records), the air, water, land, built environment, and sociodemographic domains retained 2, 9, 7, 4, and 2 data sources for inclusion in the EQI, respectively. However, differences in data quality, geographic coverage, and data availability existed between the domains. Conclusions. The data sources identified for use in the EQI may be useful to researchers, advocates, and communities to explore specific environmental quality questions. PMID:21836111
Homan, J. Michael; Yokote, Gail
This course syllabus for a continuing education course for health science librarians introduces the MEDLARS system, the MEDLINE database, and the Index Medicus. Designed to enable health science librarians to discriminate between the capabilities of manual searching and online retrieval, an overview is given of the nature and scope of MEDLINE and…
Carona, Carlos; Silva, Neuza; Moreira, Helena; Canavarro, Maria Cristina; Bullinger, Monika
The objective of this study was twofold: First, to conduct a confirmatory factor analysis of the Portuguese versions of Disabkids-10; and second, to examine potential differences in factor structures between age-groups, genders, and informants. The sample included 293 school-aged children and adolescents with chronic health conditions and 197 parents. Both family members (whenever possible) completed the self- and proxy-report versions of Disabkids-10. The factorial model of Disabkids-10 had good fit for self-reported data and minimally acceptable fit for proxy-reported data. The multigroup analyses confirmed the model invariance across age-groups (children vs. adolescents), genders (boys vs. girls), and informants (children vs. parents). The generic developmental applicability of these questionnaires makes them recommended for health care routine assessments on pediatric intervention needs and outcomes.
... Accessed: on 7/31/13 ↑ Back to top Graphs This image is described in the Data section. ... this! Email Print-Friendly Downloads Prenatal Care Utilization Graphs (56k zipped folder of 2 GIFs) Prenatal Care ...
Mapping health assessment questionnaire disability index (HAQ-DI) score, pain visual analog scale (VAS), and disease activity score in 28 joints (DAS28) onto the EuroQol-5D (EQ-5D) utility score with the KORean Observational study Network for Arthritis (KORONA) registry data.
Kim, Hye-Lin; Kim, Dam; Jang, Eun Jin; Lee, Min-Young; Song, Hyun Jin; Park, Sun-Young; Cho, Soo-Kyung; Sung, Yoon-Kyoung; Choi, Chan-Bum; Won, Soyoung; Bang, So-Young; Cha, Hoon-Suk; Choe, Jung-Yoon; Chung, Won Tae; Hong, Seung-Jae; Jun, Jae-Bum; Kim, Jinseok; Kim, Seong-Kyu; Kim, Tae-Hwan; Kim, Tae-Jong; Koh, Eunmi; Lee, Hwajeong; Lee, Hye-Soon; Lee, Jisoo; Lee, Shin-Seok; Lee, Sung Won; Park, Sung-Hoon; Shim, Seung-Cheol; Yoo, Dae-Hyun; Yoon, Bo Young; Bae, Sang-Cheol; Lee, Eui-Kyung
The aim of this study was to estimate the mapping model for EuroQol-5D (EQ-5D) utility values using the health assessment questionnaire disability index (HAQ-DI), pain visual analog scale (VAS), and disease activity score in 28 joints (DAS28) in a large, nationwide cohort of rheumatoid arthritis (RA) patients in Korea. The KORean Observational study Network for Arthritis (KORONA) registry data on 3557 patients with RA were used. Data were randomly divided into a modeling set (80 % of the data) and a validation set (20 % of the data). The ordinary least squares (OLS), Tobit, and two-part model methods were employed to construct a model to map to the EQ-5D index. Using a combination of HAQ-DI, pain VAS, and DAS28, four model versions were examined. To evaluate the predictive accuracy of the models, the root-mean-square error (RMSE) and mean absolute error (MAE) were calculated using the validation dataset. A model that included HAQ-DI, pain VAS, and DAS28 produced the highest adjusted R (2) as well as the lowest Akaike information criterion, RMSE, and MAE, regardless of the statistical methods used in modeling set. The mapping equation of the OLS method is given as EQ-5D = 0.95-0.21 × HAQ-DI-0.24 × pain VAS/100-0.01 × DAS28 (adjusted R (2) = 57.6 %, RMSE = 0.1654 and MAE = 0.1222). Also in the validation set, the RMSE and MAE were shown to be the smallest. The model with HAQ-DI, pain VAS, and DAS28 showed the best performance, and this mapping model enabled the estimation of an EQ-5D value for RA patients in whom utility values have not been measured.
Gharib, Morteza; Rambod, Edmond; Kheradvar, Arash; Sahn, David J; Dabiri, John O
Heart disease remains a leading cause of death worldwide. Previous research has indicated that the dynamics of the cardiac left ventricle (LV) during diastolic filling may play a critical role in dictating overall cardiac health. Hence, numerous studies have aimed to predict and evaluate global cardiac health based on quantitative parameters describing LV function. However, the inherent complexity of LV diastole, in its electrical, muscular, and hemodynamic processes, has prevented the development of tools to accurately predict and diagnose heart failure at early stages, when corrective measures are most effective. In this work, it is demonstrated that major aspects of cardiac function are reflected uniquely and sensitively in the optimization of vortex formation in the blood flow during early diastole, as measured by a dimensionless numerical index. This index of optimal vortex formation correlates well with existing measures of cardiac health such as the LV ejection fraction. However, unlike existing measures, this previously undescribed index does not require patient-specific information to determine numerical index values corresponding to normal function. A study of normal and pathological cardiac health in human subjects demonstrates the ability of this global index to distinguish disease states by a straightforward analysis of noninvasive LV measurements.
Hardie, Nancy A; Kyanko, Kelly; Busch, Susan; Losasso, Anthony T; Levin, Regina A
We examined health literacy and health care spending and utilization by linking responses of three health literacy questions to 2006 claims data of enrollees new to consumer-driven health plans (n = 4,130). Better health literacy on all four health literacy measures (three item responses and their sum) was associated with lower total health care spending, specifically, lower emergency department and inpatient admission spending (p < .05). Similarly, fewer inpatient admissions and emergency department visits were associated with higher adequate health literacy scores and better self-reports of the ability to read and learn about medical conditions (p-value <.05). Members with lower health literacy scores appear to use services more appropriate for advanced health conditions, although office visit rates were similar across the range of health literacy scores.
In this case study, I present descriptive findings with regard to immigrant incorporation and health service utilization. Using focus groups and survey of Korean immigrant women in Wisconsin, I examine whether the ways in which they adapt to the U.S. society is relevant to their health services utilization and the alternatives they seek when available health services are less than satisfactory. The findings suggest that adherence to Korean identity appears to be associated with health service utilization. This is evident in the immigrants' evaluation of the U.S. health services as compared to those of Korea, and the consideration given by these immigrants to seeking health services in Korea instead of the United States. Such concerns on the part of these immigrants have important implications for health researchers, as they highlight the significance of immigrants' transnational experiences and their sense of personal agency in the use of health care.
Rudra, Shalini; Subramanian, S V
Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly. PMID:26617450
Prosie, Florin; Lesage, François-Xavier; Deschamps, Frédéric
Nanotechnology is a scientific domain with a full expansion. Nanomaterials have a big variety of applications in many technological domains. The diffusion, the persistence in atmosphere and the health impacts of nanoparticles are totally different by the bigger particles for the same chemical composition. Studies made, found, cutaneous, pulmonary, cardiovascular and carcinogen toxicities. Properties of nanotubes show that their toxicity may be close to asbestos. Many studies concerning health impacts and environment effects are in course, and the results will be available in a few years. Suspected health impacts on humans and animals justify, in the spirit of precaution, to make all that's possible to reduce the exposure and to protect the health of the exposed people.
Salihu, Hamisu M.; Salinas-Miranda, Abraham A.; Wang, Wei; Turner, DeAnne; Berry, Estrellita Lo; Zoorob, Roger
Background Providing practitioners with an intuitive measure for priority setting that can be combined with diverse data collection methods is a necessary step to foster accountability of the decision-making process in community settings. Yet, there is a lack of easy-to-use, but methodologically robust measures, that can be feasibly implemented for reliable decision-making in community settings. To address this important gap in community based participatory research (CBPR), the purpose of this study was to demonstrate the utility, applicability, and validation of a community priority index in a community-based participatory research setting. Design and Methods Mixed-method study that combined focus groups findings, nominal group technique with six key informants, and the generation of a Community Priority Index (CPI) that integrated community importance, changeability, and target populations. Bootstrapping and simulation were performed for validation. Results For pregnant mothers, the top three highly important and highly changeable priorities were: stress (CPI=0.85; 95%CI: 0.70, 1.00), lack of affection (CPI=0.87; 95%CI: 0.69, 1.00), and nutritional issues (CPI=0.78; 95%CI: 0.48, 1.00). For non-pregnant women, top priorities were: low health literacy (CPI=0.87; 95%CI: 0.69, 1.00), low educational attainment (CPI=0.78; 95%CI: 0.48, 1.00), and lack of self-esteem (CPI=0.72; 95%CI: 0.44, 1.00). For children and adolescents, the top three priorities were: obesity (CPI=0.88; 95%CI: 0.69, 1.00), low self-esteem (CPI=0.81; 95%CI: 0.69, 0.94), and negative attitudes toward education (CPI=0.75; 95%CI: 0.50, 0.94). Conclusions This study demonstrates the applicability of the CPI as a simple and intuitive measure for priority setting in CBPR. Significance for public health Community-based participatory research (CBPR) has been credited to be a promising approach for the reduction of health disparities and as an effective way to create sustainable community outcomes. Priority
Wong, Tze Wai; Tam, Wilson Wai San; Yu, Ignatius Tak Sun; Lau, Alexis Kai Hon; Pang, Sik Wing; Wong, Andromeda H. S.
We developed a risk-based, multi-pollutant air quality health index (AQHI) reporting system in Hong Kong, based on the Canadian approach. We performed time series studies to obtain the relative risks of hospital admissions for respiratory and cardiovascular diseases associated with four air pollutants: sulphur dioxide, nitrogen dioxide, ozone, and particulate matter with an aerodynamic diameter less than 10 μm (PM10). We then calculated the sum of excess risks of the hospital admissions associated with these air pollutants. The cut-off points of the summed excess risk, for the issuance of different health warnings, were based on the concentrations of these pollutants recommended as short-term Air Quality Guidelines by the World Health Organization. The excess risks were adjusted downwards for young children and the elderly. Health risk was grouped into five categories and sub-divided into eleven bands, with equal increments in excess risk from band 1 up to band 10 (the 11th band is 'band 10+'). We developed health warning messages for the general public, including at-risk groups: young children, the elderly, and people with pre-existing cardiac or respiratory diseases. The new system addressed two major shortcomings of the current standard-based system; namely, the time lag between a sudden rise in air pollutant concentrations and the issue of a health warning, and the reliance on one dominant pollutant to calculate the index. Hence, the AQHI represents an improvement over Hong Kong's existing air pollution index.
Mushak, E W; Piver, W T
The public is justifiably concerned about the human health effects of agricultural chemicals. The many gaps in information about the mechanisms of toxic action, human exposures, and the nature and extent of human health effects are large. Very few older pesticides, in particular, have been tested for human health effects. Workers who produce, harvest, store, transport, process, and prepare food and fibers are exposed to many chemicals that are potentially hazardous and that are used in agriculture. The occupational health of these workers has not been adequately studied, and protective efforts have sometimes been minimal. Valid and accurate risk assessment is best based on sound information about how chemicals, in this case agricultural chemicals, are involved in toxic events--their mechanisms of action. These health effects include tumor promotion, chronic and acute neurotoxicity, immunotoxicity, and reproductive and developmental toxicity. Another key part of risk assessment is exposure assessment. Fundamental studies of the toxicology of target organisms and nontarget organisms exposed to agricultural chemicals are needed to discover and develop better solutions to the problems of agricultural pest control, including better formulations, optimal application rates and public education in safety and alternative agricultural practices. The large number of pesticides that have never been adequately tested for effects on human health is particularly worrisome in light of emerging information about delayed nervous system effects. PMID:1396466
Angley, Meghan; Gibson, Crystal; Sipsma, Heather; Kershaw, Trace
Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social–personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor–Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow-up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse’s influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples. PMID:26163272
A more comprehensive estimate of environmental quality would improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) for all counties in the U.S. was developed. The EQI was developed in four parts: doma...
Atchison, Kathryn A.; Dolan, Teresa A.
This paper describes the rationale for and the development of the Geriatric Oral Health Assessment Index (GOHAI). The GOHAI has demonstrated a high level of internal consistency and reliability. Poor GOHAI scores were significantly correlated to having fewer teeth, wearing a removable denture, and perceiving the need for dental treatment.…
Chartier, Mariette J.; Walker, John R.; Naimark, Barbara
Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization. Methods:…
Hope, R; Carter, C A; Rai, I M
Sahar Matha Secondary School and Ghoretar Health Post serve approximately 30,000 people living in scattered communities over the steep foothills of the Himalaya in East Nepal. A pilot health education and sanitation project was implemented with the objectives of giving the secondary school students the knowledge and skills necessary for building domestic pit latrines in their villages. It was hoped that the students could be motivated to create enough awareness of the need for domestic pit latrines so that latrines would continue to be built after the pilot phase of the project. At the end of the 4 week building period there were 150 completed domestic pit latrines and 45 pits or partially complete latrines. Seeing pit latrine in Ghoretar at the school and health post had not been enough to motivate people to build their own domestic pit latrine. It seemed that people could understand the convenience of privacy in an area where there was no jungle cover, but did not appreciate the hygiene reasons for using pit latrines. It is now planned to extend the project into the 19 schools which feed the 2ndarty school, with the 2ndary school boy and girl scouts taking the health messages to the primary schools. Particular attention will be given to the teaching of modes disease transmission. So that the villagers can use their latrines hygienically.
Hogan, Mary-Ellen; Taddio, Anna; Katz, Joel; Shah, Vibhuti; Krahn, Murray
Health utilities are a preference-based measure of health-related quality of life that facilitates comparison of disease burden across conditions. We estimated utilities using a population-based, matched sample of adolescents and adults with and without chronic pain, controlling for comorbidity. Ontarians aged ≥12 years with and without chronic pain were identified from the Canadian Community Health Survey (CCHS) 2000-2001 and 2009-2010 and linked to their provincial health care administrative data. Individuals with chronic pain were matched to those without using age, sex, survey year, and a propensity score for having chronic pain estimated from a rurality index, income quintile, and comorbidity. The Health Utilities Index Mark 3 instrument, included in the Canadian Community Health Survey, was used. Mean utilities were calculated for each group. Utility decrement for chronic pain was also calculated for each matched pair. A total of 65,246 responses were available for analysis. After matching, there were 12,146 matched pairs with and without pain. In the matched cohort, mean age was 54 years (SD 12); 61% were female. The matched cohort with chronic pain had a mean utility of 0.59 (95% confidence interval 0.58-0.59), and the decrement associated with chronic pain was 0.32 (95% confidence interval 0.31-0.32). Utilities in people with chronic pain were lower than, and decrements larger than, those seen with most other chronic diseases including heart disease, diabetes, and chronic obstructive pulmonary disease. These data will be useful to inform priorities and future strategies for the prevention and control of chronic pain.
Lumpkin, John R; Miller, Yoon K; Inglesby, Tom; Links, Jonathan M; Schwartz, Angela T; Slemp, Catherine C; Burhans, Robert L; Blumenstock, James; Khan, Ali S
Natural disasters, infectious disease epidemics, terrorism, and major events like the nuclear incident at Fukushima all pose major potential challenges to public health and security. Events such as the anthrax letters of 2001, Hurricanes Katrina, Irene, and Sandy, severe acute respiratory syndrome (SARS) and West Nile virus outbreaks, and the 2009 H1N1 influenza pandemic have demonstrated that public health, emergency management, and national security efforts are interconnected. These and other events have increased the national resolve and the resources committed to improving the national health security infrastructure. However, as fiscal pressures force federal, state, and local governments to examine spending, there is a growing need to demonstrate both what the investment in public health preparedness has bought and where gaps remain in our nation's health security. To address these needs, the Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (PHPR), is creating an annual measure of health security and preparedness at the national and state levels: the National Health Security Preparedness Index (NHSPI).
Zeff, Harrison B.; Characklis, Gregory W.
As developing new supply capacity has become increasingly expensive and difficult to permit (i.e., regulatory approval), utilities have become more reliant on temporary demand management programs, such as outdoor water use restrictions, for ensuring reliability during drought. However, a significant fraction of water utility income is often derived from the volumetric sale of water, and such restrictions can lead to substantial revenue losses. Given that many utilities set prices at levels commensurate with recovering costs, these revenue losses can leave them financially vulnerable to budgetary shortfalls. This work explores approaches for mitigating drought-related revenue losses through the use of third-party financial insurance contracts based on streamflow indices. Two different types of contracts are developed, and their efficacy is compared against two more traditional forms of financial hedging used by water utilities: Drought surcharges and contingency funds (i.e., self-insurance). Strategies involving each of these approaches, as well as their use in combination, are applied under conditions facing the water utility serving Durham, North Carolina. A multireservoir model provides information on the scale and timing of droughts, and the financial effects of these events are simulated using detailed data derived from utility billing records. Results suggest that third-party index insurance contracts, either independently or in combination with more traditional hedging tools, can provide an effective means of reducing a utility's financial vulnerability to drought.
Elfes, Cristiane T.; Longo, Catherine; Halpern, Benjamin S.; Hardy, Darren; Scarborough, Courtney; Best, Benjamin D.; Pinheiro, Tiago; Dutra, Guilherme F.
Brazil has one of the largest and fastest growing economies and one of the largest coastlines in the world, making human use and enjoyment of coastal and marine resources of fundamental importance to the country. Integrated assessments of ocean health are needed to understand the condition of a range of benefits that humans derive from marine systems and to evaluate where attention should be focused to improve the health of these systems. Here we describe the first such assessment for Brazil at both national and state levels. We applied the Ocean Health Index framework, which evaluates ten public goals for healthy oceans. Despite refinements of input data and model formulations, the national score of 60 (out of 100) was highly congruent with the previous global assessment for Brazil of 62. Variability in scores among coastal states was most striking for goals related to mariculture, protected areas, tourism, and clean waters. Extractive goals, including Food Provision, received low scores relative to habitat-related goals, such as Biodiversity. This study demonstrates the applicability of the Ocean Health Index at a regional scale, and its usefulness in highlighting existing data and knowledge gaps and identifying key policy and management recommendations. To improve Brazil's ocean health, this study suggests that future actions should focus on: enhancing fisheries management, expanding marine protected areas, and monitoring coastal habitats. PMID:24695103
Kiss, Valerie; Pim, Carolyn; Hemmelgarn, Brenda R; Quan, Hude
The objective of this study was to compare the utilization of outpatient physician, emergency department and hospital services between refugees and the general population in Calgary, Alberta. Data was collected on 2,280 refugees from a refugee clinic in Calgary and matched with 9,120 non-refugees. Both groups were linked to Alberta Health and Wellness administrative data to assess health services utilization over 2 years. After adjusting for age, sex and medical conditions, refugees utilized general practitioners, emergency departments and hospitals more than non-refugees. A similar proportion in the two groups had seen a general practitioner within 1 week prior to their emergency department visit; however, refugees were more likely to have been triaged for urgent conditions and female refugees seen for pregnancy-related conditions than non-refugees. Refugees were more likely to have had infectious and parasitic diseases. Refugees utilized health services more than non-refugees with no evidence of underutilization.
Jensen, Scott L.; Drouant, George J.
The valve monitoring system is a stand alone unit with network capabilities for integration into a higher level health management system. The system is designed for aiding in failure predictions of high-geared ball valves and linearly actuated valves. It performs data tracking and archiving for identifying degraded performance. The data collection types are cryogenic cycles, total cycles, inlet temperature, body temperature torsional strain, linear bonnet strain, preload position, total travel and total directional changes. Events are recorded and time stamped in accordance with the IRIG B True Time. The monitoring system is designed for use in a Class 1 Division II explosive environment. The basic configuration consists of several instrumentation sensor units and a base station. The sensor units are self contained microprocessor controlled and remotely mountable in three by three by two inches. Each unit is potted in a fire retardant substance without any cavities and limited to low operating power for maintaining safe operation in a hydrogen environment. The units are temperature monitored to safeguard against operation outside temperature limitations. Each contains 902-928 MHz band digital transmitters which meet Federal Communication Commission's requirements and are limited to a 35 foot transmission radius for preserving data security. The base-station controller correlates data from the sensor units and generates data event logs on a compact flash memory module for database uploading. The entries are also broadcast over an Ethernet network. Nitrogen purged National Electrical Manufactures Association (NEMA) Class 4 enclosures are used to house the base-station
Ports, Katie A.; Ayers, Antoinette; Crocker, Wayne; Hart, Alton; Mosavel, Maghboeba; Rafie, Carlin
The purpose of this study was to understand factors that may affect the usage of a consumer health center located in a public library. More specifically, the authors wanted to know what health resources are of interest to the community, what patrons' perceptions of their experience at the center are, and finally, how staff can increase utilization of the center. In general, perceptions of the center were positive. The findings support that participants appreciate efforts to provide health information in the public library setting and that utilization could be improved through marketing and outreach. PMID:25552943
There is ample evidence that bereavement is associated with heightened mortality. Regardless of whether this strong association is truly causal, little is known about the factors contributing to it. This study begins to unpack the black box of the bereavement-mortality puzzle by investigating the extent to which heath behaviors and health care utilization patterns vary among chronically ill elderly males living with a spouse and those who are widowed, and by asking whether these differences contribute to the well-documented correlation between widowhood and health deterioration. In order to separate the effect of health care utilization from other potential channels it uses a unique dataset of doctor-patient encounters that allows in-depth analysis of the organization and effectiveness of medical care. Changes in health care utilization attributable to bereavement have a negative effect on survival but account for a small part of the overall negative effect of widowhood on longevity.
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…
Carmona, Montserrat; García-Olmos, Luis M; García-Sagredo, Pilar; Alberquilla, Ángel; López-Rodríguez, Fernando; Pascual, Mario; Muñoz, Adolfo; Salvador, Carlos H; Monteagudo, José L; Otero-Puime, Ángel
Background. In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization. Objective. To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. Methods. Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated. Results. One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost). Conclusions. Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity. PMID:23776041
Khalifa, Mohamed; Zabani, Ibrahim; Khalid, Parwaiz
Healthcare resources are over utilized contributing more to the growing costs of care. Although laboratory testing is essential, yet it can be expensive and excessive. King Faisal Specialist Hospital and Research Center, Saudi Arabia studied lab tests utilization patterns using health analytics methods. The objective was to identify patterns of utilizing lab tests and to develop recommendations to control over utilization. Three over utilization patterns were identified; using expensive tests for many patients as routine, unnecessarily repeating lab test and a combined one. Two recommendations were suggested; a user approach, modifying user behavior through orientation about the impact of over utilization on the cost effectiveness of healthcare, and a system approach, implementing system alerts to help physicians check the results and identify the date of the last lab tests done with information about appropriate frequency of ordering such lab test and medically significant intervals at which such test should be repeated.
Cohen, Seth M; Lee, Hui-Jie; Roy, Nelson; Misono, Stephanie
Objectives To examine voice-related health care utilization of patients in the general medical community without otolaryngology evaluation and explore factors associated with prolonged voice-related health care. Study Design Retrospective cohort analysis. Setting Large, national administrative US claims database. Subjects and Methods Patients with voice disorders per International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM) codes from January 1, 2010, to December 31, 2012, seen by a general medical physician, and who did not see an otolaryngologist in the subsequent year were included. Voice-related health care utilization, patient demographics, comorbid conditions, and index laryngeal diagnosis were collected. Logistic regression with variable selection was performed to evaluate the association between predictors and ≥30 days of voice-related health care use. Results In total, 46,205 unique voice-disordered patients met inclusion criteria. Of these patients, 8.5%, 10.0%, and 12.5% had voice-related health care use of ≥90, ≥60, and ≥30 days, respectively. Of the ≥30-day subset, 80.3% and 68.5%, respectively, had ≥60 and ≥90 days of voice-related health care utilization. The ≥30-day subset had more general medicine and nonotolaryngology specialty physician visits, more prescriptions and procedures, and 4 times the voice-related health care costs compared with those in the <30-day subset. Age, sex, employment status, initial voice disorder diagnosis, and comorbid conditions were related to ≥30 days of voice-related health care utilization. Conclusions Thirty days of nonotolaryngology-based care for a voice disorder may represent a threshold beyond which patients are more likely to experience prolonged voice-related health care utilization. Specific factors were associated with extended voice-related health care.
Tuliani, Tushar A; Shenoy, Maithili; Parikh, Milind; Jutzy, Kenneth; Hilliard, Anthony
Area Deprivation Index (ADI) is a marker of neighborhood deprivation. This study investigates utilization of coronary bare-metal stent (BMS) and drug-eluting stent (DES) in Medicare patients across hospitals with varying ADI. Data were abstracted using Diagnosis-Related Group (DRG) codes 249 (BMS without major complications or comorbidities [MCC]), 246, and 247 (DES with and without MCC, respectively) from the 2011-2012 Medicare Provider Utilization and Payment Data Inpatient File, which was linked to American Hospital Association data (to determine bed size, location, ownership, teaching status), and ADI for each hospital zip code was obtained. Hospitals were divided into quintiles using ADI values: Quintile 1 (privileged) to Quintile 5 (deprived). Logistic regression was conducted to determine odds ratios (ORs) for DES utilization across ADI quintiles. There were 313,739 discharges with DRG codes 246 (52,839), 247 (203,928), and 249 (56,972). DES utilization was lower in the deprived quintile, irrespective of teaching status. It was lower in larger hospitals and hospitals with more annual stent discharges, urban locations and nongovernment not-for-profit institutes. Lower odds of DES utilization were found in Quintile 2 (OR-0.9, 95% confidence interval [CI] 0.87-0.93, P < 0.001), Quintile 3 (OR-0.89, 95% CI 0.86-0.92, P < 0.001), and Quintile 4 (OR-0.95, 95% CI 0.92-0.98, P = 0.001) versus Quintile 1 and there was no difference in utilization of DES in Quintile 5 (OR-1.01, 95% CI 0.98-1.04, P = 0.6) versus Quintile 1. Significant differences exist in DES utilization in a large, uniformly insured cohort based on neighborhood deprivation.
Kates, Emily; Gerber, Emily B; Casey, Shannon
This study examined the prevalence of mental health needs and rates of service utilization among youth detained in a metropolitan juvenile justice system in California. Of the 345 youth in the sample, 265 (76.8 %) qualified for high or acute mental health need and 210 (60.9 %) had at least one prior contact with mental health services. No differences in mental health need were found across ethnicities; however rates of prior service utilization significantly differed (χ(2) = 19.18, p < 0.001). Asian and Pacific Islander participants were less likely to have had prior contact with county services than any other ethnic group.
Kim, Seon-Ha; Jo, Min-Woo; Ock, Minsu; Lee, Hyeon-Jeong; Lee, Jong-Won
Purpose The aim of this study is to determine the utility of breast cancer health states using the standard gamble (SG) and visual analog scale (VAS) methods in the Korean general population. Materials and methods Eight hypothetical breast cancer health states were developed based on patient education material and previous publications. Data from 509 individuals from the Korean general population were used to evaluate breast cancer health states using the VAS and the SG methods, which were obtained via computer-assisted personal interviews. Mean utility values were calculated for each human papillomavirus (HPV)-related health state. Results The rank of health states was identical between two valuation methods. SG values were higher than VAS values in all health states. The utility values derived from SG were 0.801 (noninvasive breast cancer with mastectomy and followed by reconstruction), 0.790 (noninvasive breast cancer with mastectomy only), 0.779 (noninvasive breast cancer with breast-conserving surgery and radiation therapy), 0.731 (invasive breast cancer with surgery, radiation therapy, and/or chemotherapy), 0.610 (locally advanced breast cancer with radical mastectomy with radiation therapy), 0.587 (inoperable locally advanced breast cancer), 0.496 (loco-regional recurrent breast cancer), and 0.352 (metastatic breast cancer). Conclusion Our findings might be useful for economic evaluation of breast cancer screening and interventions in general populations. PMID:28352159
Garcia, John A.; Juarez, Rumaldo Z.
The dental utilization patterns of Chicanos and Anglos were compared using several socio-demographic variables to explain any differences or similarities existing between the two groups. Data for this study were part of an extensive household survey conducted in Pima County, Arizona, to obtain information on various health indicators concerning…
Karlin, Bradley E; Norris, Margaret P
The present study examined the extent to which older adults began public mental health treatment throughout Texas in 1999, the types of services they used, and how they compared on demographic and clinical variables to younger consumers. Notwithstanding recent policy and related developments, older adults were found to use public mental health services at substantially low rates, as in past decades. Significantly, older consumers tended to be relatively healthy and independent. Among younger and, even more so, older consumers, there were relatively high proportions of rural residents and minorities, groups previously found to be unlikely to utilize private mental health services. Overall, the findings urge that greater attention be devoted to public mental health outreach and service delivery with the elderly, and raise the question of what role the public mental health system should have in nursing homes and other long-term care settings.
Duc, Nguyen Huu Chau; Nakamura, Keiko; Kizuki, Masashi; Seino, Kaoruko; Rahman, Mosiur
Objective: This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. Methods: Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household’s ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. Results: Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. Conclusions: More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery
Woodside, K J; Merion, R M; Leichtman, A B; de los Santos, R; Arrington, C J; Rao, P S; Sung, R S
With the shortage of standard criteria donor (SCD) kidneys, efficient expanded criteria donor (ECD) kidney utilization has become more vital. We investigated the effects of the ECD label on kidney recovery, utilization and outcomes. Using data from the Scientific Registry of Transplant Recipients from November 2002 to May 2010, we determined recovery and transplant rates, and modeled discard risk, for kidneys within a range of kidney donor risk index (KDRI) 1.4-2.1 that included both SCD and ECD kidneys. To further compare similar quality kidneys, these kidneys were again divided into three KDRI intervals. Overall, ECD kidneys had higher recovery rates, but lower transplant rates. However, within each KDRI interval, SCD and ECD kidneys were transplanted at similar rates. Overall, there was increased risk for discard for biopsied kidneys. SCD kidneys in the lower two KDRI intervals had the highest risk of discard if biopsied. Pumped kidneys had a lower risk of discard, which was modulated by KDRI for SCD kidneys but not ECD kidneys. Although overall ECD graft survival was worse than SCD, there were no differences within individual KDRI intervals. Thus, ECD designation adversely affects neither utilization nor outcomes beyond that predicted by KDRI.
Huang, Susana Tzy-Ying
The modern food system has evolved into one with highly inefficient activities, producing waste at each step of the food pathway from growing to consumption and disposal. The present challenge is to improve recyclability in the food system as a fundamental need for food and health security. This paper develops a methodological approach for a Food Recycling Index (FRI) as a tool to assess recyclability in the food system, to identify opportunities to reduce waste production and environmental contamination, and to provide a self-assessment tool for participants in the food system. The urban Taipei framework was used to evaluate resource and nutrient flow within the food consumption and waste management processes of the food system. A stepwise approach for a FRI is described: (1) identification of the major inputs and outputs in the food chain; (2) classification of inputs and outputs into modules (energy, water, nutrients, and contaminants); (3) assignment of semi-quantitative scores for each module and food system process using a matrix; (4) assessment for recycling status and recyclability potential; (5) conversion of scores into sub-indices; (6) derivation of an aggregate FRI. A FRI of 1.24 was obtained on the basis of data for kitchen waste management in Taipei, a score which encompasses absolute and relative values for a comprehensive interpretation. It is apparent that a FRI could evolve into a broader ecosystem concept with health relevance. Community end-users and policy planners can adopt this approach to improve food and health security.
Arnott, J. C.; Katzenberger, J.; Cundiff, J.
Forest health is an oft-used term without a generally accepted definition. Nonetheless, the concept of forest health continues to permeate scientific, resource management, and public discourse, and it is viewed as a helpful communication device for engagement on issues of concern to forests and their surrounding communities. Notwithstanding the challenges associated with defining the concept of 'forest health,' we present a model for assessing forest health at a watershed scale. Utilizing the Roaring Fork Valley, Colorado--a mountain watershed of 640,000 forested acres--as a case study, we have created a Forest Health Index that integrates a range of climatic, ecological, and socioeconomic data into an assessment organized along a series of public goals including, 1) Ecosystem Services, 2) Public Health & Safety, 3) Sustainable Use & Management, and 4) Ecological Integrity. Methods for this index were adopted from an earlier effort called the Ocean Health Index by Halpern et al, 2012. Indicators that represent drivers of change, such as temperature and precipitation, as well as effects of change, such as primary productivity and phenology, were selected. Each indicator is assessed by comparing a current status of that indicator to a reference scenario obtained through one of the following methods: a) statistical analysis of baseline data from the indicator record, b) commonly accepted normals, thresholds, limits, concentrations, etc., and c) subjective expert judgment. The result of this assessment is a presentation of graphical data and accompanying ratings that combine to form an index of health for the watershed forest ecosystem. We find this product to have potential merit for communities working to assess the range of conditions affecting forest health as well as making sense of the outcomes of those affects. Here, we present a description of the index methodology, data results from engagement with forest watershed stakeholders, example results of data
Devena, Sarah E.; Watkins, Marley W.
The Wechsler Intelligence Scale for Children-Fourth Edition General Abilities Index and Cognitive Proficiency Index have been advanced as possible diagnostic markers of attention deficit hyperactivity disorder. This hypothesis was tested with a hospital sample with attention deficit hyperactivity disorder (n = 78), a referred but nondiagnosed…
US Department of Health and Human Services, 2004
In this report, the School Health Index includes a Planning for Improvement section to help schools develop an action plan for improving student health. A school's results from the Index can help promote health activities in the overall School Improvement Plan. With the growing recognition of the relationship between health and academic…
Misra, Rajul; Pahuja, G. L.
This paper presents an experimental study on detection and diagnosis of broken rotor bars in Squirrel Cage Induction Motor (SQIM). The proposed scheme is based on Motor Current Signature Analysis (MCSA) which uses amplitude difference of supply frequency to upper and lower side bands. Initially traditional MCSA has been used for rotor fault detection. It provides rotor health index on full load conditions. However in real practice if a fault occurs motor can not run at full load. To overcome the issue of reduced load condition a Fuzzy Logic based MCSA has been designed, implemented, tested and compared with traditional MCSA. A simulation result shows that proposed scheme is not only capable of detecting the severity of rotor fault but also provides remarkable performance at reduced load conditions.
The objective of this study was to develop a method of classifying comorbid conditions that accounts for both the severity and joint effects of the diseases. The Tromsø Study is a cohort study with a longitudinal design utilizing a survey approach with physical examinations in the Tromsø municipality from 1974 to 2008, where in total 40051 subjects participated. We used Tromsø 4 as reference population and the Norwegian Institute of Public Health (FHI) panel as validation population. Ordinal regression was used to assess the effect of comorbid disease on Self-Reported Health (SRH). The model is controlled for interaction between diseases, mental health, age, and gender. The health impact index estimated levels of SRH. The comparison of predicted and observed SRH showed no significant differences. Spearman’s correlation showed that increasing levels of comorbidity were related to lower levels of SRH (RS = -0.36, p <.001). The Charlson Comorbidity Index(CCI) was also associated with SRH (r = -.25, p <.001). When focusing on only individuals with a comorbid disease, the relation between SRH and the Health Impact Index (HII) was strengthened (r = -.42, p <.001), while the association between SRH and CCI was attenuated (r = -.14, p <.001). CCI was designed to control for comorbid conditions when survival/mortality is the outcome of interest but is inaccurate when the outcome is SRH. We conclude that HII should be used when SRH is not available, and well-being or quality of survival/life is the outcome of interest. PMID:26849044
The Rényi index (RI) is a one-parameter class of indices that summarize health disparities among population groups by measuring divergence between the distributions of disease burden and population shares of these groups. The rank-dependent RI introduced in this paper is a two-parameter class of health disparity indices that also accounts for the association between socioeconomic rank and health; it may be derived from a rank-dependent social welfare function. Two competing classes are discussed and the rank-dependent RI is shown to be more robust to changes in the distribution of either socioeconomic rank or health. The standard error and sampling distribution of the rank-dependent RI are evaluated using linearization and re-sampling techniques, and the methodology is illustrated using health survey data from the U.S. National Health and Nutrition Examination Survey and registry data from the U.S. Surveillance, Epidemiology and End Results Program. Such data underlie many population-based objectives within the U.S. Healthy People 2020 initiative. The rank-dependent RI provides a unified mathematical framework for eliciting various societal positions with regards to the policies that are tied to such wide-reaching public health initiatives. For example, if population groups with lower socioeconomic position were ascertained to be more likely to utilize costly public programs, then the parameters of the RI could be selected to reflect prioritizing those population groups for intervention or treatment. PMID:26566419
HARIRI, Azian; PAIMAN, Nuur Azreen; LEMAN, Abdul Mutalib; MD. YUSOF, Mohammad Zainal
Abstract Background This study aimed to develop an index that can rank welding workplace that associate well with possible health risk of welders. Methods Welding Fumes Health Index (WFHI) were developed based on data from case studies conducted in Plant 1 and Plant 2. Personal sampling of welding fumes to assess the concentration of metal constituents along with series of lung function tests was conducted. Fifteen metal constituents were investigated in each case study. Index values were derived from aggregation analysis of metal constituent concentration while significant lung functions were recognized through statistical analysis in each plant. Results The results showed none of the metal constituent concentration was exceeding the permissible exposure limit (PEL) for all plants. However, statistical analysis showed significant mean differences of lung functions between welders and non-welders. The index was then applied to one of the welding industry (Plant 3) for verification purpose. The developed index showed its promising ability to rank welding workplace, according to the multiple constituent concentrations of welding fumes that associates well with lung functions of the investigated welders. Conclusion There was possibility that some of the metal constituents were below the detection limit leading to ‘0’ value of sub index, thus the multiplicative form of aggregation model was not suitable for analysis. On the other hand, maximum or minimum operator forms suffer from compensation issues and were not considered in this study. PMID:25927034
New, M; Berliner, L
Records of 318 adult and 608 child victims of crime, eligible for Crime Victims Compensation (CVC) in Washington State, were examined. Demographic, crime, and mental health information was collected. A majority of child victims had experienced sexual assault (88%); adults were victims of both sexual (38%) and physical assault (40%). The median number of mental health sessions used by children was 23 sessions, at an average cost of $975 per case to the CVC program. Adults used a median of 15 mental health sessions at a cost of $905. Patterns of treatment utilization were associated with some demographic, crime, and psychological variables. Sexual assault and PTSD diagnosis were associated with greater use for both children and adults. Therapist variables were unrelated to use. Findings are discussed in light of concerns about coverage of mental health services.
Butina, Michelle; Brooks, Donna; Dominguez, Paul J; Mahon, Gwendolyn M
Multiple technology based tools have been used to enhance skill development in allied health education, which now includes virtual learning environments. The purpose of this study was to explore whether, and how, this latest instructional technology is being adapted in allied health education. An online survey was circulated to all Association of Schools of Allied Health Professions (ASAHP) member institutions and focused on three broad areas of virtual learning environments: the uses of, the perceived pros and cons of, and the outcomes of utilizing them. Results show 40% (17 of 42) of the respondent use some form of the technology. The use of virtual learning technology in other healthcare professions (e.g., medicine) demonstrates the potential benefits to allied health education.
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.
Prakash, Ravi; Kumar, Abhishek
Drawing upon data from the third round of the National Family Health Survey (NFHS-3) conducted in India during 2005-06, this study compares the utilization of selected maternal and child health care services between the urban poor and non-poor in India and across selected Indian states. A wealth index was created, separately for urban areas, using Principal Component Analysis to identify the urban poor. The findings suggest that the indicators of maternal and child health care are worse among the urban poor than in their non-poor counterparts. For instance, the levels of antenatal care, safe delivery and childhood vaccinations are much lower among the urban poor than non-poor, especially in socioeconomically disadvantageous states. Among all the maternal and child health care indicators, the non-poor/poor difference is most pronounced for delivery care in the country and across the states. Other than poverty status, utilization of antenatal services by mothers increases the chances of safe delivery and child immunization at both national and sub-national levels. The poverty status of the household emerged as a significant barrier to utilization of health care services in urban India.
Tayebi, Tahereh; Hamzehgardeshi, Zeinab; Ahmad Shirvani, Marjan; Dayhimi, Marjaneh; Danesh, Mahmonir
Prenatal care refers to accurate and consistent performance of the principles important to maintain healthy pregnancy outcomes and also for mother and child health. One of the new indices to assess the adequacy of care is Revised Graduated Index of Prenatal Care Utilization (R-GINDEX).The study aims to assess the relationship between quantitative prenatal care factors and preterm labor and low birth weight using R-GINDEX. This historical cohort study has been conducted on 420 mothers during the first two years after delivery in 2010. The adequacy of care was calculated by R-GINDEX. Based on this index, participants have been divided into three care groups including inadequate, adequate and intensive care groups. A significant relationship has been found between R-GINDEX and preterm birth and low birth weight (P<0.05). Thus the probability of premature labor in inadequate care group (RR=3.93) and low birth weight (RR= 2.53) was higher than that of the adequate and intensive care group. The results showed that the quantity of prenatal care is effective in reducing preterm birth and low birth weight.
Bridbord, K; Costello, J; Gamble, J; Groce, D; Hutchison, M; Jones, W; Merchant, J; Ortmeyer, C; Reger, R; Wagner, W L
An area of major concern in considering increased coal production and utilization is the health and safety of increased numbers of workers who mine, process, or utilize coal. Hazards related to mining activities in the past have been especially serious, resulting in many mine related accidental deaths, disabling injuries, and disability and death from chronic lung disease. Underground coal mines are clearly less safe than surface mines. Over one-third of currently employed underground miners experience chronic lung disease. Other stresses include noise and extremes of heat and cold. Newly emphasized technologies of the use of diesel powered mining equipment and the use of longwall mining techniques may be associated with serious health effects. Workers at coal-fired power plants are also potentially at risk of occupational diseases. Occupational safety and health aspects of coal mining are understood well enough today to justify implementing necessary and technically feasible and available control measures to minimize potential problems associated with increased coal production and use in the future. Increased emphasis on safety and health training for inexperienced coal miners expected to enter the work force is clearly needed. The recently enacted Federal Mine Safety and Health Act of 1977 will provide impetus for increased control over hazards in coal mining. PMID:540621
Martey, J O; Djan, J O; Twum, S; Browne, E N; Opoku, S A
A study on the utilization of maternal health services in Ejisu district of Ghana was carried out in January and February 1990. 1200 women aged between 15 and 49 were interviewed in 80 communities. The findings of the study indicated that over 50% of respondents married under 20 years, 70% of them attended antenatal clinic at least 4 times in their last pregnancy, over 80% had their last delivery in a health facility and over 80% knew about at least one modern method of family planning. Only 5.5% were currently using a modern family planning method. 90% of them were willing to stay in a maternity waiting home if advised to do so. Most would be prepared to stay for a month or 2. 20% of the respondents knew about local herbal preparations used for first aid in bleeding in pregnancy, although they would seek definitive treatment at a health facility. From the study, some women were not using the services. These would have to be reached through improving the quality of care in health facilities and increasing community awareness on maternal health in order to improve accessibility and utilization further.
The National Energy Plan announced by President Carter on April 29, 1977 proposed a significant increase in the utilization of the vast domestic deposits of coal to replace the dwindling supplies of oil and natural gas, and increasingly expensive oil from foreign sources, to meet national energy needs. At the same time, in recognition of possible adverse health and ecological consequences of increased coal production and use, the President announced that a special committee would be formed to study this aspect of the National Energy Plan. The Committee held a series of public meetings during November and December 1977 to review a number of special papers on particular problems associated with increased coal utilization. These papers, which were prepared by scientists of the US Environmental Protection Agency; the Department of Energy; the HEW National Institute for Occupational Safety and Health, and the National Institute of Environmental Health Sciences; New York University; and Vanderbilt University; provided essential background information for the deliberations of the Committee and were published in EHP Vol. 33, pp. 127–314, 1979. One paper by A. P. Altschuler et al. is published in this volume of EHP. The Committee's basic finding was that it is safe to proceed with plans to increase the utilization of coal if the following environmental and safety policies are adhered to: • Compliance with Federal and State air, water, and solid waste regulations • Universal adoption and successful operation of best available control technology on new facilities • Compliance with reclamation standards • Compliance with mine health and safety standards • Judicious siting of coal-fired facilities The Committee concluded that, even with the best mitigation policies, there will be some adverse health and environmental effects from the dramatic increase in coal use. However, these will not impact all regions and individuals uniformly. The Committee identified six
Domanski, Marian M.; Straub, Timothy D.; Wood, Molly S.; Landers, Mark N.; Wall, Gary R.; Brady, Steven J.
The use of acoustic and other parameters as surrogates for suspended-sediment concentrations (SSC) in rivers has been successful in multiple applications across the Nation. Critical to advancing the operational use of surrogates are tools to process and evaluate the data along with the subsequent development of regression models from which real-time sediment concentrations can be made available to the public. Recent developments in both areas are having an immediate impact on surrogate research, and on surrogate monitoring sites currently in operation. The Surrogate Analysis and Index Developer (SAID) standalone tool, under development by the U.S. Geological Survey (USGS), assists in the creation of regression models that relate response and explanatory variables by providing visual and quantitative diagnostics to the user. SAID also processes acoustic parameters to be used as explanatory variables for suspended-sediment concentrations. The sediment acoustic method utilizes acoustic parameters from fixed-mount stationary equipment. The background theory and method used by the tool have been described in recent publications, and the tool also serves to support sediment-acoustic-index methods being drafted by the multi-agency Sediment Acoustic Leadership Team (SALT), and other surrogate guidelines like USGS Techniques and Methods 3-C4 for turbidity and SSC. The regression models in SAID can be used in utilities that have been developed to work with the USGS National Water Information System (NWIS) and for the USGS National Real-Time Water Quality (NRTWQ) Web site. The real-time dissemination of predicted SSC and prediction intervals for each time step has substantial potential to improve understanding of sediment-related water-quality and associated engineering and ecological management decisions.
Wang, Wenjuan; Temsah, Gheda; Mallick, Lindsay
While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage-Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care.
Cornelisse-Vermaat, Judith R.; Antonides, Gerrit; Van Ophem, Johan A. C.; Van Den Brink, Henriette Maassen
The structural relationships between body mass index, perceived health and happiness have been studied in a survey of 700 native Dutch citizens. We found an indirect effect of body mass index on happiness, via perceived health. Age had an inverted U-shaped relationship with body mass index, and both education and smoking had a negative effect on…
Chen, Jian; Liu, Guijian; Kang, Yu; Wu, Bin; Sun, Ruoyu; Zhou, Chuncai; Wu, Dun
Coal is one of the major energy resources in China, accounting for approximately 70 % of primary energy consumption. Many environmental problems and human health risks arise during coal exploitation, utilization, and waste disposal, especially in the remote mountainous areas of western China (e.g., eastern Yunnan, western Guizhou and Hubei, and southern Shaanxi). In this paper, we report a thorough review of the environmental and human health impacts related to coal utilization in China. The abundance of the toxic trace elements such as F, As, Se, and Hg in Chinese coals is summarized. The environmental problems (i.e., water, soil, and air pollution) that are related to coal utilization are outlined. The provenance, distributions, typical symptoms, sources, and possible pathways of endemic fluorosis, arsenism, and selenosis due to improper coal usage (briquettes mixed with high-F clay, mineralized As-rich coal, and Se-rich stone coal) are discussed in detail. In 2010, 14.8, 1.9 million, and 16,000 Chinese people suffered from dental fluorosis, skeletal fluorosis, and arsenism, respectively. Finally, several suggestions are proposed for the prevention and treatment for endemic problems caused by coal utilization.
Burgette, J.M.; Lee, J.Y.; Baker, A.D.; Vann, W.F.
The objectives of this study were to examine the pattern of association between dental utilization and oral health literacy (OHL). As part of the Carolina Oral Health Literacy Project, clients in the Women, Infants, and Children’s Special Supplemental Nutrition Program completed a structured 30-min in-person interview conducted by 2 trained interviewers at 9 sites in 7 counties in North Carolina. Data were collected on clients’ OHL, sociodemographics, dental utilization, self-efficacy, and dental knowledge. The outcome, OHL, was measured with a dental word recognition test (30-item Rapid Estimate of Adult Literacy in Dentistry). Descriptive and multiple linear regression methods were used to examine the distribution of OHL and its association with covariates. After adjusting for age, education, race, marital status, self-efficacy, and dental knowledge, multiple linear regression showed that dental utilization was not a significant predictor of OHL (P > 0.05). Under the conditions of this study, dental utilization was not a significant predictor of OHL. PMID:26567035
Stevens, Katherine; McCabe, Christopher; Brazier, John; Roberts, Jennifer
A key issue in health state valuation modelling is the choice of functional form. The two most frequently used preference based instruments adopt different approaches; one based on multi-attribute utility theory (MAUT), the other on statistical analysis. There has been no comparison of these alternative approaches in the context of health economics. We report a comparison of these approaches for the health utilities index mark 2. The statistical inference model predicts more accurately than the one based on MAUT. We discuss possible explanations for the differences in performance, the importance of the findings, and implications for future research.
Meagher-Stewart, Donna; Underwood, Jane; MacDonald, Mary; Schoenfeld, Bonnie; Blythe, Jennifer; Knibbs, Kristin; Munroe, Val; Lavoie-Tremblay, Mélanie; Ehrlich, Anne; Ganann, Rebecca; Crea, Mary
Optimal utilization of public health nurses (PHNs) is important for strengthening public health capacity and sustaining interest in public health nursing in the face of a global nursing shortage. To gain an insight into the organizational attributes that support PHNs to work effectively, 23 focus groups were held with PHNs, managers, and policymakers in diverse regions and urban and rural/remote settings across Canada. Participants identified attributes at all levels of the public health system: government and system-level action, local organizational culture of their employers, and supportive management practices. Effective leadership emerged as a strong message throughout all levels. Other organizational attributes included valuing and promoting public health nursing; having a shared vision, goals, and planning; building partnerships and collaboration; demonstrating flexibility and creativity; and supporting ongoing learning and knowledge sharing. The results of this study highlight opportunities for fostering organizational development and leadership in public health, influencing policies and programs to optimize public health nursing services and resources, and supporting PHNs to realize the full scope of their competencies.
Mohammadi, Fatemeh; Kohan, Shahnaz; Mostafavi, Firoozeh; Gholami, Ali
Background: Fear of the stigma associated with reproductive health services has always been one of the reasons why youth and unmarried individuals avoid making use of such services. This stigma imposes a great deal of mental stress, fear, and depression on patients and causes delays in the diagnosis and treatment of their conditions. Objectives: This paper explores the concept of stigma in the context of the utilization of reproductive health services by unmarried women. Patients and Methods: This study is qualitative in nature. Purposive sampling was employed, and semi-structured interviews were conducted with 16 unmarried women, five midwives, and two physicians. The data were analyzed using the conventional content analysis method. Results: Four main categories constituted the general concept concerning the stigma suffered by unmarried women for using reproductive health services, i.e., prevalent stereotypical thinking patterns in society, the fear of being judged and labeled by others, discrimination, and feeling ashamed of seeking reproductive health services. Conclusions: The findings indicated that society associates reproductive health issues with sexual relations, which in turn shapes the stigma and places limitations on unmarried women for using reproductive health services. Thus, while reproductive health services are planned and provided to unmarried women, strategies are demanded for overcoming this stigma. PMID:27247794
Miller, Edward Alan; Rosenheck, Robert A.; Schneider, Lon S.
This study examined the moderating effect of caregiver burden on the relationship between patients’ health status and institutional costs in Alzheimer's disease (AD). Data were obtained on whether 421 community-dwelling patients with AD in the CATIE-AD trial received institutional services in the month preceding baseline and at 3-, 6-, and 9-months follow-up. All participants had a caregiver who lived with or visited them regularly. Outcome variables include hospital, nursing home, residential, and combined institutional costs. Mixed models were employed to estimate the interaction of Health Utility Index (HUI)-III scores (a health status measure) and five measures of caregiver burden. Wherever significant, results indicate that greater caregiver burden weakens the inverse relationship between health utilities and institutional costs, leading to greater costs than would be expected at a given level of health. Altogether 45.0% of the models (9/20) showed this effect (positive coefficient on the burden-HUI interaction term). Interventions should be based on caregiver burden, regardless of care recipient health status, for even seemingly manageable patients may be at heightened risk for institutionalization if caregivers experience sufficiently high levels of burden. PMID:20625266
Ladner, Travis R; Westrick, Ashly C; Wellons, John C; Shannon, Chevis N
OBJECT The purpose of this study was to design and validate a patient-reported health-related quality of life (HRQOL) instrument for pediatric Chiari Type I malformation (CM-I), the Chiari Health Index for Pediatrics (CHIP). METHODS The CHIP has 45 items with 4 components making up 2 domain scores, physical (pain frequency, pain severity, nonpain symptoms) and psychosocial; physical and psychosocial scores are combined to create an overall HRQOL score. Increasing scores (0 to 1) represent increasing HRQOL. Fifty-five patients with CM-I (mean age 12 ± 4 years, 53% male) were enrolled and completed the CHIP and Health Utilities Index Mark 3 (HUI3). Twenty-five healthy controls (mean age 11.9 ± 4 years, 40% male) also completed the CHIP. CHIP scores were compared between these groups via the Mann-Whitney U-test. For CHIP discriminative function, subscore versus presence of CM-I was compared via receiver operating characteristic curve analysis. CHIP scores in the CM-I group were stratified by symptomatology (asymptomatic, headaches, and paresthesias) and compared via Kruskal-Wallis test with Mann-Whitney U-test with Bonferroni correction (p < 0.0167). CHIP was compared with HUI3 (Health Utilities Index Mark 3) via univariate and multivariate linear regression. RESULTS CHIP physical and psychosocial subscores were, respectively, 24% and 18% lower in CM-I patients than in controls (p < 0.001); the overall HRQOL score was 23% lower as well (p < 0.001). The area under the curve (AUC) for CHIP physical subscore versus presence of CM-I was 0.809. CHIP physical subscore varied significantly with symptomatology (p = 0.001) and HUI3 pain-related quality of life (R(2) = 0.311, p < 0.001). The AUC for CHIP psychosocial subscore versus presence of CM-I was 0.754. CHIP psychosocial subscore varied significantly with HUI3 cognitive- (R(2) = 0.324, p < 0.001) and emotion-related (R(2) = 0.155, p = 0.003) quality of life. The AUC for CHIP HRQOL versus presence of CM-I was 0
Introduction There exist several barriers to maternal health service utilization in developing countries. Most of the previous studies conducted in India have focused on demand-side barriers, while only a few have touched upon supply-side barriers. None of the previous studies in India have investigated the factors that affect maternal health care utilization at health sub-centers (HSCs) in India, despite the fact that these institutions, which are the geographically closest available public health care facilities in rural areas, play a significant role in providing affordable maternal health care. Therefore, this study aims to examine the supply-side determinants of maternal service utilization at HSCs in rural India. Data and Methods This study uses health facility data from the nationally representative District-Level Household Survey, which was administered in 2007–2008 to examine the effect of supply-side variables on the utilization of maternal health care services across HSCs in rural India. Since the dependent variables (the number of antenatal registrations, in-facility deliveries, and postnatal care services) are count variables and exhibit considerable variability, the data were analyzed using negative binomial regression instead of Poisson regression. Results The results show that those HSCs run by a contractual auxiliary nurse midwife (ANM) are likely to offer a lower volume of services when compared to those run by a permanent ANM. The availability of obstetric drugs, weighing scales, and blood pressure equipment is associated with the increased utilization of antenatal and postnatal services. The unavailability of a labor/examination table and bed screen is associated with a reduction in the number of deliveries and postnatal services. The utilization of services is expected to increase if essential facilities, such as water, telephones, toilets, and electricity, are available at the HSCs. Monitoring of ANM’s work by Village Health and Sanitation
Sharma, Sharad Kumar; Sawangdee, Yothin; Sirirassamee, Buppha
With the objective of reducing maternal and neonatal mortality, the Safe Motherhood Program was implemented in Nepal in 1997. It was launched as a priority programme during the ninth five-year plan period, 1997-2002, with the aim of increasing women's access to health care and raising their status. This paper examines the association of access to health services and women's status with utilization of prenatal, delivery, and postnatal care during the plan period. The 1996 Nepal Family Health Survey and the 2001 Nepal Demographic and Health Survey data were pooled and the likelihood of women's using maternal health care was examined in 2001 in comparison with 1996. Multiple logistic regression analysis indicates that the utilization of maternal health services increased over the period. Programme interventions such as outreach worker's visits, radio programmes on maternal health, maternal health information disseminated through various mass media sources and raising women's status through education were able to explain the observed change in utilization. Health worker visits and educational status of women showed a large association, but radio programmes and other mass media information were only partially successful in increasing use of maternal health services. Socioeconomic and demographic variables such as household economic status, number of living children and place of residence showed stronger association with use of maternal health services then did intervention programmes.
Loeb, Stacy; Sanda, Martin G.; Broyles, Dennis L.; Shin, Sanghyuk S.; Bangma, Chris H.; Wei, John T.; Partin, Alan W.; Klee, George G.; Slawin, Kevin M.; Marks, Leonard S.; van Schaik, Ron H. N.; Chan, Daniel W.; Sokoll, Lori J.; Cruz, Amabelle B.; Mizrahi, Isaac A.; Catalona, William J.
Purpose The Prostate Health Index (phi) is a new test combining total, free and [-2]proPSA into a single score. It was recently approved by the FDA and is now commercially available in the U.S., Europe and Australia. We investigate whether phi improves specificity for detecting clinically significant prostate cancer and can help reduce prostate cancer over diagnosis. Materials and Methods From a multicenter prospective trial we identified 658 men age 50 years or older with prostate specific antigen 4 to 10 ng/ml and normal digital rectal examination who underwent prostate biopsy. In this population we compared the performance of prostate specific antigen, % free prostate specific antigen, [-2]proPSA and phi to predict biopsy results and, specifically, the presence of clinically significant prostate cancer using multiple criteria. Results The Prostate Health Index was significantly higher in men with Gleason 7 or greater and “Epstein significant” cancer. On receiver operating characteristic analysis phi had the highest AUC for overall cancer (AUCs phi 0.708, percent free prostate specific antigen 0.648, [-2]proPSA 0.550 and prostate specific antigen 0.516), Gleason 7 or greater (AUCs phi 0.707, percent free prostate specific antigen 0.661, [-2]proPSA 0.558, prostate specific antigen 0.551) and significant cancer (AUCs phi 0.698, percent free prostate specific antigen 0.654, [-2]proPSA 0.550, prostate specific antigen 0.549). At the 90% sensitivity cut point for phi (a score less than 28.6) 30.1% of patients could have been spared an unnecessary biopsy for benign disease or insignificant prostate cancer compared to 21.7% using percent free prostate specific antigen. Conclusions The new phi test outperforms its individual components of total, free and [-2]proPSA for the identification of clinically significant prostate cancer. Phi may be useful as part of a multivariable approach to reduce prostate biopsies and over diagnosis. PMID:25463993
Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.
Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…
Watson, Crystal; Prosser, Christine; Braun, Sebastian; Landsman-Blumberg, Pamela B; Gleissner, Erika; Naoshy, Sarah
Background Multiple sclerosis (MS), a progressive neurodegenerative disease, greatly impacts the quality of life and economic status of people affected by this disease. In Germany, the total annual cost of MS is estimated at €40,000 per person with MS. Natalizumab has shown to slow MS disease progression, reduce relapses, and improve the quality of life of people with MS. Objective To evaluate MS-related and all-cause health care resource utilization and costs among German MS patients during the 12 months before and after initiation of natalizumab in a real-world setting. Methods The current analysis was conducted using the Health Risk Institute research database. Identified patients were aged ≥18 years with ≥1 diagnosis of MS and had initiated natalizumab therapy (index), with 12-month pre– and post–index-period data. Patients were stratified by prior disease-modifying therapy (DMT) usage or no DMT usage in the pre-index period. Outcome measures included corticosteroid use and number of sick/disability days, inpatient stays, and outpatient visits. Health care costs were calculated separately for pre- and post-index periods on a per-patient basis and adjusted for inflation. Results In a final sample of 193 natalizumab-treated patients, per-patient MS-related corticosteroid use was reduced by 62.3%, MS-related sick days by 27.6%, and inpatient costs by 78.3% from the pre- to post-index period. Furthermore, the proportion of patients with MS-related hospitalizations decreased from 49.7% to 14.0% (P<0.001); this reduction was seen for patients with and without prior DMT use. Conclusions In a real-world setting in Germany, initiation of natalizumab treatment in people with MS significantly reduced MS-related hospitalizations, corticosteroid use, sick days, and associated costs. PMID:28203098
Payakachat, Nalin; Tilford, J. Mick; Kuhlthau, Karen A.; van Exel, N. Job; Kovacs, Erica; Bellando, Jayne; Pyne, Jeffrey M.; Brouwer, Werner BF
Scientific Abstract Comparative effectiveness of interventions for children with ASDs that incorporates costs is lacking due to the scarcity of information on health utility scores or preference-weighted outcomes typically used for calculating quality-adjusted life years (QALYs). This study created algorithms for mapping clinical and behavioral measures for children with ASDs to health utility scores. The algorithms could be useful for estimating the value of different interventions and treatments used in the care of children with ASDs. Participants were recruited from two Autism Treatment Network sites. Health utility data based on the HUI3 for the child was obtained from the primary caregiver (proxy-reported) through a survey (N=224). During the initial clinic visit, proxy-reported measures of the Child Behavior Checklist, Vineland II Adaptive Behavior Scales, and the PedsQL 4.0 (start measures) were obtained and then merged with the survey data. Nine mapping algorithms were developed using the HUI3 scores as dependent variables in ordinary least squares regressions along with the start measures, the Autism Diagnostic Observation Schedule to measure severity, child age, and cognitive ability as independent predictors. In-sample cross-validation was conducted to evaluate predictive accuracy. Multiple imputation techniques were used for missing data. The average age for children with ASDs in this study was 8.4 (SD=3.5) years. Almost half of the children (47%) had cognitive impairment (IQ<=70). Total scores for all of the outcome measures were significantly associated with the HUI3 score. The algorithms can be applied to clinical studies containing start measures of children with ASDs to predict QALYs gained from interventions. PMID:25255789
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
Al-Krenawi, A; Graham, J R; Kandah, J
A revised Hopkins Symptom Checklist (HSCL), translated into Arabic, was distributed to a sample of 87 nonpsychotic mental health out-patients in Zarka, Jordan (male = 61, female = 26). Findings revealed no significant gendered differences, but higher responses among women in all dimensions. Regardless of gender, patients also expected and were satisfied with medicinal treatment; explained etiologies as having supernatural origins; and utilized informal community traditional healing and religious healing systems. The supernatural explanations and community healing systems varied by gender. Findings emphasize future treatment and programme development strategies that take into account the biomedical/traditional interface, culturally appropriate treatment modalities, different gendered patient needs, and the potential stigma of professional treatment.
Sun, Feng-Hua; Wong, Stephen Heung-Sang; Chen, Ya-Jun; Huang, Ya-Jun; Hsieh, Sandy Shen-Yu
The purpose of the present study was to investigate the effect of glycemic index (GI) and fructose content in lunch on substrate utilization during subsequent brisk walking. Ten healthy young males completed 3 main trials in a counterbalanced crossover design. They completed 60 min of brisk walking at approximately 50% maximal oxygen consumption after consuming a standard breakfast and 1 of 3 lunch meals, i.e., a low GI meal without fructose (LGI), a low GI meal that included fructose beverage (LGIF), or a high GI meal (HGI). The 3 lunch meals were isocaloric and provided 1.0 g·kg⁻¹ carbohydrate. Substrate utilization was measured using indirect respiratory calorimetry method. Blood samples were collected at certain time points. During the 2-h postprandial period after lunch, the incremental area under the blood response curve values of glucose and insulin were higher (p < 0.05) in the HGI trial than those in the LGI and LGIF trials (HGI vs. LGI and LGIF: glucose, 223.5 ± 24.4 vs. 92.5 ± 10.4 and 128.0 ± 17.7 mmol·min·L⁻¹; insulin, 3603 ± 593 vs. 1425 ± 289 and 1888 ± 114 mU·min·L⁻¹). During brisk walking, decreased carbohydrate oxidation was observed (p < 0.05) in the LGI trial than in the LGIF and HGI trials (LGI vs. LGIF and HGI: 60.8 ± 4.0 vs. 68.1 ± 6.0 and 74.4 ± 4.7 g). No difference was found in fat oxidation among the 3 trials (LGI vs. LGIF vs. HGI: 21.6 ± 2.3 vs. 19.2 ± 2.3 vs. 16.4 ± 2.2 g). It appeared that fructose content was an important influencing factor when considering the effect of different GI lunch meals on substrate utilization during subsequent moderate intensity exercise.
Trepka, Mary Jo; Maddox, Lorene M; Lieb, Spencer; Niyonsenga, Theophile
To assess the utility of the National Death Index (NDI) in improving the ascertainment of deaths among people diagnosed with acquired immunodeficiency syndrome (AIDS), the authors determined the number and characteristics of additional deaths identified through NDI linkage not ascertained by using standard electronic linkage with Florida Vital Records and the Social Security Administration's Death Master File. Records of people diagnosed with acquired immunodeficiency syndrome between 1993 and 2007 in Florida were linked to the NDI. The demographic characteristics and reported human immunodeficiency virus (HIV) transmission modes of people whose deaths were identified by using the NDI were compared with those whose deaths were ascertained by standard linkage methods. Of the 15,094 submitted records, 719 had confirmed matches, comprising 2.1% of known deaths (n = 34,504) within the cohort. Hispanics, males, people 40 years of age or older, and injection drug users were overrepresented among deaths ascertained only by the NDI. In-state deaths comprised 59.0% of newly identified deaths, and human immunodeficiency virus was less likely to be a cause of death among newly identified compared with previously identified deaths. The newly identified deaths were not previously ascertained principally because of slight differences in personal identifying information and could have been identified through improved linkages with Florida Vital Records.
Bell, Michelle L.; Peng, Roger D.
Background: Environmental health research employs a variety of metrics to measure heat exposure, both to directly study the health effects of outdoor temperature and to control for temperature in studies of other environmental exposures, including air pollution. To measure heat exposure, environmental health studies often use heat index, which incorporates both air temperature and moisture. However, the method of calculating heat index varies across environmental studies, which could mean that studies using different algorithms to calculate heat index may not be comparable. Objective and Methods: We investigated 21 separate heat index algorithms found in the literature to determine a) whether different algorithms generate heat index values that are consistent with the theoretical concepts of apparent temperature and b) whether different algorithms generate similar heat index values. Results: Although environmental studies differ in how they calculate heat index values, most studies’ heat index algorithms generate values consistent with apparent temperature. Additionally, most different algorithms generate closely correlated heat index values. However, a few algorithms are potentially problematic, especially in certain weather conditions (e.g., very low relative humidity, cold weather). To aid environmental health researchers, we have created open-source software in R to calculate the heat index using the U.S. National Weather Service’s algorithm. Conclusion: We identified 21 separate heat index algorithms used in environmental research. Our analysis demonstrated that methods to calculate heat index are inconsistent across studies. Careful choice of a heat index algorithm can help ensure reproducible and consistent environmental health research. Citation: Anderson GB, Bell ML, Peng RD. 2013. Methods to calculate the heat index as an exposure metric in environmental health research. Environ Health Perspect 121:1111–1119; http://dx.doi.org/10.1289/ehp.1206273
... process to compute a cost index(es) for heating and cooling a standard home to a given ambient temperature... cost indexes? 591.220 Section 591.220 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ALLOWANCES AND DIFFERENTIALS Cost-of-Living Allowance and Post...
Baidawi, Susan; Trotter, Christopher
Physical and functional health issues among older prisoners may be difficult to address in an environment designed for younger inmates. This article investigates the relationships between older prisoners' health, their experiences of the prison environment and health services, and their levels of psychological distress. One hundred and seventy-three older prisoners (aged 50 years and older) from eight Australian prisons were interviewed using the Kessler Psychological Distress Scale, with additional information collected from prisoner interviews and correctional health files. Distress scores were significantly associated with measures of physical health, functional independence, and health care utilization. However, a hierarchical regression analysis determined that physical difficulties in the prison environment and issues accessing prison health care explained a significant proportion of the variation in older prisoners' distress scores.
Woo, Gloria; Tomlinson, George; Yim, Colina; Lilly, Les; Therapondos, George; Wong, David KH; Ungar, Wendy; Einarson, Thomas R; Sherman, Morris; Heathcote, E Jenny; Krahn, Murray
BACKGROUND: The effect of chronic hepatitis B (CHB) infection on health-related quality of life (HRQoL) and health state utilities has not been well characterized. OBJECTIVE: To measure utility scores and HRQoL across disease states associated with CHB infection. METHODS: Patients attending four tertiary care clinics for CHB were approached between July 2007 and March 2009. Respondents completed version 2 of the Short-Form 36 Health Survey, the EQ5D, a visual analogue scale, the Health Utilities Index Mark 3, standard gamble, and demographics and risk factor surveys in English, Cantonese or Mandarin. Charts were reviewed to determine disease stage and comorbidities. RESULTS: A total of 433 patients were studied: 294 had no cirrhosis; 79 had compensated cirrhosis; seven had decompensated cirrhosis; 23 had hepatocellular carcinoma; and 30 had received a liver transplant. The mean standard gamble utilities for these disease states were 0.89, 0.87, 0.82, 0.84 and 0.86, respectively. HRQoL scores in noncirrhotic patients were similar to those of the general population. Scores of patients with compensated cirrhosis were not significantly lower; however, patients with decompensated cirrhosis and hepatocellular carcinoma had significantly lower HRQoL scores compared with noncirrhotic patients (P<0.05). Similar scores were observed among patients on and off oral antiviral treatment. Post-liver transplant patients had a higher HRQoL than patients with decompensated cirrhosis. Age, number of comorbidities and relationship status were significantly associated with HRQoL scores. CONCLUSIONS: HRQoL in CHB patients is only impaired in the later stages of liver disease. Neither CHB infection nor antiviral treatment is associated with a lower quality of life. PMID:22803020
Journal of Allied Health, 1991
Contains 1,073 entries from 91 institutions, giving author, institution, year, degree, emphasis, discipline, and title, arranged by topic: allied health, biocommunication arts, child development/care, clinical psychology, dentistry, environmental health, exercise science, food service, health education, health services, medical laboratories, nurse…
Maclean, Johanna Catherine; Xu, Haiyong; French, Michael T; Ettner, Susan L
Objective To analyze the associations between Axis II (A2) disorders and two measures of health care utilization with relatively high cost: emergency department (ED) episodes and hospital admissions. Data Source/Study Setting Wave I (2001/2002) and Wave II (2004/2005) of the National Longitudinal Survey on Alcohol and Related Conditions (NESARC). Study Design A national probability sample of adults. Gender-stratified regression analysis adjusted for a range of covariates associated with health care utilization. Data Collection The target population of the NESARC is the civilian noninstitutionalized population aged 18 years and older residing in the United States. The cumulative survey response rate is 70.2 percent with a response rate of 81 percent (N = 43,093) in Wave I and 86.7 percent (N = 34,653) in Wave II. Principal Findings Both men and women with A2 disorders are at elevated risk for ED episodes and hospital admissions. Associations are robust after adjusting for a rich set of confounding factors, including Axis I (clinical) psychiatric disorders. We find evidence of a dose–response relationship, while antisocial and borderline disorders exhibit the strongest associations with both measures of health care utilization. Conclusions This study provides the first published estimates of the associations between A2 disorders and high-cost health care utilization in a large, nationally representative survey. The findings underscore the potential implications of these disorders on health care expenditures. PMID:24117342
Toomey, Joseph A.; Kucharski, L. Thomas; Duncan, Scott
This study examined the utility of the Minnesota Multiphasic Personality Inventory-2's (MMPI-2) malingering discriminant function index (M-DFI), recently developed by Bacchiochi and Bagby, in the detection of malingering in a forensic sample. Criminal defendants were divided into "malingering" and "not malingering" groups using…
Bime, Christian; Wei, Christine Y.; Holbrook, Janet T.; Sockrider, Marianna M.; Revicki, Dennis A.; Wise, Robert A.
Background The evaluation of asthma symptoms is a core outcome measure in asthma clinical research. The Asthma Symptom Utility Index (ASUI) was developed to assess frequency and severity of asthma symptoms. The psychometric properties of the ASUI are not well characterized and a minimal important difference (MID) is not established. Objectives We assessed the reliability, validity, and responsiveness to change of the ASUI in a population of adult asthma patients. We also sought to determine the MID for the ASUI. Methods Adult asthma patients (n = 1648) from two previously completed multicenter randomized trials were included. Demographic information, spirometry, ASUI scores, and other asthma questionnaire scores were obtained at baseline and during follow-up visits. Participants also kept a daily asthma diary. Results Internal consistency reliability of the ASUI was 0.74 (Cronbach’s alpha). Test-retest reliability was 0.76 (intra-class correlation). Construct validity was demonstrated by significant correlations between ASUI scores and Asthma Control Questionnaire (ACQ) scores (Spearman correlation r = −0.79, 95% CI [−0.85, −0.75], P<0.001) and Mini Asthma Quality of Life Questionnaire (Mini AQLQ) scores (r = 0.59, 95% CI [0.51, 0.61], P<0.001). Responsiveness to change was demonstrated, with significant differences between mean changes in ASUI score across groups of participants differing by 10% in the percent predicted FEV1 (P<0.001), and by 0.5 points in ACQ score (P < 0.001). Anchor-based methods and statistical methods support an MID for the ASUI of 0.09 points. Conclusions The ASUI is reliable, valid, and responsive to changes in asthma control over time. The MID of the ASUI (range of scores 0–1) is 0.09. PMID:23026499
Platt, Lisa F; Wolf, Julia Kay; Scheitle, Christopher P
Prior studies of the utilization of mental health professionals by sexual minority populations have relied on data that are now dated and\\or not nationally representative. These studies have also provided mixed findings regarding gender differences in the utilization of mental health professionals among sexual minority individuals. Using data from the 2013-2015 National Health Interview Surveys, this study investigates (1) how sexual minority individuals compare to heterosexual participants in their utilization of mental health professionals and (2) gender differences in that utilization. The results indicate sexual minority individuals utilize mental health care professionals at higher rates than heterosexual individuals even after controlling for measures of mental health and other demographic characteristics; this is true for both men and women. However, gender moderates the sexual minority effect on utilization rates. Sexual minority men utilize mental health professionals at a high rate, such that their utilization rates are similar to sexual minority women, contrary to the gender seen gap among heterosexuals.
Chartier, M J; Walker, J R; Naimark, B
The long-term consequences of childhood abuse on adult mental health have been a major focus of research. Much less attention has been directed to its effects on physical health outcomes. By use of data from the Ontario Health Survey (n = 9,953), the association between retrospective reports of childhood physical and sexual abuse and adult health and health care utilization was examined in men and women. The population health survey was conducted from November 1990 to March 1991 in the Canadian province of Ontario. An association of moderate strength was found between childhood abuse and multiple health problems, poor or fair self-rated health, pain that interferes with activities, disability due to physical health problems, and frequent emergency room and health professional visits but not frequent general practitioner visits. These effects were more pronounced in females and younger respondents. The strength of the associations reported here with odds ratios of 1.3-2.2 was lower than that found between childhood abuse and adult mental health, with odds ratios of 1.9-3.4. Given the growing evidence of the long-term effects of childhood abuse, greater efforts are clearly needed in developing more effective strategies for the prevention and treatment of child abuse.
Tucker, Larry A.; Clegg, Alan G.
Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…
Wadden, Richard A., Ed.
A variety of socio-economic criteria are suggested for the choice of how best to utilize energy resources. One of the most significant of these criteria is the prediction and evaluation of existing and potential human health effects of recovery and usage of various energy resources. Suggestions are made for incorporation of these methods in site…
Lin, Junji; Li, Yunfeng; Tian, Haijun; Goodman, Michael J; Gabriel, Susan; Nazareth, Tara; Turner, Stuart J; Arcona, Stephen; Kahler, Kristijan H
Background Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for lung infections and other pathologies (eg, pneumonia); however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia. Methods A retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index), and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits), and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching. Results In the baseline cohort (N=467,578), patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years) and had higher Charlson Comorbidity Index scores (3.3 vs 2.6) than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely to have a hospitalization (odds ratio; 95% confidence intervals [CI] =9.2; 8.9, 9.4) and four times more likely to have an ER visit (odds ratio; 95% CI =4.4; 4.3, 4.5) over the 12-month follow-up period compared to the control cohort. The estimated 12-month mean hospitalization costs ($14,353 [95% CI: $14,037–$14,690]), outpatient costs ($6,891 [95% CI: $6,706–$7,070]), and prescription drug costs ($1,104 [95% CI
Niskanen, I; Räty, J; Peiponen, K E
The knowledge of the refractive index of a particle is important in sensing and imaging applications, e.g., in biology, medicine and process industry. The refractive index of tiny solid particles such as microsize particles can be determined by the so-called liquid immersion technique. This study deals with three different types of interrogation methods to get the refractive index of a particle in a liquid matrix. These methods utilize thermo-optical properties and wavelength-dependent refractive index of the particle and the immersion liquids, as well as, the classical method using a set of in advance prepared set of immersion liquids with different refractive indices. The emphasis is on a method to get especially the wavelength-dependent refractive index of microparticles and exploiting different wavelength-dependences of immersion liquid and a solid particle because identification of a particle is more reliable if the refractive index of the particle is known at several wavelengths. In this study glycerol-water mixtures served as immersion liquids to obtain the refractive index of CaF2 at several discrete wavelengths in the spectral range 200-500 nm. The idea is to find the maximum value of light transmission of suspension by scanning the wavelength of a commercial spectrophotometer. The light dispersion-based method is suggested as a relatively easy, economic and fast method to determine the refractive index of a particle by a spectrophotometer at several wavelengths of light. The accuracy of the detection of the refractive index is suggested to be better than ± 0.005 refractive index units.
Mahmood, Saeed; Parchani, Ashok; El-Menyar, Ayman; Zarour, Ahmad; Al-Thani, Hassan; Latifi, Rifat
Background: Bispectral index (BIS) monitoring in multiple trauma patients has become a common practice in monitoring the sedation levels. We aimed to assess the utility of BIS in the trauma intensive care unit (ICU). Methods: A prospective observational study was conducted in the trauma ICU at Hamad General Hospital in Qatar between 2011 and 2012. Patients were divided in two groups: Group I (without BIS monitoring) and Group II (with BIS monitoring). The depth of sedation was clinically evaluated with Ramsey Sedation Scale, changes in vital signs and Glasgow Coma Scale (GCS) level. Use of sedatives, analgesics, and muscle relaxants were also recorded. Data were compared using Chi-square and Student t-tests. Results: A total of 110 mechanically ventilated trauma patients were enrolled with a mean age of 36 ± 14 years. The rate of head injury was greater in Group I when compared with Group II (94% vs. 81%, P = 0.04). In comparison to Group I, patients in Group II had lower GCS and higher mean Injury Severity Score (ISS) (6.3 ± 2.5 vs. 7.4 ± 2.7 and 25.5 ± 8.5 vs. 21.2 ± 4.7, respectively, P = 0.03). The used midazolam dose was less in Group II in comparison to Group I (5.2 ± 2.3 vs. 6.1 ± 2.1, P = 0.03). Also, fentanyl dose was less in Group II (152 ± 58 vs. 187 ± 59, P = 0.004). The rate of agitation, failure of extubation and tracheostomy in Group II were lower than those in Group I, P = 0.001. The length of stay for patients Group I was longer (14.6 ± 7.1 vs. 10.2 ± 5.9 days) in comparison to group II, P = 0.001. Conclusion: Management of multiple trauma patients in the trauma ICU with BIS monitoring was found to be associated with better outcomes. BIS monitoring is a guide for adjusting the dosage of sedative agents. It can also minimize agitation, failure of extubation, and length of stay in ICU. PMID:25317356
Ackermann, Ronald T.; Edelstein, Sharon L.; Narayan, K.M. Venkat; Zhang, Ping; Engelgau, Michael M.; Herman, William H.; Marrero, David G.
Health utilities are measures of health-related quality of life (HRQL) used in cost-effectiveness research. We evaluated whether changes in body weight were associated with changes in health utilities in the Diabetes Prevention Program (DPP) and whether associations differed by treatment assignment (lifestyle intervention, metformin, placebo) or baseline obesity severity. We constructed physical (PCS-36) and mental component summary (MCS-36) subscales and short-form-6D (SF-6D) health utility index for all DPP participants completing a baseline 36-item short form (SF-36) HRQL assessment (N = 3,064). We used linear regression to test associations between changes in body weight and changes in HRQL indicators, while adjusting for other demographic and behavioral variables. Overall differences in HRQL between treatment groups were highly statistically significant but clinically small after 1 year. In multivariable models, weight change was independently associated with change in SF-6D score (increase of 0.007 for every 5 kg weight loss; P < 0.001), but treatment effects independent of weight loss were not. We found no significant interaction between baseline obesity severity and changes in SF-6D with changes in body weight. However, increases in physical function (PCS-36) with weight loss were greater in persons with higher baseline obesity severity. In summary, improvements in HRQL are associated with weight loss but not with other effects of obesity treatments that are unrelated to weight loss. Although improvements in the SF-6D did not exceed commonly reported thresholds for a minimally important difference (0.04), these changes, if causal, could still have a significant impact on clinical cost-effectiveness estimates if sustained over multiple years. PMID:19390518
Kamimura, Akiko; Christensen, Nancy; Tabler, Jennifer; Ashby, Jeanie; Olson, Lenora M
This cross sectional study assessed the physical and mental health, health literacy and social support of the uninsured utilizing a free clinic to develop intervention programs and research projects to improve the health of free clinic patients. Free clinics are nonprofit organizations that provide underserved and uninsured individuals access to a broad array of free or low cost healthcare services. English or Spanish speaking patients (N = 187) aged 18 years or older completed a self-administered survey. Physical, mental and oral health, health literacy, and social support were measured using standardized instruments. Eighty-two participants (45 US born and 37 non-US born) chose the English version of the survey (English speakers) while 105 participants (2 US born and 103 non-US born) chose the Spanish version (Spanish speakers). Overall, both the physical and mental health functioning of the participants was lower than that of the US general population. The participants reported being moderately depressed. US-born English speakers reported the poorest physical and mental health while Spanish speakers reported the best physical health and the lowest level of depression. A higher level of health literacy was associated with better physical health functioning, whereas reporting higher social support was associated with better mental health functioning and less severe depression. Because most free clinics have limited resources, developing services and programs that fit free clinics' circumstances are needed. Our study finding indicates that health literacy education, mental health services, and social support are key services needed by free clinic patients to achieve better health.
Barrios, Lisa C.; Burgeson, Charlene R.; Crossett, Linda; Harrykissoon, Samantha D.; Pritzl, Jane; Wechsler, Howell; Kuester, Sarah A.; Pederson, Linda; Graffunder, Corinne; Rainford, Neil; Sleet, David
The "School Health Index" is a self-assessment and planning guide that will enable schools to: (1) identify the strengths and weaknesses of school policies and programs for promoting health and safety; (2) develop an action plan for improving student health and safety, and (3) involve teachers, parents, students, and the community in improving…
Brener, Nancy D.; Pejavara, Anu; Barrios, Lisa C.; Crossett, Linda; Lee, Sarah M.; McKenna, Mary; Michael, Shannon; Wechsler, Howell
The School Health Index (SHI) is a self-assessment and planning tool that helps individual schools identify the strengths and weaknesses of their health policies and programs. To determine the percentage of US schools meeting the recommendations in the SHI, the present study analyzed data from the School Health Policies and Programs Study (SHPPS)…
Miller, Edward Alan; Rosenheck, Robert A.; Schneider, Lon S.
Objective This study examined the moderating effect of caregiver burden on the relationship between the health status of Alzheimer’s disease (AD) patients and their use of institutional services (i.e., hospitalization, nursing home, and residential care). Methods Data were obtained at baseline and 3-, 6-, and 9-months following study entry on 421 community-dwelling patients with AD in the CATIE-AD trial. The outcome variable includes use of any institutional services. Logistic regression was employed to estimate the interaction of Health Utility Index (HUI)-III score (a general health status measure) at outcome and four concurrent caregiver burden measures. Marginal effects were calculated and plotted using random effects models for observations at multiple time points per individual. Average effects were calculated across all observations using models without random effects. Results Random effects results suggest that caregiver burden weakens the inverse relationship between health utilities and institutional service use, leading to greater likelihood of institutional use than would be expected at a given level of health. This is indicated by positive, significant signs on the HUI-III*caregiver burden interaction when burden is measured using the Caregiver Distress Scale, Beck Depression Inventory (BDI), and Caregiver Assessment Survey (all p<.05). It is reinforced by positive, significant average effects deriving from Caregiver Distress and BDI models without random effects (both p<.10). Results deriving from the Burden Interview Scale, though positive, were non-significant and weak by comparison. Conclusion Caregiver support interventions should be offered to individuals caring for less advanced AD patients. Otherwise healthy patients may be at increased risk for institutionalization when caregivers experience high levels of burden. PMID:21560160
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...
Van Vliet-Brown, Cheryl E; Shahram, Sana; Oelke, Nelly D
The aim of this scoping review was to examine the utilization of a Health in All Policies (HiAP) approach in municipal government settings. Specific objectives included: to review peer reviewed and grey literature, to identify common themes from the literature, and to highlight gaps in the evidence base for HiAP. An iterative scoping review method was used. Documents were identified through searches of academic databases, reference lists and journal indices, and the World Wide Web. Included documents focused on HiAP in the local or municipal government context, published in English, between 2006 and 2015. Data were extracted and analyzed using descriptive statistics and a narrative thematic method. As of June 2015, 26 documents met the inclusion criteria. A lack of research studies examining HiAP in the municipal government context was identified. Three broad themes were abstracted from analysis of the documents: the conceptualization of HiAP, the adoption of HiAP, and the implementation of HiAP. The focus on a HiAP approach at the municipal level of government is growing. A majority of the existing documents provide narrative evidence and recommendations for implementing a HiAP approach at the municipal level. Research is needed in the areas of conceptualization, implementation, adoption and evaluation of a HiAP approach in municipal settings.
included variables for certain health factors ( diabetes , cardiovascular disorders, and rheumatic fever) ; temporomandibular joint (TMJ) dysfunc- tions...yielded 208 variables, as indicated in Figure 3. As can be seen, these included age; sex; race; history of diabetes , cardiovascular disease, or...Female___ Race: American Indian (1) Health: Diabetes I Black (2) Cardiovascular -- " Oriental (3) - Rheumatic Feverj..._ Spanish (4) W’hite (5) Other
Anson, O; Haanappel, F W
Almost five decades ago, the Chinese Communist Party wished to abolish all "remnants of feudalism," including the patriarchal social order. Just one year after the revolution, the Marriage Law endorsed women's rights within the family, but no operative measures were taken to enforce it. Some of the economic reforms since independence even strengthened patrilocality and, possibly, patriarchal values. The purpose of this study was to explore the degree to which patrilocality served to maintain the traditional patriarchal stratification among women in the household by exploring women's health patterns and utilization of health services. Data were collected from 3859 women residing in rural Hebei, and variation in health and help seeking of six categories of relation to household head--mothers, wives, daughters, daughters-in-law, family heads, and other relatives--were explored. Utilization of health services is not dependent on women's position in the household, but primarily on per-capita income. Health patterns seem to indicate that mothers of the head of the household still have a considerable power to define their roles and share of household work. Women head of family, most of whom are married, appear to be under strain, which could be a result of their culturally "deviant" position. We conclude that old patriarchal values are intertwined with values of equality in current rural China.
Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming
The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901…
Rowe, Jennifer L.; Bruce, Martha L.; Conwell, Yeates
Home health care patients often have several late-life risk factors for suicide and constitute a high risk group for suicidal behaviors. In this study, we examined the characteristics of 14 older adult home health care utilizers who died by suicide and four community controls who used similar services. Both groups of home health care utilizers had…
Martin, Jose Antonio Rodriguez
In this article we present a new composite index of child health, applied to the Least Developed Countries (LDCs) of Africa, one of the areas of the planet most castigated by poverty. Our index has been constructed attending to the variables defined in the Goals of the Millennium Declaration. For this purpose we will use the P2 distance method for…
Ibrahim, Kamarulzaman; Jemain, Abdul Aziz
Objective The health of an individual is influenced by many factors. These could include factors that are related to the economy and the environment, as well as social and biological factors. Many studies have been carried out to study the effect of these factors on health, in terms of the individual factors or combined factors. The main purpose of this study was to demonstrate the value of structural equation modeling for the construction of an index to describe the health status of an individual. Methods Structural equation modeling was applied to data obtained from 5035 respondents in a survey conducted in the district of Hulu Langat, Malaysia, in the year 2001 by the Department of Community Health, Medical Faculty, Universiti Kebangsaan Malaysia, Malaysia. The survey involved the gathering of information on the respondents’ demography, lifestyles, mental health condition, and biomarkers. Results Socio-demography and mental health condition were found to have a direct effect on the health index. However, lifestyle had an indirect effect on the health index, as mediated by the mental health. Based on the indicator of model fit, the proposed model fits the data well. Conclusions Structural equation modeling was found to be pertinent to be used for analyzing the health index of a particular individual. PMID:21432557
Dias, Sónia; Gama, Ana; Silva, António Carlos; Cargaleiro, Helena; Martins, Maria O
The growing international migration has reinforcing the importance of a greater adequacy of health services in order to respond effectively to immigrants' needs. Previous studies indicate that several difficulties in the access and utilization of health services persist for some immigrant groups. The objective of this study was to understand the perspective of different health professionals' groups about the barriers in access and utilization of services by immigrants. In a transversal study a questionnaire was applied to 320 primary health care professionals of Lisbon and Tagus Valley. Differences between professional groups were analysed using the Kruskal-Wallis test. To determine which groups diverged more in their perceptions, mean ranks of each group were compared. Of the total participants, 64.2% evaluated their knowledge and competencies to deal with immigrants as reasonable however, 15.2% evaluated it as bad. Around one third of professionals admitted to be unaware of the legislation which regulates migrants' access to services. The largest proportion considered that, at the individual level, the frequent change of residence, the lack of economic resources, the cultural and religious beliefs and traditions, the fear of denunciation when the immigrant is undocumented, the lack of knowledge about legislation and services, and the linguistic differences influence access and utilization of health services. Most considered as barriers at the professionals' and services' level the limited sociocultural skills, the complex bureaucratic procedures, the cost and the lack of interpreters. The divergences in the perception of these factors occurred mainly between office workers and the other professionals. The perceptions of health professionals about the barriers in access and utilization of services by immigrants highlight opportunities for intervention in the context of cultural diversity. Given the different perceptions among the professional groups, which may be
Li, Xin; Zhang, Wei
In an effort to solve the problems that exist in the current health care system, the Chinese government has announced three different types of health insurance programs. We examine the impacts of these programs (Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and New Cooperative Medical Scheme (NCMS)) on health care utilization among older people in two provinces of China - Zhejiang and Gansu. The data comes from the pilot survey of the China Health and Retirement Longitudinal Study (CHARLS) collected in 2008, which contains 2685 individuals in 1570 households. We use a two-part model to analyze outpatient care. The first part is a binary equation modeling the probability of any use of outpatient service; For the second part, we use a zero-truncated Poisson model and a generalized linear model with a gamma distribution and a log link to explain the number of outpatient visits and the level of out-of-pocket (OOP) payments conditional on at least one visit to a service provider, respectively. For the inpatient care, the logistic regression is employed to predict the probability of being hospitalized. All analyses are weighted and marginal effects are reported. We find that compared with people without health insurance, people with UEBMI and URBMI are more likely to use outpatient services and people with UEBMI have less OOP payments in Zhejiang while in Gansu province, people with NCMS are less likely to have outpatient visits, while people with UEBMI are more likely to be hospitalized. In addition, among those who have at least one outpatient visit, different insurance types do not make much difference in terms of the number of outpatient visits in both provinces. Our study indicates that although the health insurance programs have some positive impacts on the health care utilization, these impacts are still limited.
Background New pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning), forecasting of drug utilization and expenditure, critical drug evaluation as well as structured programs for the introduction and follow-up of new drugs. The aim of this paper is to present the forecasting model and the predicted growth in all therapeutic areas in 2010 and 2011. Methods Linear regression analysis was applied to aggregate sales data on hospital sales and dispensed drugs in ambulatory care, including both reimbursed expenditure and patient co-payment. The linear regression was applied on each pharmacological group based on four observations 2006-2009, and the crude predictions estimated for the coming two years 2010-2011. The crude predictions were then adjusted for factors likely to increase or decrease future utilization and expenditure, such as patent expiries, new drugs to be launched or new guidelines from national bodies or the regional Drug and Therapeutics Committee. The assessment included a close collaboration with clinical, clinical pharmacological and pharmaceutical experts from the regional Drug and Therapeutics Committee. Results The annual increase in total expenditure for prescription and hospital drugs was predicted to be 2.0% in 2010 and 4.0% in 2011. Expenditures will increase in most therapeutic areas, but most predominantly for antineoplastic and immune modulating agents as well as drugs for the nervous system, infectious diseases, and blood and blood-forming organs. Conclusions The utilisation and expenditure of drugs is difficult to forecast due to uncertainties about the rate of adoption of new
Turner, Judith; And Others
Examined the ability of the Pain Assesment Index, determined from presurgery Minnesota Multiphasic Personality Inventory scores, to predict outcome subsequent to lumbar laminectomy and discectomy. The PAI was found to have good ability to identify patients who were doing well after surgery, but low power in predicting which patients would have…
The effects of natural disasters on public health are a rising concern, with increasing severity of disaster events. Many disaster studies utilize county-level analysis, however most do not control for county level environmental factors. Hurricane exposure during pregnancy could ...
Song, Insu; Marsh, Nigel V
A health social network is an online information service which facilitates information sharing between closely related members of a community with the same or a similar health condition. Over the years, many automated recommender systems have been developed for social networking in order to help users find their communities of interest. For health social networking, the ideal source of information for measuring similarities of patients is the medical information of the patients. However, it is not desirable that such sensitive and private information be shared over the Internet. This is also true for many other security sensitive domains. A new information-sharing scheme is developed where each patient is represented as a small number of (possibly disjoint) d-words (discriminant words) and the d-words are used to measure similarities between patients without revealing sensitive personal information. The d-words are simple words like "food,'' and thus do not contain identifiable personal information. This makes our method an effective one-way hashing of patient assessments for a similarity measure. The d-words can be easily shared on the Internet to find peers who might have similar health conditions.
Jørgensen, Jeanette Therming; Andersen, John Sahl; Tjønneland, Anne; Andersen, Zorana Jovanovic
Objective This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50–65 years. Design Cohort-based cross-sectional study. Setting Danish general practice. Subjects Totally, 54,849 participants of the Danish Diet, Cancer and Health cohort (50–65 years). Main outcome measures The sum of cohort members’ face-to-face consultations with general practitioner (GP) at the cohort baseline year (1993–1997). We obtained data on GP visits from the Danish National Health Service Register at the cohort baseline (1993–1997), when information on lifestyle (smoking, body mass index (BMI), alcohol use, physical activity), medical conditions (somatic and mental), employment, education, gravidity, and hormone therapy (HT) use was collected by questionnaire. Results Women had on average 4.1 and men 2.8 consultations per year. In a crude model, women had 47% higher rate of GP visits than men (incidence rate ratio: 1.47; 95% Confidence Interval: 1.45–1.50), which remained unchanged after adjustment for lifestyle, socio-demographic and medical factors, but attenuated to 18% (1.18; 1.13–1.24) after adjustment for female factors (gravidity and post-menopausal HT. In a fully adjusted model, subjects with hypertension (1.63; 1.59–1.67), mental illness (1.63; 1.61–1.66), diabetes (1.56; 1.47–1.65), angina pectoris (1.28; 1.21–1.34), and unemployed persons (1.19; 1.18–1.21) had highest rates of GP visits. Conclusions Gravidity and HT use explain a large proportion, but not all of the gender difference in GP utilization. Medical conditions (somatic and mental) and unemployment are the main determinants of GP utilization in men and women, while lifestyle has minor effect. Key Points Female gender remained a dominant determinant of GP utilization, after adjustment for lifestyle, socio-demography, medical and gender specific factors, with females consulting their GP 18% more often than males
Hone, Thomas; Gurol-Urganci, Ipek; Millett, Christopher; Başara, Berrak; Akdağ, Recep; Atun, Rifat
Strengthening primary health care (PHC) is considered a priority for efficient and responsive health systems, but empirical evidence from low- and middle-income countries is limited. The stepwise introduction of family medicine across all 81 provinces of Turkey (a middle-income country) between 2005 and 2010, aimed at PHC strengthening, presents a natural experiment for assessing the effect of family medicine on health service utilization and user satisfaction.The effect of health system reforms, that introduced family medicine, on utilization was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services was explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings.Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (P < 0.001), and slower annual growth in PHC and secondary care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30, respectively, a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8%, respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (P < 0.001) in PHC settings, but remained higher among urban, low-income and working-age populations.
Rahn, Rhonda N.; Pruitt, Buster; Goodson, Patricia
Objective: To analyze the literature in which researchers have utilized the National College Health Assessment (NCHA) I or the NCHA II. Participants and Methods: The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument…
Ali, Mir M; Teich, Judith L; Mutter, Ryan
Adolescents living in single-mother households are more likely to have behavioral health conditions, but are less likely to utilize any behavioral health services. Using nationally representative mother-child pair data pooled over 6 years from the National Survey on Drug Use and Health, the study finds that when single mothers were uninsured, their adolescent children were less likely to utilize any behavioral health services, even when the children themselves were covered by insurance. The extension of health coverage under the Affordable Care Act (ACA) to uninsured single mothers could improve the behavioral health of the adolescent population.
Chen, Shih-Neng; Tseng, Jauling
Objective: To assess various marginal effects of nutrient intakes, health behaviours and nutrition knowledge on the entire distribution of body mass index (BMI) across individuals. Design: Quantitative and distributional study. Setting: Taiwan. Methods: This study applies Becker's (1965) model of health production to construct an individual's BMI…
Brener, Nancy D.; Pejavara, Anu; McManus, Tim
Background: The School Health Index (SHI) is a tool designed to help schools assess the extent to which they are implementing practices included in the research-based guidelines and strategies for school health and safety programs developed by the Centers for Disease Control and Prevention (CDC). CDC previously analyzed data from the 2000 School…
Faith, Jennifer; Thorburn, Sheryl; Smit, Ellen
Objective: Individuals who experience or anticipate negative interactions from medical providers related to conditions such as obesity may preferentially use the Internet for health information. Our objectives in this study were to (1) examine the association between body mass index (BMI) and Internet health information-seeking and (2) examine…
Richmond, Tracy K.; Milliren, Carly; Walls, Courtney E.; Kawachi, Ichiro
Background: Social capital in neighborhoods and workplaces positively affects health. Less is known about the influence of school social capital on student health outcomes, in particular weight status. We sought to examine the association between individual- and school-level social capital and student body mass index (BMI). Methods: Analyzing data…
Adams, S.M. ); Brown, A.M. ); Goede, R.W. )
The health assessment index (HAI) is an extension and refinement of a previously published field necropsy system. The HAI is a quantitative index that allows statistical comparisons of fish health among data sets. Index variables are assigned numerical values based on the degree of severity or damage incurred by an organ or tissue from environmental stressors. This approach has been used to evaluate the general health status of fish populations in a wide range of reservoir types in the Tennessee River basin (North Carolina, Tennessee, Alabama, Kentucky), in Hartwell Reservoir (Georgia, South Carolina) that is contaminated by polychlorinated biphenyls, and in the Pigeon River (Tennessee, North Carolina) that receives effluents from a bleaches kraft mill. The ability of the HAI to accurately characterize the health of fish in these systems was evaluated by comparing this index to other types of fish health measures (contaminant, bioindicator, and reproductive analysis) made at the same time as the HAI. In all cases, the HAI demonstrated the same pattern of fish health status between sites as did each of the other more sophisticated health assessment methods. The HAI has proven to be a simple and inexpensive means of rapidly assessing general fish health in field situations. 29 refs., 5 tabs.
Sherwood-Puzzello, Catherine M.; Miller, Michelle; Lohrmann, David; Gregory, Patricia
Background: The Centers for Disease Control and Prevention's School Health Index (SHI), a guide for completing a coordinated school-based program needs assessment relative to healthy eating, physical activity, a tobacco-free lifestyle, and prevention of other health risk behaviors and conditions, was used to assess current programming at 3…
Kaplan, R M; Bush, J W; Berry, C C
The concept of validity as it applies to measures of health and health status is examined in the context of a set of standard, widely accepted definitions of validity. Criterion validity is shown to be irrelevant to health status measures because of the lack of a single specific, directly observable measure of health for use as a criterion. To overcome this problem, the Index of Well-being has been constructed to fulfill the definition of content validity by including all levels of function and symptom/problem complexes, a clearly defined relation to the death state, and consumer ratings of the relative desirability of the function levels. Data from a two-wave household interview survey provide convergent evidence of construct validity by demonstrating an expected positive correlation of the Index of Well-being with self-rated well-being and expected negative correlations with age, number of chronic medical conditions, number of reported symptoms or problems, number of physician contacts, and dysfunctional status. Discriminant evidence of construct validity is demonstrated by predicted differences in correlation between concurrent Index of Well-being scores and self-assessed overall health status, and between the Index of Well-being scores and self-rated well-being on different days. A simple method of estimating a currently usable comprehensive population index of health status, the Weighted Life Expectancy, is described. PMID:1030700
Butt, Thomas; Tufail, Adnan; Rubin, Gary
Health state utility values are a major source of uncertainty in economic evaluations of interventions for age-related macular degeneration (AMD). This review identifies and critiques published utility values and methods for eliciting de novo utility values in AMD. We describe how utility values have been used in healthcare decision making and provide guidance on the choice of utility values for future economic evaluations for AMD. Literature was searched using PubMed, and health technology assessments (HTA) were searched using HTA agency websites to identify articles reporting utility values or approaches to derive utility values in AMD and articles applying utilities for use in healthcare decision making relating to treatments for AMD. A total of 70 studies qualified for data extraction, 22 of which were classified as containing utility values and/or elicitation methods, and 48 were classified as using utility values in decision making. A large number of studies have elicited utility values for AMD, although those applied to decision making have focused on a few of these. There is an appreciation of the challenges in the measurement and valuation of health states, with recent studies addressing challenges such as the insensitivity of generic health-related quality of life (HRQoL) questionnaires and utility in the worse-seeing eye. We would encourage careful consideration when choosing utility values in decision making and an explicit critique of their applicability to the decision problem.
Marrying scientific and health research with natural resource management should be a straightforward process. However, differences in purpose, goals, language, levels of detail and implementation authority between the scientists who conduct research and resource managers who plan and implement projects make it difficult for resource managers to include information not specific to the problem at hand. One method to overcome this barrier is a Health Impact Assessment (HIA) or process that uses scientific data, health expertise and public input to factor public health considerations into the decision-making process. An HIA informs decision makers and stakeholders of the potential health effects of a proposed program, policy, project or plan through a systematic investigation of impacts to health and health determinants and deliberative engagement of community members and other stakeholders throughout the HIA process. USEPA will be conducting an HIA on the Minnesota Department of Natural Resources’ sediment remediation and habitat restoration project at Kingsbury Bay and Grassy Point. This poster outlines the HIA process, illustrates how technical and stakeholder committees inform the process, and presents the determinants of health that will be explored in the HIA. This poster will illustrate how a Health Impact Assessment, a process that uses scientific data, health expertise and public input to factor public health considerations into the decision-making proces
Nakonezny, Paul A.; Ojeda, Michael
Purpose: Our purpose in the current study was to examine the relationship between health services utilization delivered by means of the Homeless Outreach Medical Services (HOMES) program and health services utilization delivered by means of the Parkland emergency room and inpatient units among a sample of older and younger homeless adults being…
Iecovich, Esther; Carmel, Sara
To examine differences in health and functional status and in utilization of health services between holocaust survivors and their counterparts; and (b) to investigate if holocaust survivor status is a significant predictor of health status, functional status, and utilization of health services. The study included 1255 respondents of whom 272 were holocaust survivors. Interviews were conducted face-to-face at the respondents' homes. Participants were asked about their health (self-rated health and comorbidity) and functional (ADL and IADL) status, utilization of inpatient and outpatient health care services, age, gender, education, marital status, length of residence in Israel, and if they were holocaust survivors. Holocaust survivors, who were frailer and more chronically ill compared to their counterparts, visited their family physician and the nurse at the health care clinic more often than their counterparts did, and received more homecare services. Yet, there were no differences between them in the utilization of other health care services such as visits to specialists, emergency department, and hospitalizations. Holocaust survivors are more homebound due to more morbidity and functional limitations and therefore receive more health home care services that offset the utilization of other health services.
Ormond, Gillian; Murphy, Rosemary
This paper presents a study of the effect of alcohol consumption on individual health status and health care utilization in Ireland using the 2007 Slán National Health and Lifestyle Survey, while accounting for the endogenous relationship between alcohol and health. Drinkers are categorized as those who never drank, non-drinkers, moderate drinkers, or heavy drinkers, based on national recommended weekly drinking levels in Ireland. The drinking-status equation is estimated using an ordered probit model. Predicted values for the inverse mills ratio are generated, which are then included in the health and health-care utilization equations. Differences in health status for each category of drinker are examined, and the relationship between both alcohol consumption and health with a host of other personal and socio-economic variables is also identified. Given that the measure of health status available is self-assessed, the effect of alcohol consumption on health-care utilization is also analyzed as an alternative measure of health. Findings show that in Ireland, moderate drinkers enjoy the best health status. More moderate drinkers report having very good or excellent health compared with heavy drinkers, non-drinkers, or those who never drank. While heavy drinkers do not report having as good a health status as moderate drinkers, they are better off in terms of health when compared with non-drinkers and those who are lifetime abstainers.
Benissa, Mohamed-Rida; Khirani, Sonia; Hartley, Sarah; Adala, Annie; Ramirez, Adriana; Fernandez-Bolanos, Marta; Quera-Salva, Maria-Antonia; Fauroux, Brigitte
Polysomnography (PSG) is the gold standard for the analysis of sleep architecture but is not always available in routine practice, as it is time consuming and cumbersome for patients. Bispectral index (BIS), developed to quantify the deepness of general anesthesia, may be used as a simplified tool to evaluate natural sleep depth. We objectively recorded sleep architecture in young patients using the latest BIS Vista monitor and correlated BIS values with PSG sleep stages in order to determine BIS thresholds. Patients, referred for the screening of sleep apnea/hypopnea syndrome or differential diagnosis of hypersomnia were recruited. Overnight PSG and BIS were performed simultaneously. BIS values were averaged for each sleep stage. Pre-sleep wakefulness (W) and wake after sleep onset (WASO) were also differentiated. BIS values were discarded for a signal quality index <90 %. ROC curves were plotted to discriminate sleep stages from each other. Twelve patients (5.7-29.3 years old) were included. Mean BIS values were 83 ± 8, 76 ± 12, 77 ± 11, 70 ± 10, 43 ± 10, and 75 ± 10 for W, WASO, N1, N2, N3 and R (REM) stages, respectively. BIS failed to distinguish W, WASO, N1 and R stages. BIS threshold that identified stage N2 was <73 (AUC = 0.784, p < 0.001) with low sensitivity (75 %) and poor specificity (64 %). BIS threshold that identified stage N3 was <55 (AUC = 0.964, p < 0.001) with an 87 %-sensitivity and a 93 %-specificity. BIS identified stage N3 with satisfactory sensitivity and specificity but is limited by its inability to distinguish REM sleep from wake. Further studies combining BIS with chin electromyogram and/or electrooculogram could be of interest.
Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Oweis, Arwa; Al Ward, Nada; Burton, Ann
Introduction The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings. Methods A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Results Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications. Discussion Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs. PMID:27073930
Background Health care systems initiating major behavioral health programs often face challenges with variable implementation and uneven patient engagement. One large health care system, Veterans Health Administration (VHA), recently initiated the MOVE!® Weight Management Program, but it is unclear if veterans most in need of MOVE!® services are accessing them. The purpose of this study was to examine patient and facility factors associated with MOVE!® utilization (defined as 1 or more visits) across all VHA facilities. Methods Using national administrative data in a retrospective cohort study of eligible overweight (25 < = body mass index (BMI) < 30 and at least one obesity associated comorbidity) and obese (BMI > =30) VHA outpatients, we examined variation in and predictors of MOVE!® utilization in fiscal year (FY) 2010 using generalized linear mixed models. Results 4.39% (n = 90,230) of all eligible overweight and obese patients using VHA services utilized MOVE!® services at least once in FY 2010. Facility-level MOVE! Utilization rates ranged from 0.05% to 16%. Veterans were more likely to have at least one MOVE!® visit if they had a higher BMI, were female, unmarried, younger, a minority, or had a psychiatric or obesity-related comorbidity. Conclusions Although substantial variation exists across VHA facilities in MOVE!® utilization rates, Veterans most in need of obesity management services were more likely to access MOVE!®, although at a low level. However, there may still be many Veterans who might benefit but are not accessing these services. More research is needed to examine the barriers and facilitators of MOVE!® utilization, particularly in facilities with unusually high and low reach. PMID:24325730
Probst, Janice C.; Moore, Charity G.; Baxley, Elizabeth G.
Context: Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. Purpose: To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. Methods:…
Copeland, Valire Carr
Despite remarkable improvements in the overall health of the nation during the past two decades, compelling evidence suggests that the nation's racial and ethnic minority Americans suffer increasing disparities in the incidence, prevalence, mortality, and burden of diseases and adverse health outcomes compared with white Americans. The 1998…
adjunctive dental care, cataract removals, mental health, MRIs, and pregnancy excluding active labor and cesarean section . However, these procedures may not...cataracts, - mental health, and - pregnancy excluding active labor or scheduled cesarean section . In addition, the prospective reviews are required for...i Section A: General Information ................................................. I B ackground
Marrying scientific and health research with natural resource management should be a straightforward process. However, differences in purpose, goals, language, levels of detail and implementation authority between the scientists who conduct research and resource managers who plan and implement projects make it difficult for resource managers to include information not specific to the problem at hand. One method to overcome this barrier is a Health Impact Assessment (HIA) or process that uses scientific data, health expertise and public input to factor public health considerations into the decision-making process. An HIA informs decision makers and stakeholders of the potential health effects of a proposed program, policy, project or plan through a systematic investigation of impacts to health and health determinants and deliberative engagement of community members and other stakeholders throughout the HIA process. USEPA will be conducting an HIA on the Minnesota Department of Natural Resources’ sediment remediation and habitat restoration project at Kingsbury Bay and Grassy Point. This poster outlines the HIA process, illustrates how technical and stakeholder committees inform the process, and presents the determinants of health that will be explored in the HIA. not applicable
Lim, Byung Gun; Lee, Il Ok; Kim, Young Sung; Won, Young Ju; Kim, Heezoo; Kong, Myoung Hoon
Abstract Background: This study was designed to determine whether a deep hypnotic state with a bispectral index (BIS) value less than 40 could alleviate withdrawal movement (WM) upon rocuronium injection during anesthesia induction in children. Methods: Finally, 135 healthy children (3–12 years) scheduled for minor elective surgery were studied. Without premedication, anesthesia was induced with thiopental sodium 5 mg/kg. Patients were randomized into 2 groups (control vs experimental) and then by virtue of rocuronium injection time, patients in the experimental group were allocated into 2 groups, as follows: in the control group (group C; n = 45), rocuronium 0.6 mg/kg was administered at the loss of eyelash reflex; in the 1st experimental group, rocuronium 0.6 mg/kg was administered when BIS fell to less than 40 (group T; n = 45); however, if BIS did not fall below 40 after thiopental sodium administration, manual ventilation was provided with oxygen 6 L/minute using sevoflurane 8% and then rocuronium was administered when BIS fell below 40 (the 2nd experimental group, group S; n = 45). Rocuronium-induced WM was evaluated using a 4-point scale (no movement; movement/withdrawal involving the arm only; generalized response, with movement/withdrawal of more than 1 extremity, but no requirement for restraint of the body; and generalized response which required restraint of the body and caused coughing or breath-holding). Results: No significant differences were found among the groups for patient characteristics including age, sex, height, and location of venous cannula. However, body weight, height, and body mass index in group S were all smaller than those in group T. The incidence of WM caused by rocuronium was 100% in group C, 95.6% in group T, and 80% in group S, and was significantly lower in group S than in group C. The grade of WM was 3.7 ± 0.6 in group C, 3.2 ± 0.9 in group T, and 2.6 ± 1.0 in group S. It was significantly
Wong, Albert; Wouterse, Bram; Slobbe, Laurentius C J; Boshuizen, Hendriek C; Polder, Johan J
Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends in health care utilization are presented for different health care sectors in the Netherlands, for the period 1981-2009. For the hospital sector we also explore the link between these trends and the state of medical technology. Using aggregated data from a Dutch health survey and a nationwide hospital register, regression analysis was used to examine age-specific trends in the probability of utilizing health care. To determine the influence of medical technology, the growth in age-specific probabilities of hospital care was regressed on the number of medical patents while adjusting for confounders related to demographics, health status, supply and institutional factors. The findings suggest that for most health care sectors, the trend in the probability of health care utilization is highest for ages 65 and up. Larger advances in medical technology are found to be significantly associated with a higher growth of hospitalization probability, particularly for the higher ages. Age-specific trends will raise questions on the sustainability of intergenerational solidarity in health care, as solidarity will not only be strained by the ageing population, but also might find itself under additional pressure as the gap in health care utilization between elderly and non-elderly grows over time. For hospital care utilization, this process might well be accelerated by advances in medical technology.
Zhang, Liangliang; Zhu, Josh; Fang, Shiyuan; Cheng, Tim; Hong, Chloe; Shah, Nigam H
Background By recent estimates, the steady rise in health care costs has deprived more than 45 million Americans of health care services and has encouraged health care providers to better understand the key drivers of health care utilization from a population health management perspective. Prior studies suggest the feasibility of mining population-level patterns of health care resource utilization from observational analysis of Internet search logs; however, the utility of the endeavor to the various stakeholders in a health ecosystem remains unclear. Objective The aim was to carry out a closed-loop evaluation of the utility of health care use predictions using the conversion rates of advertisements that were displayed to the predicted future utilizers as a surrogate. The statistical models to predict the probability of user’s future visit to a medical facility were built using effective predictors of health care resource utilization, extracted from a deidentified dataset of geotagged mobile Internet search logs representing searches made by users of the Baidu search engine between March 2015 and May 2015. Methods We inferred presence within the geofence of a medical facility from location and duration information from users’ search logs and putatively assigned medical facility visit labels to qualifying search logs. We constructed a matrix of general, semantic, and location-based features from search logs of users that had 42 or more search days preceding a medical facility visit as well as from search logs of users that had no medical visits and trained statistical learners for predicting future medical visits. We then carried out a closed-loop evaluation of the utility of health care use predictions using the show conversion rates of advertisements displayed to the predicted future utilizers. In the context of behaviorally targeted advertising, wherein health care providers are interested in minimizing their cost per conversion, the association between show
Among the many important services that the American Association of Variable Star Observers (AAVSO) provides to the astronomical community is the Variable Star Index (VSX - https://www.aavso.org/vsx/). This online catalog of variable stars is the repository of data on over 334,000 variable stars, including information on spectral type, range of magnitude, period, and type of variable, among other properties. A number of these stars were identified as being variable through automated telescope surveys, such as ASAS (All Sky Automated Survey). The computer code of this survey classified newly discovered variables as best it could, but a significant number of false classifications have been noted. The reclassification of ASAS variables in the VSX data, as well as a closer look at variables identified as miscellaneous type in VSX, are two of many projects that can be undertaken by interested undergraduates. In doing so, students learn about the physical properties of various types of variable stars as well as statistical analysis and computer software, especially the VStar variable star data visualization and analysis tool that is available to the astronomical community free of charge on the AAVSO website (https://www.aavso.org/vstar-overview). Two such projects are described in this presentation, the first to identify BY Draconis variables erroneously classified as Cepheids in ASAS data, and the second to identify SRD semiregular variables misidentified as "miscellaneous" in VSX.
(Abstract only) Among the many important services that the American Association of Variable Star Observers (AAVSO) provides to the astronomical community is the Variable Star Index (VSX; https://www.aavso.org/vsx/). This online catalog of variable stars is the repository of data on over 334,000 variable stars, including information on spectral type, range of magnitude, period, and type of variable, among other properties. A number of these stars were identified as being variable through automated telescope surveys, such as ASAS (All Sky Automated Survey). The computer code of this survey classified newly discovered variables as best it could, but a significant number of false classifications have been noted. The reclassification of ASAS variables in the VSX data, as well as a closer look at variables identified as miscellaneous type in VSX, are two of many projects that can be undertaken by interested undergraduates. In doing so, students learn about the physical properties of various types of variable stars as well as statistical analysis and computer software, especially the vstar variable star data visualization and analysis tool that is available to the astronomical community free of charge on the AAVSO website (https://www.aavso.org/vstar-overview). Three such projects are described in this presentation, to identify BY Draconis variables misidentified as Cepheids or "miscellaneous", and SRD semiregular variables and ELL (rotating ellipsoidal) variables misidentified as "miscellaneous", in ASAS data and VSX.
The study comprised modification of the Canadian Council of Ministers of the Environment (CCME) Water Quality Index (CCMEWQI) to obtain a tool in classification of surface waters according to quality defined by the European Legislation-75/440/EEC. Three categories were proposed, and the category ranges of CCMEWQI have been modified depending on the objective chosen. The application of the CCMEWQI with modified categorization scheme was demonstrated to assess overall water quality by integrating observed water quality determinants in the Kucuk Menderes Basin, Turkey. In this scope, the samples analyzed for pH, total dissolved solids (TDS), chlorides (Cl), nitrate-nitrogen (NO3-N), dissolved oxygen (DO), biochemical oxygen demand (BOD5), sulfate (SO4), and boron (B), variables taken monthly over 2 years from the five monitoring sites, were processed. Results revealed that the overall surface water mainly fell within the A2 water class. The CCMEWQI with modified categorization scheme is believed to assist water managers to integrate and interpret the picture of overall water quality based on the European legislation concerning the quality required of surface water intended for the abstraction of drinking water in the Member States (75/440/EEC).
A good understanding of the health heterogeneity of elderly people, their characteristics, patterns of health care utilization and subsequent expenditures is necessary to adequately evaluate the policy options and interventions aimed at improving quality and efficiency of care for older people. This article reviews studies that used Latent Class Analysis to identify four health profiles among elderly people in Taiwan: High Comorbidity (HC), Functional Impairment (FI), Frail (FR), and Relatively Healthy (RH). Variables associated with increased likelihood of being in the FR group were older age, female gender, and living with one’s family, and these also correlated with ethnicity and level of education. The HC group tended to use more ambulatory care services compared with those in the RH group. The HC group tended to be younger, better educated, and was more likely to live in urban areas than were people in the FI group. The FI group, apart from age and gender, was less likely be of Hakka ethnicity and more likely to live with others than were individuals in the RH group. The FI group had relatively high probabilities of needing assistance, and the FR group had higher healthcare expenditures. A person-centered approach would better satisfy current healthcare needs of elderly people and help forecast future expenditures. PMID:24473113
Morrisey, M A
This note focuses on the role of the personal income tax in reducing the effective price of health care benefits. Tax-bracket creep is shown to provide a cushion that absorbs relatively large increases in health benefit costs, thus reducing the impetus for employer initiatives to control health care costs. It is hypothesized that the Economic Recovery Tax Act of 1981, with its provision for the indexing of tax brackets, will increase employer concern, and may therefore spur the development of effective employer initiatives to reduce the costs of health benefits.
Studies document numerous threats to human health exacerbated by multiple factors, including inadequate access to health-related information. The Internet has developed as one resource to provide health information; however, there remains a significant gap in understanding how personality differences influence the use and perceived utility of the…
Feldman, Steven R.; Vallejos, Quirina M.; Quandt, Sara A.; Fleischer, Alan B., Jr.; Schulz, Mark R.; Verma, Amit; Arcury, Thomas A.
Context: Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. Purpose: Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods: Three hundred and four migrant…
Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.
Context: Mexico. Purpose: Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods: The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's "model of health…
This study investigated the association of the Wealth Index of married women in Egypt with a number of gender and reproductive health issues found in the 2005 Egypt Demographic Health Survey. The data from a subsample of 5249 currently married women from a total of 19,474 was examined using logistic regression analysis. The women's lowest wealth quintile predicted the intention to continue female genital cutting for their daughters, exposure to physical and sexual marital violence, not being empowered in household decisions, having a higher number of children, having an unintended last child, mothers' maltreatment of their children, the perception of a lack of health-care providers or drugs as an obstacle to receiving care, and not being covered by health insurance. The association of poverty with the aforementioned adverse health outcomes are discussed. Physicians should understand the effect of poverty on health and endeavour to influence policy-makers to reduce the poverty burden on health.
Brener, Nancy D; Pejavara, Anu; Barrios, Lisa C; Crossett, Linda; Lee, Sarah M; McKenna, Mary; Michael, Shannon; Wechsler, Howell
The School Health Index (SHI) is a self-assessment and planning tool that helps individual schools identify the strengths and weaknesses of their health policies and programs. To determine the percentage of US schools meeting the recommendations in the SHI, the present study analyzed data from the School Health Policies and Programs Study (SHPPS) 2000. The SHPPS 2000 data were collected through computer-assisted personal interviews with faculty and staff in a nationally representative sample of schools. The SHPPS 2000 questions were then matched to SHI items to calculate the percentage of schools meeting the recommendations in 4 areas: school health and safety policies and environment, health education, physical education and other physical activity programs, and nutrition services. Although schools nationwide are meeting a few SHI items in each of these areas, few schools are addressing the entire breadth of items. A more coordinated approach to school health would help schools reinforce health messages.
Manheim, Larry M.; Dunlop, Dorothy; Song, Jing; Semanik, Pamela; Lee, Jungwha; Chang, Rowland W.
Objective To estimate the relationship between physical activity and health-related utility for people with knee OA and implications for designing cost effective interventions. Methods Use GEE regression analysis to estimate partial association of accelerometer-measured physical activity levels with health-related utility after controlling for demographics, health status, knee OA severity level, pain and functioning. Results Moving from lowest to middle tertile of physical activity levels is associated with .071 (p<.01) increase in health-related utility after controlling for demographics and .036 (p<.05) increase in utility after controlling for demographics, health status, knee OA severity level, weight, pain, and functional impairments. Conclusion Intervention programs that move individuals out of the lowest tertile of physical activity have the potential to be cost effective. PMID:22328141
Vargas Bustamante, Arturo; Fang, Hai; Rizzo, John A; Ortega, Alexander N
This study hypothesizes that differences in health care access and utilization exist across Latino adults (>18 years), with U.S. Latino adults of Mexican ancestry demonstrating the worst patterns of access and utilization. The analyses use the National Health Interview Survey (NHIS) data from 1999 to 2007 (N = 33,908). The authors first estimate the disparities in health care access and utilization among different categories of Latinos. They also implement Blinder-Oaxaca techniques to decompose disparities into observed and unobserved components, comparing Latinos of Mexican ancestry with non-Mexican Latinos. Latinos of Mexican ancestry consistently demonstrate lower health care access and utilization patterns than non-Mexican Latinos. Health insurance and region of residence were the most important factors that explained observable differences. In contrast, language and citizenship status were relatively unimportant. Although a significant share of these disparities may be explained by observed characteristics, disparities because of unobserved heterogeneity among the different Latino cohorts are also considerable.
van der Linde, C; de Jong, G; Koenen, E P C; Eding, H
The purpose of this study was to develop a model for a routine genetic evaluation of claw health traits and to develop an index including data on claw health and conformation traits. Claw health data comprised observations on 40,536 dairy cows of claw traits recorded by claw trimmers. Claw health traits scored were sole hemorrhage (SH), digital dermatitis (DD), interdigital dermatitis (ID), wall ulcer (WU), sole ulcer (SU), interdigital hyperplasia (IH), and white line disease (WL). A combined claw health trait was added as a trait to the data, combining all claw disorders. Observations on 5 feet and leg conformation traits on 41,048 animals were evaluated as predictive traits for claw health. These conformation traits were rear leg side view, rear leg rear view, foot angle, locomotion, and feet and legs. Prevalence of claw disorders ranged from 3% (WU) to 38% (SH). Overall, 69% of the animals had at least one claw disorder. Estimated heritabilities for claw health traits ranged from 0.01 (WU) to 0.13 (IH), and repeatabilities (within and across lactation) ranged from 0.15 (WU) to 0.57 (IH). Genetic correlations of claw health traits in parity 1 and parities ≥2 ranged from 0.72 to 1.00. Estimated genetic correlations among claw health traits ranged from -0.35 to 0.88 and between claw health and conformation traits ranged from -0.58 to 0.41. The breeding goal for claw health was to reduce costs due to claw disorders. The economic index for claw health, which included claw health and feet and leg conformation traits, had a reliability of 59% for an average progeny-tested bull in the Netherlands. The prevalence of claw disorders can be reduced up to 0.7% per year with selection on claw health only.
Mehta, Jyotsna; Wang, Hongwei; Fryzek, Jon P; Iqbal, Sheikh Usman; Mesa, Ruben
Myelofibrosis (MF), polycythemia vera (PV) and essential thrombocythemia (ET) may lead to bone marrow fibrosis. Because the disease course of ET and PV are long and the disease course of MF may be fatal, healthcare resource utilization (HRU) associated costs of these neoplasms are especially important to understand. We used a large US health insurance claim database to describe the costs of these diseases. Compared to age-gender matched comparisons without myeloproliferative neoplasms (MPN), all aspects of HRU that we examined, including inpatient, outpatient and emergency room visits and pharmacy, as well as overall healthcare expenditures, were significantly higher in patients with MF, PV and ET (e.g. MF total costs = $54 168 vs. $10 203; PV = $14 903 vs. $7913; ET = $29 553 vs. $8026) than in matched comparisons. In order to reduce the burden of illness associated with these diseases, continued efforts in the development of more efficacious treatments for these disorders are needed.
Jenkins, Marion W.; Freeman, Matthew C.; Routray, Parimita
Methods to assess household excreta disposal practices are critical for informing public health outcomes of efforts to improve sanitation in developing countries. We present a new metric, the Safe San Index (SSI), to quantify the hygienic safety of a household’s defecation and human feces disposal practices in India, where behavioral outcomes from on-going public expenditures to construct household sanitation facilities and eliminate open defecation are poorly measured. We define hygienic safety of feces disposal as capture in a hygienic sanitation facility. The SSI consists of 15 self-report items and two sub-scales, Latrine Use Frequency and Seven-Day Open Defecation Rate. Households are scored on a standardized scale from 0 (no defecation safely captured) to 100 (all defecation safely captured). We present results of a pilot study in Odisha, India to apply the Index to assess excreta disposal behaviors among rural households and evaluate the reliability and validity of the Index for estimating the rate of correct and consistent sanitation facility usage of household with an improved latrine. PMID:25153464
Jenkins, Marion W; Freeman, Matthew C; Routray, Parimita
Methods to assess household excreta disposal practices are critical for informing public health outcomes of efforts to improve sanitation in developing countries. We present a new metric, the Safe San Index (SSI), to quantify the hygienic safety of a household's defecation and human feces disposal practices in India, where behavioral outcomes from on-going public expenditures to construct household sanitation facilities and eliminate open defecation are poorly measured. We define hygienic safety of feces disposal as capture in a hygienic sanitation facility. The SSI consists of 15 self-report items and two sub-scales, Latrine Use Frequency and Seven-Day Open Defecation Rate. Households are scored on a standardized scale from 0 (no defecation safely captured) to 100 (all defecation safely captured). We present results of a pilot study in Odisha, India to apply the Index to assess excreta disposal behaviors among rural households and evaluate the reliability and validity of the Index for estimating the rate of correct and consistent sanitation facility usage of household with an improved latrine.
Murawiec, Sławomir; Krysta, Krzysztof
The Mental Health Integration Index developed by the Economist Intelligence Unit describes and explores the challenges of European countries of integrating people with mental illness into society and employment, within the European Union's 28 Member States, plus Norway and Switzerland. Countries have been ranked according to estimation based on indicators of their degree of commitment to support those living with mental illness into society and employment. The Index is based on a list of indicators including the environment for those with mental illness, their access to medical help and services, their opportunities--specifically job-related--and the governance of the system, including human rights issues and efforts to combat stigma. The indicators were developed in consultation with a panel of independent experts on mental health. Key findings of the research are that Germany's strong healthcare system and generous social provision put it at the top of the Index, with the UK and Scandinavian states not far behind. However, examples of best practice "islands of excellence" in integration are not limited to the leading countries and exists in all European Countries. The Index reveals also the discrepancy between perfect legislation and poor implementation of it in practice in many European countries. It proposes that the investment figure is a proxy for seriousness in establishing good policy and practice. According to the Index some reform plans including entire national mental health programmes are largely aspirational and are grossly under-funded. Moreover various levels of government responsible for the implementation of its component parts are largely ignoring its implementation. When we consider the legislation as an promise to professionals and people with mental health problems, this promise is largely unfulfilled. The is a need for strong leadership in mental health changes process, policy capacity and real financial investments in the way of The European
Hochart, Cindy; Lang, Michelle
In 2005, Blue Cross Blue Shield of Kansas City initiated a comprehensive worksite wellness program designed to impact employer culture and to assist healthy employees to stay at low risk and to reduce risk levels for those at moderate or high risk. Fifteen employer groups (9637 employees) participated in the A Healthier You (AHY) program for 3 consecutive years, 2006-2008. The results of health risk appraisals and biometric screening were used to evaluate program impact. Among the 4230 employees (44.0% of eligible employees) who completed health risk appraisals in all 3 years, 85.8% of individuals in the low-risk category in 2006 remained at low risk in 2008. There were also improvements in other risk categories, with 39.9% of those in the medium-risk category and 48.9% of those in the high-risk category in 2006 moving to a lower risk category in 2008. There were improvements in blood pressure control and total cholesterol, but no improvement in weight control. To assess financial and utilization outcomes, claims for the participating employer groups were compared to those for 7 employers (3800 employees) who did not participate in AHY in 2006-2008. Although none of the utilization measures was statistically different, the AHY groups had significantly smaller increases in both overall and emergency room costs per member per month. The AHY program now has over 180 employer groups, which will allow future evaluations to examine the impact of the program on a much larger population and to focus on the comparative effectiveness of different intervention strategies across implementations.
Sun, Feng-Hua; Wong, Stephen Heung-Sang; Huang, Ya-Jun; Chen, Ya-Jun; Tsang, Ka-Fai
The purpose of the present study was to investigate whether both glycemic index (GI) and fructose content of a pre-exercise meal would affect substrate utilization during subsequent brisk walking. Ten healthy young males completed 60 min of 46% [Formula: see text] brisk walking 2 h after they consumed one of three breakfasts: a low-GI meal without fructose (LGI), a low-GI meal including fructose (LGIF), and a high-GI meal without fructose (HGI). The calculated GI values for the three meals were 41, 39, and 72, respectively. Substrate utilization was measured using indirect respiratory calorimetry method. During the postprandial period, the incremental area under the blood response curve values of glucose and insulin were higher in the HGI trial, compared with those in the LGI and LGIF trials (HGI vs. LGI and LGIF: Glucose 223.6 ± 19.1 vs. 70.2 ± 7.4 and 114.1 ± 16.4 mmol min L(-1); Insulin 4257 ± 932 vs. 920 ± 319 and 1487 ± 348 mU min L(-1)). During exercise, substrate preference was distinct based on different pre-exercise carbohydrate meals. Higher fat and lower carbohydrate oxidation was observed in the LGI trial, whereas both the HGI and LGIF trials were characterized by higher carbohydrate and lower fat oxidation (LGI vs. LGIF and HGI: Carbohydrate 59.3 ± 2.4 vs. 69.8 ± 3.9 and 72.7 ± 3.9 g; Fat 22.7 ± 2.0 vs. 18.5 ± 1.7 and 17.6 ± 1.3 g; P < 0.05). In conclusion, the presence of fructose in a LGI breakfast resulted in similar substrate utilization during subsequent brisk walking with that induced by a HGI breakfast. It appears that both the GI and fructose content in a breakfast individually affect substrate utilization during subsequent moderate intensity exercise.
Dahnke, Michael D.
Codes of ethics abound in health care, the aims and purposes of which are multiple and varied, from operating as a decision making tool to acting as a standard of practice that can be operational in a legal context to providing a sense of elevated seriousness and professionalism within a field of practice. There is some doubt and controversy,…
This syllabus for a continuing education course describes the OCLC system and considers how it can be used by health science libraries. The general governance and administrative structure of OCLC and its network affiliates are detailed, and the OCLC subsystems--online union catalog, serials, interlibrary loan, and acquisitions--and their major…
Vural, Fisun; Yildirim, Filiz; Vural, Birol
OBJECTIVE: Postnatal care is an important issue in maintaining and promoting maternal and neonatal health. However, utilization of postpartum maternal health care services is at a low rate in many countries. This study was aimed to investigate the impact of integrated obstetric and neonatal services on utilization rates of postnatal health care service among mothers. METHODS: This study was performed among a total of 4193 mothers who gave birth at Maternity Unit of Golcuk Necati Celik State Hospital of Kocaeli Province between 2010 and 2013. All mothers were called back to postnatal care clinic (PNC) for newborn hearing test (NHT) screenings, neonatal and maternal care within two weeks after delivery. The deliveries after, (n=3093) and before (n=1100) utilization of integrated services were compared as for postnatal service utilization rates. RESULTS: Utilization rates of neonatal health care, NHT and postpartum maternal health care services significantly increased after implementation of integrated services (p<0.0001). Especially maternal service utilization rates increased from 34% to 99 percent. CONCLUSION: Integration of newborn and maternal health care services as a unit increases the utilization of PNC services. PMID:28058353
Andreas, Darian; Tosoian, Jeffrey J; Landis, Patricia; Wolf, Sacha; Glavaris, Stephanie; Lotan, Tamara L; Schaeffer, Edward M; Sokoll, Lori J; Ross, Ashley E
The Prostate Health Index (phi) has been FDA approved for decision-making regarding prostate biopsy. Phi has additionally been shown to positively correlate with tumor volume, extraprostatic disease and higher Gleason grade tumors. Here we describe a case in which an elevated phi encouraged biopsy of a gentleman undergoing active surveillance leading to reclassification of his disease as high risk prostate cancer.
Considerable epidemiologic evidence links consuming lower glycemic index (GI) diets with good health, particularly upon aging. The GI is a kinetic parameter that reflects the ability of carbohydrate (CHO) contained in consumed foods to raise blood glucose in vivo. Newer nutritional, clinical, and ex...
Nowotny, Kathryn M
This study examines the demographic and social factors related to health care utilization in prisons using the 2004 Survey of Inmates in State Correctional Facilities. The findings show that education and employment, strong predictors of health care in the community, are not associated with health care in prisons. Although female inmates have a higher disease burden than male inmates, there are no sex differences in health care usage. The factors associated with health care, however, vary for women and men. Notably, Black men are significantly more likely to utilize health care compared to White and Latino men. The findings suggest that, given the constitutionally mandated health care for inmates, prisons can potentially minimize racial disparities in care and that prisons, in general, are an important context for health care delivery in the United States.
Halpern, Benjamin S; Longo, Catherine; Hardy, Darren; McLeod, Karen L; Samhouri, Jameal F; Katona, Steven K; Kleisner, Kristin; Lester, Sarah E; O'Leary, Jennifer; Ranelletti, Marla; Rosenberg, Andrew A; Scarborough, Courtney; Selig, Elizabeth R; Best, Benjamin D; Brumbaugh, Daniel R; Chapin, F Stuart; Crowder, Larry B; Daly, Kendra L; Doney, Scott C; Elfes, Cristiane; Fogarty, Michael J; Gaines, Steven D; Jacobsen, Kelsey I; Karrer, Leah Bunce; Leslie, Heather M; Neeley, Elizabeth; Pauly, Daniel; Polasky, Stephen; Ris, Bud; St Martin, Kevin; Stone, Gregory S; Sumaila, U Rashid; Zeller, Dirk
The ocean plays a critical role in supporting human well-being, from providing food, livelihoods and recreational opportunities to regulating the global climate. Sustainable management aimed at maintaining the flow of a broad range of benefits from the ocean requires a comprehensive and quantitative method to measure and monitor the health of coupled human–ocean systems. We created an index comprising ten diverse public goals for a healthy coupled human–ocean system and calculated the index for every coastal country. Globally, the overall index score was 60 out of 100 (range 36–86), with developed countries generally performing better than developing countries, but with notable exceptions. Only 5% of countries scored higher than 70, whereas 32% scored lower than 50. The index provides a powerful tool to raise public awareness, direct resource management, improve policy and prioritize scientific research.
Diawara, A; Sangho, H; Maiga, D; Kone, A B D; Maiga, M D; Simaga, S Y
The rationalization of the prescription and the good use of the drugs generally constitute a major problem in the health facilities. The present survey led in November 2002 in Mali assessed the practices of prescription and the use of the drugs by the populations. The indicators of drugs use rational have been measured from 600 drawn prescriptions randomly select at the level of 20 community health center (CSCOM) retained at random in the regions of Ségou, Sikasso, Mopti and the District of Bamako. The means of drugs by order (2.8), the percentages of prescription with antibiotic (61.6%) and injectable drugs (35%) are raised in relation to the normative values of WHO (Wold Health Organization). The rate of conformity to the treatments standardized estimated on exploitation of consultations registers in the centers is estimated to 0.5% for the simple diarrhoea, 13.5% for the acute respiratory infections (ARI) without pneumonia and 60.5% for the pneumonia. On 293 patients in the households our survey permitted to estimate to 84.6% the observance of the treatment by the persons having bought the prescribed drugs totality. The percentage of antibiotics prescription and injectable drugs, and the big insufficiency in the non respect of the treatment standard constitutes some practices potentially to high risk justifying the necessity of an urgent training to the rational prescription.
Hao, Yanni; Wolfram, Verena; Cook, Jennifer
Background Health utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies. Methods Searches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases), online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center), and web sites of health technology assessment (HTA) bodies. Publications were selected based on the search strategy and the overall study objectives. Results A total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D). Other utility measures, such as the direct methods standard gamble (SG), time trade-off (TTO), and visual analog scale (VAS), were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL) instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer 23 (EORTC QLQ-BR23), Functional Assessment of Cancer Therapy – General questionnaire (FACT-G), and Utility-Based Questionnaire-Cancer (UBQ-C); most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex, income, and education, as well as disease progression, choice of utility elicitation method, and country settings, were identified
Coca Perraillon, Marcelo; Shih, Ya-Chen Tina; Thisted, Ronald A.
Background. When data on preferences are not available, analysts rely on condition-specific or generic measures of health status like the SF-12 for predicting or mapping preferences. Such prediction is challenging because of the characteristics of preference data, which are bounded, have multiple modes, and have a large proportion of observations clustered at values of 1. Methods. We developed a finite mixture model for cross-sectional data that maps the SF-12 to the EQ-5D-3L preference index. Our model characterizes the observed EQ-5D-3L index as a mixture of 3 distributions: a degenerate distribution with mass at values indicating perfect health and 2 censored (Tobit) normal distributions. Using estimation and validation samples derived from the Medical Expenditure Panel Survey 2000 dataset, we compared the prediction performance of these mixture models to that of 2 previously proposed methods: ordinary least squares regression (OLS) and two-part models. Results. Finite mixture models in which predictions are based on classification outperform two-part models and OLS regression based on mean absolute error, with substantial improvement for samples with fewer respondents in good health. The potential for misclassification is reflected on larger root mean square errors. Moreover, mixture models underperform around the center of the observed distribution. Conclusions. Finite mixtures offer a flexible modeling approach that can take into account idiosyncratic characteristics of the distribution of preferences. The use of mixture models allows researchers to obtain estimates of health utilities when only summary scores from the SF-12 and a limited number of demographic characteristics are available. Mixture models are particularly useful when the target sample does not have a large proportion of individuals in good health. PMID:25840902
Shen, Shiwei; Lu, Yun; Qi, Huajin; Li, Feng; Shen, Zhenhai; Wu, Liuxin; Yang, Chengjian; Wang, Ling; Shui, Kedong; Wang, Yaping; Qiang, Dongchang; Yun, Jingting; Weng, Xiaofeng
Abstract The American Heart Association aims to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health behaviors and factors. The atherogenic index of plasma (AIP) is an important index. Our aim is to evaluate the relationship between ideal cardiovascular health and the atherogenic index of plasma (AIP) in middle-aged Chinese men. A cross-sectional study was performed. A total of 27,824 middle-aged Chinese men were enrolled. The association between ideal cardiovascular health behaviors and factors and AIP was determined. The 7 cardiovascular health metrics were scored as follows: 0, poor; 1, general; and 2, ideal. The cardiovascular health status was classified according to the total score, as follows: 0 to 4, inadequate; 5 to 9, average; and 10 to 14, optimum. Analyses assessed the prevalence of 7 cardiovascular health metrics, its association with AIP. Logistic regression models were used to calculate odds ratios (ORs), adjusting for age. All 7 cardiovascular health metrics were shown to correlate with AIP (all P values < 0.05), and the strongest correlation existed between body mass and AIP, followed by total cholesterol and AIP. The mean AIP level increased with the decrease in the score of each of the 7 cardiovascular health metrics (all P values < 0.05). The subjects with poor cardiovascular health status had a 4.982-fold increase in the high risk of developing atherosclerosis, whereas a 1-point increase in the cardiovascular health score resulted a 0.046 reduction in AIP and a 22.3% reduction in the high-risk of developing atherosclerosis (OR = 0.777, 95% CI: 0.768–0.787). The ideal cardiovascular health score correlated significantly with AIP, and a 1-point increase in the cardiovascular health score led to a 0.046 reduction in AIP and a 22.3% reduction in the high risk of developing atherosclerosis. These validated the value of ideal cardiovascular health behaviors and factors in the prediction of high
Weeks, William B.; Bott, David M.; Lamkin, Rebecca P.; Wright, Steven M.
Older veterans often use both the Veterans Health Administration (VHA) and Medicare to obtain health care services. The authors sought to compare outpatient medical service utilization of Medicare-enrolled rural veterans with their urban counterparts in New England. The authors combined VHA and Medicare databases and identified veterans who were…
Turner, James C.; Keller, Adrienne
Objective: This description of the College Health Surveillance Network (CHSN) includes methodology, demography, epidemiology, and health care utilization. Participants: Twenty-three universities representing approximately 730,000 enrolled students contributed data from January 1, 2011, through May 31, 2014. Methods: Participating schools uploaded…
Objective: To determine the associations between health literacy, the reasons for seeking health information, and the information sources utilized by Taiwanese adults. Method: A cross-sectional survey of 752 adults residing in rural and urban areas of Taiwan was conducted via questionnaires. Chi-squared tests and logistic regression were used for…
The Integrated Health Interview Series (IHIS) is a public data repository that harmonizes four decades of the National Health Interview Survey (NHIS). The NHIS is the premier source of information on the health of the U.S. population. Since 1957 the survey has collected information on health behaviors, health conditions, and health care access. The long running time series of the NHIS is a powerful tool for health research. However, efforts to fully utilize its time span are obstructed by difficult documentation, unstable variable and coding definitions, and non-ignorable sample re-designs. To overcome these hurdles the IHIS, a freely available and web-accessible resource, provides harmonized NHIS data from 1969-2010. This paper describes the challenges of working with the NHIS and how the IHIS reduces such burdens. To demonstrate one potential use of the IHIS we examine utilization patterns in the U.S. from 1972-2008. PMID:22463071
Bakeera, Solome K; Wamala, Sarah P; Galea, Sandro; State, Andrew; Peterson, Stefan; Pariyo, George W
Background Healthcare utilization has particular relevance as a public health and development issue. Unlike material and human capital, there is little empirical evidence on the utility of social resources in overcoming barriers to healthcare utilization in a developing country context. We sought to assess the relevance of social resources in overcoming barriers to healthcare utilization. Study Objective To explore community perceptions among three different wealth categories on factors influencing healthcare utilization in Eastern Uganda. Methods We used a qualitative study design using Focus Group Discussions (FGD) to conduct the study. Community meetings were initially held to identify FGD participants in the different wealth categories, ('least poor', 'medium' and 'poorest') using poverty ranking based on ownership of assets and income sources. Nine FGDs from three homogenous wealth categories were conducted. Data from the FGDs was analyzed using content analysis revealing common barriers as well as facilitating factors for healthcare service utilization by wealth categories. The Health Access Livelihood Framework was used to examine and interpret the findings. Results Barriers to healthcare utilization exist for all the wealth categories along three different axes including: the health seeking process; health services delivery; and the ownership of livelihood assets. Income source, transport ownership, and health literacy were reported as centrally useful in overcoming some barriers to healthcare utilization for the 'least poor' and 'poor' wealth categories. The 'poorest' wealth category was keen to utilize free public health services. Conversely, there are perceptions that public health facilities were perceived to offer low quality care with chronic gaps such as shortages of essential supplies. In addition to individual material resources and the availability of free public healthcare services, social resources are perceived as important in overcoming
Pooled data from the 2007, 2009, and 2011/2012 California Health Interview Surveys were used to compare the number of self-reported annual physician visits among 36,808 Medicare beneficiaries ≥65 in insurance groups with differential cost-sharing. Adjusted for adverse selection and a set of health covariates, Medicare fee-for-service (FFS) only beneficiaries had similar physician utilization compared with HMO enrollees but fewer visits compared with those with supplemental (1.04, p = .001) and Medicaid (1.55, p = .003) coverage. FFS only beneficiaries in very good or excellent health had fewer visits compared with those of similar health status with supplemental (1.30, p = .001) or Medicaid coverage (2.15, p = .002). For subpopulations with several chronic conditions, FFS only beneficiaries also had fewer visits compared with beneficiaries with supplemental or Medicaid coverage. Observed differences in utilization may reflect efficient and necessary physician utilization among those with chronic health needs.
Wilk, Joshua E.; Thomas, Jeffrey L.; Bray, Robert M.; Rae Olmsted, Kristine L.; Brown, Janice M.; Williams, Jason; Kim, Paul Y.; Clarke-Walper, Kristina; Hoge, Charles W.
Objectives. We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers. Methods. We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12 835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22 627). Results. HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care. Conclusions. Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention. PMID:25033143
Jones, Ashley R; Jivraj, Naheed; Balendra, Rubika; Murphy, Caroline; Kelly, Joanna; Thornhill, Marie; Young, Carolyn; Shaw, Pamela J; Leigh, P Nigel; Turner, Martin R; Steen, I Nick; McCrone, Paul; Al-Chalabi, Ammar
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease typically causing death within three years. Understanding the impact of disease on patients using health utility at different stages of ALS would allow meaningful cost-benefit analysis of new potential therapies. A common health-related quality of life measurement, developed and validated for the UK, is the EQ-5D. Using clinical trial data from the LiCALS study, we calculated health utility using the EQ-5D for each King's ALS clinical stage from 214 patients. We analysed whether health utility, and other health-related measures, significantly changed between each of the clinical stages. Results showed that mean health utility decreased by 0.487 (the scale runs from 1 to - 0.594) between clinical stages 2A and 4. Emotional states, measured using the Hospital Anxiety and Depression Scale (HADS), showed worsening depression and anxiety scores as ALS progressed. Age of onset, disease onset, gender and treatment group were not predictors of EQ-5D, depression or anxiety. In conclusion, increasing severity of King's ALS Clinical Stage is associated with a progressive decrease in EQ-5D health utility. This is useful for cost-benefit analysis of new therapies and validates this ALS clinical staging system.
Walker, G M
In 1973, three groups of randomly selected migrant labor families resident in Laredo, Texas were enrolled in a prepaid health insurance study. A study was implemented to determine the kinds and costs of medical care used by Mexican American migrant labor families in their homebase and travel areas where financial barriers to care were eliminated or reduced. At the end of three years it was found that the study population used ambulatory services about one-half as much as the general U.S. population while hospital use approached regional norms. The differences between homebase and out-of-area use are highlighted, and the reported failure to use any public facilities outside of Laredo is discussed.
Whitehead, J.; Shaver, John; Stephenson, Rob
Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas. PMID:26731405
Schonfeld, Lawrence; Larsen, Rebecca G.; Stiles, Paul G.
Purpose: This study examined the extent to which older adults identified in a statewide abuse hotline registry utilized behavioral health services. This is important as mental health issues have been identified as a high priority for filling gaps in services for victims of mistreatment. Design and Methods: We compared Medicaid and Medicare claims…
Cahill, Janet; McGurrin, Martin
Research has found a strong relationship between aggregate economic indicators and the number of individuals receiving services from mental health facilities. To examine the relationship between macroeconomics and health, the broad utilization patterns and demographic information on the aggregate number of individuals using the mental health…
Burnett-Zeigler, Inger; Lyons, John S.
Large numbers of children and adolescents experience diagnosable psychiatric disturbances; however, the majority of those with need do not utilize mental health services. Characteristics of caregivers are important predictors of which youth will access and continue to use services over time. In recent years school-based mental health intervention…
Musich, Shirley; Wang, Shaohung; Hawkins, Kevin
Abstract The objective of this study was to evaluate the impact on health care utilization and expenditure trends over time of a personalized preventive medicine program delivering individualized care focused on lifestyle behavior modification, disease prevention, and compliance with quality-related metrics. MD-Value in Prevention (MDVIP) is a network of affiliated primary care physicians who utilize a model of health care delivery based on an augmented physician-patient relationship and focused on personalized preventive health care. Multivariate modeling was used to control for demographics, socioeconomics, supply of health care services, and health status among 10,186 MDVIP members and randomly selected, matched nonmembers. Health care utilization and expenditure trends were tracked from the pre period prior to member enrollment for a period of up to 3 years post enrollment. MDVIP members experienced reduced utilization of emergency room and urgent care services compared to nonmembers. Program savings ranges indicated that, over time, increasing percentages of members achieved cost savings compared to nonmembers. Older age groups were more likely to realize savings in the early years with preventive activities indicating condition management, and younger age groups were most likely to achieve savings by the third year after enrollment. These results indicate that a primary care model based on an enhanced physician-patient relationship and focused on quality and personalized preventive care within a time frame of 3 years can achieve positive health care expenditure outcomes and improved health management. PMID:26871762
Aljunied, Mariam; Frederickson, Norah
Despite embracing a bio-psycho-social perspective, the World Health Organization's International Classification of Functioning, Disability and Health (ICF) assessment framework has had limited application to date with children who have special educational needs (SEN). This study examines its utility for educational psychologists' work with…
The author reviewed the literature to identify the variables associated with home health care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Home health care was defined as in-home skilled nursing,…
Because geographic variation in medical care utilization is jointly determined by both supply and demand, it is difficult to empirically estimate whether capacity itself has a causal impact on utilization in health care. In this paper, I exploit short-term variation in Neonatal Intensive Care Unit (NICU) capacity that is unlikely to be correlated with unobserved demand determinants. I find that available NICU beds have little to no effect on NICU utilization for the sickest infants, but do increase utilization for those in the range of birth weights where admission decisions are likely to be more discretionary. PMID:27942353
Because geographic variation in medical care utilization is jointly determined by both supply and demand, it is difficult to empirically estimate whether capacity itself has a causal impact on utilization in health care. In this paper, I exploit short-term variation in Neonatal Intensive Care Unit (NICU) capacity that is unlikely to be correlated with unobserved demand determinants. I find that available NICU beds have little to no effect on NICU utilization for the sickest infants, but do increase utilization for those in the range of birth weights where admission decisions are likely to be more discretionary.
Lau, Josephine S.; Adams, Sally H.; Boscardin, W. John; Irwin, Charles E.
Purpose Examine young adults' health care utilization and expenditures prior to the ACA. Methods We used 2009 Medical Expenditure Panel Survey (MEPS) to 1) compare young adults' health care utilization and expenditures of a full-spectrum of health services to children and adolescents and 2) identify disparities in young adults' utilization and expenditures, based on access (insurance and usual source of care) and other socio-demographic factors, including race/ethnicity and income. Results Young adults had: 1) significantly lower rates of overall utilization (72%) than other age groups (83-88%, P<.001) and 2), the lowest rate of office-based utilization (55% vs. 67-77%, P<.001) and higher rate of ER visits compared to adolescents (15% v. 12%, P<.01). Uninsured young adults had high out-of-pocket expenses. Compared to the young adults with private insurance, the uninsured spent less than half on health care ($1,040 vs. $2,150/ person, P<.001), but essentially the same out-of-pocket expenses ($403 vs. $380/person, p =.57). Among young adults, we identified significant disparities in utilization and expenditures based on the presence/absence of a usual source of care, race/ethnicity, home language and sex. Conclusions Young adults may not be utilizing the health care system optimally by having low rates of office-based visits and high rates of ER visits. The ACA provision of insurance for those previously uninsured or under-insured will likely increase their utilization and expenditures and lower their out-of-pocket expenses. Further effort is needed to address non-insurance barriers and ensure equal access to health services. PMID:24702839
Turner, James C.; Keller, Adrienne
Abstract Objective: This description of the College Health Surveillance Network (CHSN) includes methodology, demography, epidemiology, and health care utilization. Participants: Twenty-three universities representing approximately 730,000 enrolled students contributed data from January 1, 2011, through May 31, 2014. Methods: Participating schools uploaded de-identified electronic health records from student health services monthly. Results: During this study, just over 800,000 individuals used the health centers, comprising 4.17 million patient encounters. Sixty percent of visits included primary care, 13% mental health, 9% vaccination, and 31% other miscellaneous services. The 5 most common specific diagnostic categories (with annual rates per 100 enrolled students) were preventive (16); respiratory (12); skin, hair, and nails; infectious non–sexually transmitted infection (5 each); and mental health (4). Utilization and epidemiologic trends are identified among subpopulations of students. Conclusions: CHSN data establish trends in utilization and epidemiologic patterns by college students and the importance of primary and behavioral health care services on campuses. PMID:26086428
Erbes, Christopher R; Stinson, Rebecca; Kuhn, Eric; Polusny, Melissa; Urban, Jessica; Hoffman, Julia; Ruzek, Josef I; Stepnowsky, Carl; Thorp, Steven R
Mobile health (mHealth) refers to the use of mobile technology (e.g., smartphones) and software (i.e., applications) to facilitate or enhance health care. Several mHealth programs act as either stand-alone aids for Veterans with post-traumatic stress disorder (PTSD) or adjuncts to conventional psychotherapy approaches. Veterans enrolled in a Veterans Affairs outpatient treatment program for PTSD (N = 188) completed anonymous questionnaires that assessed Veterans' access to mHealth-capable devices and their utilization of and interest in mHealth programs for PTSD. The majority of respondents (n = 142, 76%) reported having access to a cell phone or tablet capable of running applications, but only a small group (n = 18) reported use of existing mHealth programs for PTSD. Age significantly predicted ownership of mHealth devices, but not utilization or interest in mHealth applications among device owners. Around 56% to 76% of respondents with access indicated that they were interested in trying mHealth programs for such issues as anger management, sleep hygiene, and management of anxiety symptoms. Findings from this sample suggest that Veterans have adequate access to, and interest in, using mHealth applications to warrant continued development and evaluation of mobile applications for the treatment of PTSD and other mental health conditions.
Thorrington, Dominic; Eames, Ken
Background The objective of this review was to evaluate the use of all direct and indirect methods used to estimate health utilities in both children and adolescents. Utilities measured pre- and post-intervention are combined with the time over which health states are experienced to calculate quality-adjusted life years (QALYs). Cost-utility analyses (CUAs) estimate the cost-effectiveness of health technologies based on their costs and benefits using QALYs as a measure of benefit. The accurate measurement of QALYs is dependent on using appropriate methods to elicit health utilities. Objective We sought studies that measured health utilities directly from patients or their proxies. We did not exclude those studies that also included adults in the analysis, but excluded those studies focused only on adults. Methods and Findings We evaluated 90 studies from a total of 1,780 selected from the databases. 47 (52%) studies were CUAs incorporated into randomised clinical trials; 23 (26%) were health-state utility assessments; 8 (9%) validated methods and 12 (13%) compared existing or new methods. 22 unique direct or indirect calculation methods were used a total of 137 times. Direct calculation through standard gamble, time trade-off and visual analogue scale was used 32 times. The EuroQol EQ-5D was the most frequently-used single method, selected for 41 studies. 15 of the methods used were generic methods and the remaining 7 were disease-specific. 48 of the 90 studies (53%) used some form of proxy, with 26 (29%) using proxies exclusively to estimate health utilities. Conclusions Several child- and adolescent-specific methods are still being developed and validated, leaving many studies using methods that have not been designed or validated for use in children or adolescents. Several studies failed to justify using proxy respondents rather than administering the methods directly to the patients. Only two studies examined missing responses to the methods administered with
Gadomski, Anne; Wissow, Lawrence S.; Slade, Eric; Jenkins, Paul
Objective Although it is known that children with mental health problems utilize primary care services more than most other children, it is unknown how addressing mental health problems in primary care affects children’s subsequent services utilization. This study measures primary care utilization in the context of a randomized trial of a communication skills training program for primary care clinicians that had a positive impact on child mental health outcomes. Methods From 2002 to 2005, 48 pediatric primary care clinicians at 13 sites in rural upstate New York, urban Maryland, and Washington, DC were randomized to in-office training or to a control group. Consecutive primary care patients between the ages of 5 and 16 years were screened for mental health problems, as indicated by a possible or probable score on the Strengths and Difficulties Questionnaire (SDQ). For 397 screened children, primary care visits during the next 6 months were identified using chart review and administrative databases. Using generalized estimating equation regression to account for clustering at the clinician level, primary care utilization was compared by study group and SDQ status. Results The number of primary care visits to the trained clinicians did not differ significantly from those made to control clinicians (2.5 for both groups, p=0.63). Children with possible or probable SDQ scores made, on average, 0.38 or 0.65 more visits on a per-child basis, respectively, during the six-month follow-up period than SDQ unlikely children (p-value=0.0002). Conclusions Seeing a trained clinician did not increase subsequent primary care utilization. However, primary care utilization was greater among children with mental health problems as measured by the SDQ. Addressing children’s mental health in primary care does not increase the primary care visit burden. Research on overall health services utilization is needed. PMID:20685190
recommend apps to patients for mental health care outside of appointments and 3) patient perception of the usefulness of apps and subsequent increased...For submission to the December, 2015 meeting of AMSUS (The Society of Federal Health Professionals; San Antonio, TX) Utilization and perceived...impact of smart phone apps among persons pursuing mental health services Robin E. Becker, MA*, Daniel G. Cassidy, PhD, and William C. Isler, PhD
Yitayal, Mezgebu; Berhane, Yemane; Worku, Alemayehu; Kebede, Yigzaw
Background Ethiopia has implemented a nationwide primary health program at grassroots level (known as the Health Extension Program) since 2003 to increase public access to basic health services. This study was conducted to assess whether households that fully implemented the Health Extension Program have improved current contraceptive use. Methods A cross-sectional community-based survey was conducted to collect data from 1,320 mothers using a structured questionnaire. A multivariate logistic regression was used to identify the predictors of current contraceptive utilization. A propensity score analysis was used to determine the contribution of the Health Extension Program “model households” on current contraceptive utilization. Result Mothers from households which fully benefited from the Health Extension Program (“model households”) were 3.97 (adjusted odds ratio, 3.97; 95% confidence interval, 3.01–5.23) times more likely to use contraceptives compared with mothers from non-model households. Model household status contributed to 29.3% (t=7.08) of the increase in current contraceptive utilization. Conclusion The Health Extension Program when implemented fully could help to increase the utilization of contraceptives in the rural community and improve family planning. PMID:24868165
Hosain, G M; Chatterjee, N
The purpose of the present study was to examine the utilization of health services by disabled persons in rural Bangladesh and to identify associated factors to inform the development of appropriate health services. Household surveys were conducted in two villages of Bangladesh by a trained primary-care specialist who lived in the study area for 4 months. About 81% of the sample had utilized some form of health care with more than half consulting unqualified practitioners of modern medicine. Disabled persons whose families perceived they were disabled were 14 times more likely than others to seek treatment. Being male and in the economically productive age group, having an acquired disability and having some form of belief about disability causation were associated with utilization. The conclusions of the study are that social and cultural barriers prevent certain groups, notably women and demographically dependent age groups, from accessing health care. Those who are economically beneficial to the family usually utilize health services. A combination of educational and economic initiatives such as a disability benefits allowance would strongly promote the health of disabled persons and create a general awareness of disability in Bangladesh. A long-term programme which includes disability training for health-care workers and use of financial institutions and existing local government infrastructure for intensive rehabilitation will improve quality of life for disabled persons and is proposed for urgent implementation.
George, Sheba; Garth, Belinda; Fish, Allison; Baker, Richard
Urban safety-net clinics are considered prime targets for the adoption of health information technology innovations; however, little is known about their utilization in such safety-net settings. Current scholarship provides limited guidance on the implementation of health information technology into safety-net settings as it typically assumes that adopting institutions have sufficient basic resources. This study addresses this gap by exploring the unique challenges urban resource-poor safety-net clinics must consider when adopting and utilizing health information technology. In-depth interviews (N = 15) were used with key stakeholders (clinic chief executive officers, medical directors, nursing directors, chief financial officers, and information technology directors) from staff at four clinics to explore (a) nonhealth information technology-related clinic needs, (b) how health information technology may provide solutions, and (c) perceptions of and experiences with health information technology. Participants identified several challenges, some of which appear amenable to health information technology solutions. Also identified were requirements for effective utilization of health information technology including physical infrastructural improvements, funding for equipment/training, creation of user groups to share health information technology knowledge/experiences, and specially tailored electronic billing guidelines. We found that despite the potential benefit that can be derived from health information technologies, the unplanned and uninformed introduction of these tools into these settings might actually create more problems than are solved. From these data, we were able to identify a set of factors that should be considered when integrating health information technology into the existing workflows of low-resourced urban safety-net clinics in order to maximize their utilization and enhance the quality of health care in such settings.
George, Sheba; Garth, Belinda; Fish, Allison; Baker, Richard
Urban safety-net clinics are considered prime targets for the adoption of health information technology innovations; however, little is known about their utilization in such safety-net settings. Current scholarship provides limited guidance on the implementation of health information technology into safety-net settings as it typically assumes that adopting institutions have sufficient basic resources. This study addresses this gap by exploring the unique challenges urban resource-poor safety-net clinics must consider when adopting and utilizing health information technology. In-depth interviews (N = 15) were used with key stakeholders (clinic chief executive officers, medical directors, nursing directors, chief financial officers, and information technology directors) from staff at four clinics to explore (a) nonhealth information technology-related clinic needs, (b) how health information technology may provide solutions, and (c) perceptions of and experiences with health information technology. Participants identified several challenges, some of which appear amenable to health information technology solutions. Also identified were requirements for effective utilization of health information technology including physical infrastructural improvements, funding for equipment/training, creation of user groups to share health information technology knowledge/experiences, and specially tailored electronic billing guidelines. We found that despite the potential benefit that can be derived from health information technologies, the unplanned and uninformed introduction of these tools into these settings might actually create more problems than are solved. From these data, we were able to identify a set of factors that should be considered when integrating health information technology into the existing workflows of low-resourced urban safety-net clinics in order to maximize their utilization and enhance the quality of health care in such settings. PMID:23981394
Bortz, Martin; Kano, Megumi; Ramroth, Heribert; Barcellos, Christovam; Weaver, Scott R.; Rothenberg, Richard; Magalhães, Monica
An urban health index (UHI) was used to quantify health inequalities within Rio de Janeiro, Brazil, for the years 2002-2010. Eight main health indicators were generated at the ward level using mortality data. The indicators were combined to form the index. The distribution of the rank ordered UHI-values provides information on inequality among wards, using the ratio of the extremes and the gradient of the middle values. Over the decade the ratio of extremes in 2010 declined relative to 2002 (1.57 vs. 1.32) as did the slope of the middle values (0.23 vs. 0.16). A spatial division between the affluent south and the deprived north and east is still visible. The UHI correlated on an ecological ward-level with socioeconomic and urban environment indicators like square meter price of apartments (0.54, p < 0.01), low education of mother (-0.61, p < 0.01), low income (-0.62, p < 0.01) and proportion of black ethnicity (-0.55, p < 0.01). The results suggest that population health and equity have improved in Rio de Janeiro in the last decade though some familiar patterns of spatial inequality remain. PMID:26648367
Bonomi, Amy E; Anderson, Melissa L; Rivara, Frederick P; Thompson, Robert S
Objective To estimate health care utilization and costs associated with the type of intimate partner violence (IPV) women experience by the timing of their abuse. Methods A total of 3,333 women (ages 18–64) were randomly sampled from the membership files of a large health plan located in a metropolitan area and participated in a telephone survey to assess IPV history, including the type of IPV (physical IPV or nonphysical abuse only) and the timing of the abuse (ongoing; recent, not ongoing but occurring in the past 5 years; remote, ending at least 5 years prior). Automated annual health care utilization and costs were assembled over 7.4 years for women with physical IPV and nonphysical abuse only by the time period during which their abuse occurred (ongoing, recent, remote), and compared with those of never-abused women (reference group). Results Mental health utilization was significantly higher for women with physical or nonphysical abuse only compared with never-abused women—with the highest use among women with ongoing abuse (relative risk for those with ongoing abuse: physical, 2.61; nonphysical, 2.18). Physically abused women also used more emergency department, hospital outpatient, primary care, pharmacy, and specialty services; for emergency department, pharmacy, and specialty care, utilization was the highest for women with ongoing abuse. Total annual health care costs were higher for physically abused women, with the highest costs for ongoing abuse (42 percent higher compared with nonabused women), followed by recent (24 percent higher) and remote abuse (19 percent higher). Women with recent nonphysical abuse only had annual costs that were 33 percent higher than nonabused women. Conclusion Physical and nonphysical abuse contributed to higher health care utilization, particularly mental health services utilization. PMID:19674432
Blaisdell-Brennan, H K; Goebert, D
Women generally seek and use more health care services than do men. Women are also more likely to encounter financial and non-financial barriers to care than do their male counterparts. These differences are accentuated among low income and minority women. We examined health care utilization patterns among women on O'ahu using survey data, and compared those patterns among Native Hawaiian and other ethnic groups. We also provide prevalence rates for several critical women's health issues by ethnic group and explore demographic predictors for health care utilization. Although the vast majority of women have seen health care providers in the last year, ethnic and socioeconomic disparities were identified, especially with respect to our Native Hawaiian female population. A pattern for Native Hawaiian women reveals among the highest rates of depression, as well as sexual/physical/emotional abuse. Alarmingly, Native Hawaiian women are also less likely to have seen a provider in the last year, less likely to have insurance coverage, and more likely to visit emergency departments. Differences by provider type served to reinforce these disparities. In order to reduce barriers to health care utilization for Native Hawaiian women--and for all women in Hawai'i--we recommend universal insurance coverage that includes screening and counseling services. Additionally, training for health care providers is essential in order to improve culturally competent, psychological assessments of health issues for women, particularly Native Hawaiian women.
Williams, Michael; Longstaff, Ben; Buchanan, Claire; Llansó, Roberto; Dennison, William
In an effort to better portray changing health conditions in Chesapeake Bay and support restoration efforts, a Bay Health Index (BHI) was developed to assess the ecological effects of nutrient and sediment loading on 15 regions of the estuary. Three water quality and three biological measures were combined to formulate the BHI. Water quality measures of chlorophyll-a, dissolved oxygen, and Secchi depth were averaged to create the Water Quality Index (WQI), and biological measures of the phytoplankton and benthic indices of biotic integrity (P-IBI and B-IBI, respectively) and the area of submerged aquatic vegetation (SAV) were averaged to create the Biotic Index (BI). The WQI and BI were subsequently averaged to give a BHI value representing ecological conditions over the growing season (i.e., March-October). Lower chlorophyll-a concentrations, higher dissolved oxygen concentrations, deeper Secchi depths, higher phytoplankton and benthic indices relative to ecological health-based thresholds, and more extensive SAV area relative to restoration goal areas, characterized the least-impaired regions. The WQI, P-IBI and BHI were significantly correlated with (1) regional river flow (r=-0.64, -0.57 and -0.49, respectively; p<0.01), (2) nitrogen (N), phosphorus (P) and sediment loads (all positively correlated with flow), and (3) the sum of developed and agricultural land use (highest annual r(2)=0.86, 0.71 and 0.68, respectively) in most reporting regions, indicating that the BHI is strongly regulated by nutrient and sediment loads from these land uses. The BHI uses ecological health-based thresholds that give an accurate representation of the health conditions in Chesapeake Bay and was the basis for an annual, publicly released environmental report card that debuted in 2007.
Dangerfield, Derek T; Craddock, Jaih B; Bruce, Omar J; Gilreath, Tamika D
Emphasis has been placed on HIV testing and health care engagement, but little is known about how testing and engagement intersect, especially for men. We used latent class analysis to explore underlying profiles of U.S. men regarding HIV testing and health care utilization using data from the 2014 National Health Interview Survey. Multinomial regression was used to predict class membership in four classes: (a) Low HIV Testing/No Health Care Utilization, (b) Some HIV Testing/Low Health Care Utilization, (c) No HIV Testing/Some Health Care Utilization, and (d) High HIV Testing/High Health Care Utilization. Most men were in the No HIV Testing/Some Health Care Utilization class (46%), with a 0% chance of ever having had an HIV test but an 89% chance of seeing a general practitioner in the previous year. Research should include qualitative measures to capture information on facilitators and barriers to HIV testing for men who see general practitioners.
NOVINS, DOUGLAS K.; BEALS, JANETTE; CROY, CALVIN; MANSON, SPERO M.
Objectives of Study Psychiatric epidemiologic studies often include two or more sets of questions regarding service utilization, but the agreement across these different questions and the factors associated with their endorsement have not been examined. The objectives of this study were to describe the agreement of different sets of mental health service utilization questions that were included in the American Indian Service Utilization Psychiatric Epidemiology Risk and Protective Factors Project (AI-SUPERPFP), and compare the results to similar questions included in the baseline National Comorbidity Survey (NCS). Methods Responses to service utilization questions by 2878 AI-SUPERPFP and 5877 NCS participants were examined by calculating estimates of service use and agreement (κ) across the different sets of questions. Logistic regression models were developed to identify factors associated with endorsement of specific sets of questions. Results In both studies, estimates of mental health service utilization varied across the different sets of questions. Agreement across the different question sets was marginal to good (κ = 0.27–0.69). Characteristics of identified service users varied across the question sets. Limitations Neither survey included data to examine the validity of participant responses to service utilization questions. Recommendations for Further Research Question wording and placement appear to impact estimates of service utilization in psychiatric epidemiologic studies. Given the importance of these estimates for policy-making, further research into the validity of survey responses as well as impacts of question wording and context on rates of service utilization is warranted. PMID:18767205
Leroux, Todd C; Kum, Hye-Chung; Dabney, Alan; Wells, Rebecca
Since the onset of the wars in Iraq and Afghanistan attention has increased on the importance of mental health with military service members. An integral component, although far less studied, are the ties between mental health and military spouses. Military deployments place considerable stress on military families. This study analyzed the mental health utilization of military spouses of active duty service members assigned to an aircraft carrier between 2011 and 2014. A negative binomial generalized estimating equation was used to examine the rate of change in mental health utilization over time against various deployment phases. Associations emerged between select deployment phases (i.e., deployment 1, between deployments, deployment 2) with increases in mental health utilization ranging between 12% and 20% for military spouses. This study demonstrated, for military spouses, the in between deployment phase has associations with mental health utilization rates similar to actual deployed periods. As a result, military leaders should continue to monitor the well-being of their service members' families throughout all deployment phases.
Manuvinakurike, Ramesh; Velicer, Wayne F
Background Automated health behavior change interventions show promise, but suffer from high attrition and disuse. The Internet abounds with thousands of personal narrative accounts of health behavior change that could not only provide useful information and motivation for others who are also trying to change, but an endless source of novel, entertaining stories that may keep participants more engaged than messages authored by interventionists. Objective Given a collection of relevant personal health behavior change stories gathered from the Internet, the aim of this study was to develop and evaluate an automated indexing algorithm that could select the best possible story to provide to a user to have the greatest possible impact on their attitudes toward changing a targeted health behavior, in this case weight loss. Methods An indexing algorithm was developed using features informed by theories from behavioral medicine together with text classification and machine learning techniques. The algorithm was trained using a crowdsourced dataset, then evaluated in a 2×2 between-subjects randomized pilot study. One factor compared the effects of participants reading 2 indexed stories vs 2 randomly selected stories, whereas the second factor compared the medium used to tell the stories: text or animated conversational agent. Outcome measures included changes in self-efficacy and decisional balance for weight loss before and after the stories were read. Results Participants were recruited from a crowdsourcing website (N=103; 53.4%, 55/103 female; mean age 35, SD 10.8 years; 65.0%, 67/103 precontemplation; 19.4%, 20/103 contemplation for weight loss). Participants who read indexed stories exhibited a significantly greater increase in self-efficacy for weight loss compared to the control group (F 1,107=5.5, P=.02). There were no significant effects of indexing on change in decisional balance (F 1,97=0.05, P=.83) and no significant effects of medium on change in self
Compston, Juliet E; Flahive, Julie; Hooven, Frederick H; Anderson, Frederick A; Adachi, Jonathan D; Boonen, Steven; Chapurlat, Roland D; Cooper, Cyrus; Díez-Perez, Adolfo; Greenspan, Susan L; LaCroix, Andrea Z; Lindsay, Robert; Netelenbos, J Coen; Pfeilschifter, Johannes; Roux, Christian; Saag, Kenneth G; Silverman, Stuart; Siris, Ethel S; Watts, Nelson B; Gehlbach, Stephen H
Fractures may be associated with higher morbidity in obese postmenopausal women than in nonobese women. We compared health-care utilization, functional status, and health-related quality of life (HRQL) in obese, nonobese, and underweight women with fractures. Information from the GLOW study, started in 2006, was collected at baseline and at 1, 2, and 3 years. In this subanalysis, self-reported incident clinical fractures, health-care utilization, HRQL, and functional status were recorded and examined. Women in GLOW (n = 60,393) were aged ≥55 years, from 723 physician practices at 17 sites in 10 countries. Complete data for fracture and body mass index were available for 90 underweight, 3,270 nonobese, and 941 obese women with one or more incident clinical fractures during the 3-year follow-up. The median hospital length of stay, adjusted for age, comorbidities, and fracture type, was significantly greater in obese than nonobese women (6 vs. 5 days, p = 0.017). Physical function and vitality score were significantly worse in obese than in nonobese women, both before and after fracture; but changes after fracture were similar across groups. Use of antiosteoporosis medication was significantly lower in obese than in nonobese or underweight women. In conclusion, obese women with fracture undergo a longer period of hospitalization for treatment and have poorer functional status and HRQL than nonobese women. Whether these differences translate into higher economic costs and adverse effects on longer-term outcomes remains to be established.
McKnight, Courtney; Shumway, Martha; Masson, Carmen L; Pouget, Enrique R; Jordan, Ashly E; Des Jarlais, Don C; Sorensen, James L; Perlman, David C
People who use drugs (PWUDs) are at increased risk for several medical conditions, yet they delay seeking medical care and utilize emergency departments (EDs) as their primary source of care. Limited research regarding perceived discrimination and PWUDs' use of health care services exists. This study explores the association between interpersonal and institutional racial/ethnic and drug use discrimination in health care settings and health care utilization among respondents (N = 192) recruited from methadone maintenance treatment programs (36%), HIV primary care clinics (35%), and syringe exchange programs (29%) in New York City (n = 88) and San Francisco (n = 104). The Kaiser Family Foundation Survey of Race, Ethnicity, and Medical Care questionnaire was utilized to assess perceived institutional racial/ethnic and drug use discrimination. Perceived institutional discrimination was examined across race/ethnicity and by regular use of ERs, having a regular doctor, and consistent health insurance. Perceived interpersonal discrimination was examined by race/ethnicity. Perceived interpersonal drug use discrimination was the most common type of discrimination experienced in health care settings. Perceptions of institutional discrimination related to race/ethnicity and drug use among non-Hispanic Whites did not significantly differ from those among non-Hispanic Blacks or Hispanics. A perception of less frequent institutional racial/ethnic and drug use discrimination in health care settings was associated with increased odds of having a regular doctor. Awareness of perceived interpersonal and institutional discrimination in certain populations and the effect on health care service utilization should inform future intervention development to help reduce discrimination and improve health care utilization among PWUDs.
Background There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services. Methods This study is cross-sectional and analyzes data from the 2004 National Demographic and Maternal & Child Health dataset. Provider variables come from the Ecuadorian System of Social Indicators (SIISE). Global Moran's I statistic is used to assess spatial autocorrelation of the provider variables. Multilevel modeling is used for the simultaneous analysis of provision of services at the province-level with use of services at the individual level. Results Spatial analysis indicates no significant differences in the density of health care providers among Ecuadorian provinces. After adjusting for various predisposing, enabling, need factors and interaction terms, density of public practice health personnel was positively associated with use of preventive care, particularly among rural households. On the other hand, density of private practice physicians was positively associated with use of curative care, particularly among urban households. Conclusions There are significant public/private, urban/rural gaps in provision of services in Ecuador; which in turn affect people's use of services. It is necessary to strengthen the public health care delivery system (which includes addressing distribution of health workers) and national health information systems. These efforts could improve access to health care, and inform the civil society and policymakers on the advances of health care reform. PMID:20222988
Wu, Qunhong; Hao, Yanhua; Ning, Ning; Xu, Ling; Liu, Chaojie; Li, Ye; Kang, Zheng; Liu, Guoxiang
Background People with chronic non-communicable diseases (NCD) are particularly vulnerable to socioeconomic inequality due to their long-term expensive health needs. This study aimed to assess socioeconomic-related inequality in health service utilization among NCD patients in China and to analyze factors associated with this disparity. Methods Data were taken from the 2008 Chinese National Health Survey, in which a multiple stage stratified random sampling method was employed to survey 56,456 households. We analyzed the distribution of actual use, need-expected use, and need-standardized usage of outpatient services (over a two-week period) and inpatient services (over one-year) across different income groups in 27,233 adult respondents who reported as having a NCD. We used a concentration index to measure inequality in the distribution of health services, which was expressed as HI (Horizontal Inequity Index) for need-standardized use of services. A non-linear probit regression model was employed to detect inequality across socio-economic groups. Results Pro-rich inequity in health services among NCD patients was more substantial than the average population. A higher degree of pro-rich inequity (HI = 0.253) was found in inpatient services compared to outpatient services (HI = 0.089). Despite a greater need for health services amongst those of lower socio-economic status, their actual use is much less than their more affluent counterparts. Health service underuse by the poor and overuse by the affluent are evident. Household income disparity was the greatest inequality factor in NCD service use for both outpatients (71.3%) and inpatients (108%), more so than health insurance policies. Some medical insurance schemes, such as the MIUE, actually made a pro-rich contribution to health service inequality (16.1% for outpatient and 12.1% for inpatient). Conclusions Inequality in health services amongst NCD patients in China remains largely determined by patient
Leininger, Lindsey Jeanne
A large literature examines the effects of health insurance on the health care utilization of children; however, most existing studies conceptualize coverage as a point-in-time measure rather than as a dynamic phenomenon. The major contribution of this article is its provision of estimates on the relationship between the duration of coverage over the course of a calendar year and health care utilization among children. Using child-level fixed-effects regression, we find that an incremental uninsured month is associated with a 0.7 percentage point decline in the probability of receiving a visit over the course of a year and a 3% decrease in the number of visits received. Children with intrayear coverage losses are more likely than those with continuous coverage to lose their usual source of care, which serves as a potential mechanism through which short gaps in coverage may lead to longer-term decrements in utilization.
Montero, Isabel; Martín-Baena, David; Escribà-Agüir, Vicenta; Ruiz-Pérez, Isabel; Vives-Cases, Carmen; Talavera, Marta
The purpose of this study is to estimate the prevalence of lifetime intimate partner violence (IPV) in older women and to analyze its effect on women's health and Healthcare Services utilization. Women aged 55 years and over (1,676) randomly sampled from Primary Healthcare Services around Spain were included. Lifetime IPV prevalence, types, and duration were calculated. Descriptive and multivariate procedures using logistic and multiple lineal regression models were used. Of the women studied, 29.4% experienced IPV with an average duration of 21 years. Regardless of the type of IPV experienced, abused women showed significantly poorer health and higher healthcare services utilization compared to women who had never been abused. The high prevalence detected long standing duration, negative health impact, and high healthcare services utilization, calling attention to a need for increased efforts aimed at addressing IPV in older women.
Wallace, Phyllis M.; Pomery, Elizabeth A.; Latimer, Amy E.; Martinez, Josefa L.; Salovey, Peter
The authors reviewed the acculturation literature with the goal of identifying measures used to assess acculturation in Hispanic populations in the context of studies of health knowledge, attitudes, and behavior change. Twenty-six acculturation measures were identified and summarized. As the Hispanic population continues to grow in the United States, there is a need to develop rigorous acculturation measures that include health indicators. Findings suggest that multidimensional acculturation scales are robust measurement tools when assessing nationality, cultural awareness, media and language preferences, and health status. Furthermore, aspects of Hispanic cultural lifestyle, such as beliefs about nutrition and physical activity, affect health care utilization, treatment, and prevention. Health communication researchers should consider aspects of cultural values and beliefs, and their impact on health status, for future research and health promotion interventions. PMID:20582238
Story, William T; Burgard, Sarah A
This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service utilization focus on women's reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands' involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized.
Slikkerveer, L J
In Ethiopia, a pluralistic complex of multiple and simultaneous medical care utilization has constituted the Ethiopian variant of medical pluralism in East Africa, where through a process of acculturation, Cushitic, Arabic and Amharic medical traditions co-exist with cosmopolitan medicine. On request of the central government, joint medical-sociological and anthropological research between in Universities of Addis Ababa and Leiden was conducted in the Eastern Highlands with the main objective to formulate recommendations for the improvement and extension of the health care facilities in the rural areas. The situational analysis revealed relatively low utilization rates of the "official' health services by the local population. Consequently a desire was expressed to undertake health services development research, particularly centered upon the functioning of the various medical systems and sub-systems in Hararghe. In order to assess the overall pattern of illness behaviour special consideration was given to the question "when, and to what extent do people use the available medical systems?". After the completion of the subsequent subjective and objective health surveys the concept of "distance reduction' between provider and consumer of health care was introduced in order to increase the utilization of the formal health services, taking into account the problems related to geographical, economic and socio-cultural distance. In this paper, a description will be given of the existing alternative health care resources. In addition, the positive contribution which the concept of medical pluralism could provide to rural health planning will be examined within the context of the research project. This will include a discussion of the problems encountered in connection with the utilization of traditional healers and the possibilities for their incorporation into a future syncretic type of national health care delivery system.
Ye, Jiali; Mack, Dominic; Fry-Johnson, Yvonne; Parker, Katrina
Despite efforts to eliminate inequality in health and health care, disparities in health care access and utilization persist in the United States. The purpose of this study was to compare the access to care and use of health care services of US-born and foreign-born Asian Americans. We used aggregated data from the National Health Interview Survey (NHIS) from 2003 to 2005, including 2,500 participants who identified themselves as Asian. Associations between country of birth and reported access and utilization of care in the previous 12 months were examined. After controlling for covariates, being foreign-born was negatively related to indicators of access to care, including health insurance (OR = 0.29, 95%CI = 0.18-0.48), routine care access (OR = 0.52, 95%CI = 0.36-0.75), and sick care access [OR = 0.67, 95%CI = 0.47-0.96)]. Being foreign-born was also negatively related to all indicators of health care utilization (office visit: OR = 0.58, 95%CI = 0.41-0.81; seen/talked to a general doctor: OR = 0.69, 95%CI = 0.52-0.90; seen/talked to a specialist: OR = 0.42, 95%CI = 0.28-0.63) but ER visit (OR = 0.84, 95%CI = 0.59-1.20). There are substantial differences by country of birth in health care access and utilization among Asian Americans. Our findings emphasize the need for developing culturally sensitive health services and intervention programs for Asian communities.
Xu, Ke; Evans, David B; Kadama, Patrick; Nabyonga, Juliet; Ogwal, Peter Ogwang; Nabukhonzo, Pamela; Aguilar, Ana Mylena
There is currently considerable discussion between governments, international agencies, bilateral donors and advocacy groups on whether user fees levied at government health facilities in poor countries should be abolished. It is claimed that this would lead to greater access for the poor and reduce the risks of catastrophic health expenditures if all other factors remained constant, though other factors rarely remain constant in practice. Accordingly, it is important to understand what has actually happened when user fees have been abolished, and why. All fees at first level government health facilities in Uganda were removed in March 2001. This study explores the impact on health service utilization and catastrophic health expenditures using data from National Household Surveys undertaken in 1997, 2000 and 2003. Utilization increased for the non-poor, but at a lower rate than it had in the period immediately before fees were abolished. Utilization among the poor increased much more rapidly after the abolition of fees than beforehand. Unexpectedly, the incidence of catastrophic health expenditure among the poor did not fall. The most likely explanation is that frequent unavailability of drugs at government facilities after 2001 forced patients to purchase from private pharmacies. Informal payments to health workers may also have increased to offset the lost revenue from fees. Countries thinking of removing user charges should first examine what types of activities and inputs at the facility level are funded from the revenue collected by fees, and then develop mechanisms to ensure that these activities can be sustained subsequently.
Heatwole, Chad; Bode, Rita; Johnson, Nicholas; Dekdebrun, Jeanne; Dilek, Nuran; Eichinger, Katy; Hilbert, James E.; Logigian, Eric; Luebbe, Elizabeth; Martens, William; McDermott, Michael P.; Pandya, Shree; Puwanant, Araya; Rothrock, Nan; Thornton, Charles; Vickrey, Barbara G.; Victorson, David; Moxley, Richard T.
Introduction The Myotonic Dystrophy Health Index (MDHI) is a disease-specific patient-reported outcome measure. Here we examine the associations between the MDHI and other measures of disease burden in a cohort of individuals with myotonic dystrophy type-1 (DM1). Methods We conducted a cross-sectional study of 70 patients with DM1. We examined the associations between MDHI total and subscale scores and scores from other clinical tests. Participants completed assessments of strength, myotonia, motor and respiratory function, ambulation, and body composition. Participants also provided blood samples, underwent physician evaluations, and completed other patient-reported outcome measures. Results MDHI total and subscale scores were strongly associated with muscle strength, myotonia, motor function, and other clinical measures. Conclusion Patient-reported health status, as measured by the MDHI, is associated with alternative measures of clinical health. These results support the use of the MDHI as a valid tool to measure disease burden in DM1 patients. PMID:26044513
Swan, Gillian M; Selvaraj, Sivasubramaniam; Godden, David J
Background The configuration of rural health services is influenced by geography. Rural health practitioners provide a broader range of services to smaller populations scattered over wider areas or more difficult terrain than their urban counterparts. This has implications for training and quality assurance of outcomes. This exploratory study describes the development of a "clinical peripherality" indicator that has potential application to remote and rural general practice communities for planning and research purposes. Methods Profiles of general practice communities in Scotland were created from a variety of public data sources. Four candidate variables were chosen that described demographic and geographic characteristics of each practice: population density, number of patients on the practice list, travel time to nearest specialist led hospital and travel time to Health Board administrative headquarters. A clinical peripherality index, based on these variables, was derived using factor analysis. Relationships between the clinical peripherality index and services offered by the practices and the staff profile of the practices were explored in a series of univariate analyses. Results Factor analysis on the four candidate variables yielded a robust one-factor solution explaining 75% variance with factor loadings ranging from 0.83 to 0.89. Rural and remote areas had higher median values and a greater scatter of clinical peripherality indices among their practices than an urban comparison area. The range of services offered and the profile of staffing of practices was associated with the peripherality index. Conclusion Clinical peripherality is determined by the nature of the practice and its location relative to secondary care and administrative and educational facilities. It has features of both gravity model-based and travel time/accessibility indicators and has the potential to be applied to training of staff for rural and remote locations and to other aspects
Hipwell, Alison E.; Stepp, Stephanie D.; Keenan, Kate
Structural equation modeling was used to examine the effects of cultural factors (ethnic identity, perceived discrimination), family relations, and child problem type on mental health service utilization in a community sample of 1,480 adolescent girls (860 African American, 620 European American) between ages 15 and 17 years enrolled in the Pittsburgh Girls Study. Results revealed ethnic identity, caregiver attachment, and conduct disorder were related to service use among African American girls. Among European American girls, correlate patterns differed by clinical need. Findings highlight the need for research on health disparities to examine racially specific influences on service utilization. PMID:25380787
Yoos, H Lorrie; Kitzman, Harriet; Halterman, Jill S; Henderson, Charles; Sidora-Arcoleo, Kimberly; McMullen, Ann
This study evaluated the anti-inflammatory medication regimens in children with persistent asthma, determined their health care utilization patterns, and evaluated factors associated with failure to seek and/or receive appropriate treatment. Parents of 68% of children who qualified for anti-inflammatory medications by National Asthma Education and Prevention Program (NAEPP) guidelines reported their use. However, only 14% received an optimal regimen (mild intermittent symptoms), while 55% were still symptomatic despite reported medications (suboptimal regimen). Nearly half of symptomatic children did not have a health care visit; of those who did, 61% had no corrective action documented. Factors contributing to variations in regimen and utilization are discussed.
Yasui, Miwa; Hipwell, Alison E; Stepp, Stephanie D; Keenan, Kate
Structural equation modeling was used to examine the effects of cultural factors (ethnic identity, perceived discrimination), family relations, and child problem type on mental health service utilization in a community sample of 1,480 adolescent girls (860 African American, 620 European American) between ages 15 and 17 years enrolled in the Pittsburgh Girls Study. Results revealed ethnic identity, caregiver attachment, and conduct disorder were related to service use among African American girls. Among European American girls, correlate patterns differed by clinical need. Findings highlight the need for research on health disparities to examine racially specific influences on service utilization.
Sicard, Pierre; Lesne, Olivia; Alexandre, Nicolas; Mangin, Antoine; Collomp, Rémy
The "Provence Alpes Côte d'Azur" (PACA) region, in the South East of France, is one of Europe's regions most influenced by the atmospheric pollution. During the last 15 years, the industrial emissions decrease caused an evolution of the atmospheric pollution nature. Nowadays, atmospheric pollution is more and more influenced by the road traffic, the dominating pollution source in urban zones for the PACA region. Combined with this intense road traffic, the strong hot season of the Mediterranean climate contributes to the region bad air quality; it is known to be one of the worse in Europe. The recognized air pollution effects over public health include increased risk of hospital admissions and mortality by respiratory or cardiovascular diseases. The combination of these serious pollution related health hazards with senior and children vulnerabilities leads to serious sanitary concerns. Over the 1990-2005 period, we obtained, using the non-parametric Mann-Kendall test from annual mortality dataset (CépiDC), decreasing trends for Asthma (-5.00% year -1), Cardiovascular (-0.73% year -1), Ischemic (-0.69% year -1) and cerebrovascular diseases (-3.10% year -1). However, for "Other heart diseases" (+0.10% year -1) and "Respiratory" (+0.10% year -1) an increase was observed. The development of an adequate tool to understand impacts of pollution levels is of utmost importance. Different pollutants have different health endpoints, information may be lost through the use of a single index consequently, in this study we present the modified formula of air quality index, based on Cairncross's concept the Aggregate Risk Index (ARI). ARI is based on the relative risk of the well-established increased daily mortality, or morbidity, enabling an assessment of additive effects of short-term exposure to the main air pollutants: PM 2.5, PM 10, SO 2, O 3 and NO 2 in order to account for the reality of the multiple exposures impacts of chemical agents. The ARI, developed per pathology
McLaughlin, Gerald W.; McLaughlin, Josetta S.; White, Carla Y.
Objectives This study explored new models of diversity for health professions education that incorporate multiple attributes and examined differences in diversity based on urbanicity, geographic region, and institutional structure. Methods Simpson’s Diversity Index was used to develop race, gender, and interprofessional diversity indices for health professions schools in the United States (N = 318). Sullivan’s extension was used to develop a composite diversity index that incorporated multiple individual attributes for each school. Pearson’s r was used to investigate correlations between continuous variables. ANOVA and independent t-tests were used to compare groups based on urbanicity, geographic region, and Basic Carnegie Classification. Results Mean (SD) for race, gender, and interprofessional diversity indices were 0.36(0.17), 0.45(0.07), and 0.22(0.27) respectively. All correlations between the three indices were weak. The composite diversity index for this sample was 0.34(0.13). Significant differences in diversity were found between institutions based on urbanicity, Basic Carnegie Classification, and geographic region. Conclusions Multidimensional models provide support for expanding measures of diversity to include multiple characteristics and attributes. The approach demonstrated in this study enables institutions to complement and extend traditional measures of diversity as a means of providing evidence for decision-making and progress towards institutional initiatives. PMID:26724917
Deen, Tisha L.; Bridges, Ana J.; McGahan, Tara C.; Andrews, Arthur R., III
Purpose: Rural individuals utilize specialty mental health services (eg, psychiatrists, psychologists, counselors, and social workers) at lower rates than their urban counterparts. This study explores whether cognitive appraisals (ie, individual perceptions of need for services, outcome expectancies, and value of a positive therapeutic outcome) of…
Longo, Catherine; Halpern, Benjamin S.
Indicators are increasingly used to measure environmental systems; however, they are often criticized for failing to measure and describe uncertainty. Uncertainty is particularly difficult to evaluate and communicate in the case of composite indicators which aggregate many indicators of ecosystem condition. One of the ongoing goals of the Ocean Health Index (OHI) has been to improve our approach to dealing with missing data, which is a major source of uncertainty. Here we: (1) quantify the potential influence of gapfilled data on index scores from the 2015 global OHI assessment; (2) develop effective methods of tracking, quantifying, and communicating this information; and (3) provide general guidance for implementing gapfilling procedures for existing and emerging indicators, including regional OHI assessments. For the overall OHI global index score, the percent contribution of gapfilled data was relatively small (18.5%); however, it varied substantially among regions and goals. In general, smaller territorial jurisdictions and the food provision and tourism and recreation goals required the most gapfilling. We found the best approach for managing gapfilled data was to mirror the general framework used to organize, calculate, and communicate the Index data and scores. Quantifying gapfilling provides a measure of the reliability of the scores for different regions and components of an indicator. Importantly, this information highlights the importance of the underlying datasets used to calculate composite indicators and can inform and incentivize future data collection. PMID:27483378
Frazier, Melanie; Longo, Catherine; Halpern, Benjamin S
Indicators are increasingly used to measure environmental systems; however, they are often criticized for failing to measure and describe uncertainty. Uncertainty is particularly difficult to evaluate and communicate in the case of composite indicators which aggregate many indicators of ecosystem condition. One of the ongoing goals of the Ocean Health Index (OHI) has been to improve our approach to dealing with missing data, which is a major source of uncertainty. Here we: (1) quantify the potential influence of gapfilled data on index scores from the 2015 global OHI assessment; (2) develop effective methods of tracking, quantifying, and communicating this information; and (3) provide general guidance for implementing gapfilling procedures for existing and emerging indicators, including regional OHI assessments. For the overall OHI global index score, the percent contribution of gapfilled data was relatively small (18.5%); however, it varied substantially among regions and goals. In general, smaller territorial jurisdictions and the food provision and tourism and recreation goals required the most gapfilling. We found the best approach for managing gapfilled data was to mirror the general framework used to organize, calculate, and communicate the Index data and scores. Quantifying gapfilling provides a measure of the reliability of the scores for different regions and components of an indicator. Importantly, this information highlights the importance of the underlying datasets used to calculate composite indicators and can inform and incentivize future data collection.
De Jesus, Maria; Xiao, Chenyang
There are two competing research explanations to account for Latinos' underutilization of health services relative to non-Latino Whites in the United States. One hypothesis examines the impact of health locus of control (HLOC) beliefs, while the other focuses on the role of access factors on health care use. To date, the relative strength of…
de Souza, Leonardo Cordeiro; Lugon, Jocemir Ronaldo
ABSTRACT OBJECTIVE: The use of the rapid shallow breathing index (RSBI) is recommended in ICUs, where it is used as a predictor of mechanical ventilation (MV) weaning success. The aim of this study was to compare the performance of the RSBI calculated by the traditional method (described in 1991) with that of the RSBI calculated directly from MV parameters. METHODS: This was a prospective observational study involving patients who had been on MV for more than 24 h and were candidates for weaning. The RSBI was obtained by the same examiner using the two different methods (employing a spirometer and the parameters from the ventilator display) at random. In comparing the values obtained with the two methods, we used the Mann-Whitney test, Pearson's linear correlation test, and Bland-Altman plots. The performance of the methods was compared by evaluation of the areas under the ROC curves. RESULTS: Of the 109 selected patients (60 males; mean age, 62 ± 20 years), 65 were successfully weaned, and 36 died. There were statistically significant differences between the two methods for respiratory rate, tidal volume, and RSBI (p < 0.001 for all). However, when the two methods were compared, the concordance and the intra-observer variation coefficient were 0.94 (0.92-0.96) and 11.16%, respectively. The area under the ROC curve was similar for both methods (0.81 ± 0.04 vs. 0.82 ± 0.04; p = 0.935), which is relevant in the context of this study. CONCLUSIONS: The satisfactory performance of the RSBI as a predictor of weaning success, regardless of the method employed, demonstrates the utility of the method using the mechanical ventilator. PMID:26785962
Piovesan, Chaiana; Antunes, José Leopoldo Ferreira; Guedes, Renata Saraiva; Ardenghi, Thiago Machado
The influence of socioeconomic factors and self-rated oral health on children's dental health assistance was assessed. This study followed a cross-sectional design, with a multistage random sample of 792 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. A dental examination provided information on the prevalence of dental caries (DMFT index). Data about the use of dental service, socioeconomic status, and self-perceived oral health were collected by means of structured interviews. These associations were assessed using Poisson regression models (prevalence ratio; 95% confidence interval). The prevalence of regular use of dental service was 47.8%. Children from low socioeconomic backgrounds and those who rated their oral health as "poor" used the service less frequently. The distribution of the kind of oral healthcare assistance used (public/private) varied across socioeconomic groups. The better-off children were less likely to have used the public service. Clinical, socioeconomic, and psychosocial factors were strong predictors for the utilization of dental care services by schoolchildren.
From an outline of a general model of inequalities in oral health, three main issues are addressed: (1) Self-perceived oral health; (2) Utilization of dental care; and (3) Satisfaction with dental care. The aim was to study these aspects in relation to each other as well as aspects such as socio-economic factors, health factors, and attitudes to teeth and care organization. Another aim was to study changes between the two study years. The study is a questionnaire study of a longitudinal sample: people born in 1942 and at the time of the studies living in Orebro or Ostergötland county in Sweden. A cohort (5363 persons) was established with those who completed the questionnaire in both 1992 and 1997. The main results were that there were social differences in self-perceived oral health, with those born outside Sweden, those living single, those with lower level of education and those being blue-collar worker perceiving worse oral health. Changes between the two study years were moderate despite major cutbacks in dental care insurance during this period. Socio-economic factors affected dental care utilization as well. Having a private care provider gave higher utilization and higher cost for care. Health perception, both oral and general health, and dental anxiety also affected utilization. Increasing patient cost for care did not appreciably affect utilization. The overall satisfaction with dental care was high, both in general terms and with the most recent dental visit. Differences between the two studied years were small. Persons not visiting dental care within the last year were more dissatisfied, both generally and with the most recent visit. A large number of regular attenders had no feelings of anxiety, pain or unpleasantness at all. Oral health related factors and dental care factors such as cost for care and care organization were related to satisfaction with dental care. So were experiences from the most recent dental visit and, to some extent, past care
Shin, Soon Ae; Lee, Kunsei; Lin, Vivian; Liu, George; Shin, Eunyoung
Purpose This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. Materials and Methods The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. Results The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. Conclusion This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program. PMID:25510771
and their families at an Army Medical Center. Using data covering three fiscal years from 2005 through 2007, 33,860 direct care and 27,300 purchased... care outpatient mental health visits were analyzed to identify the factors that influenced mental health service use to determine if outpatient mental...the hypotheses. The predisposing factors, beneficiary category and branch of service explained about 1% of the variance in utilization in direct care
Kim, Jaeuk U.; Ku, Boncho; Kim, Young-Min; Do, Jun-Hyeong; Jang, Eunsu; Jeon, Young Ju; Kim, Keun Ho; Kim, Jong Yeol
Sasang constitutional medicine (SCM) shares its philosophy with that of personalized medicine: it provides constitution-specific treatment and healthcare individualized for each patient. In this work, we propose the concept of the Sasang Health Index (SHI) as an attempt to assess the individualized health status in the framework of SCM. From the target population of females in their fifties and older, we recruited 298 subjects and collected their physiological data, including complexion, radial pulse, and voice, and their questionnaire responses. The health status of each subject was evaluated by two Korean medical doctors independently, and the SHI model was obtained by combining all the integrative features of the phenotype data using a regression technique. As a result, most subjects belonged to either the healthy, subhealthy, or slightly diseased group, and the intraclass correlation coefficient between the two doctors' health scoring reached 0.95. We obtained an SHI model for each constitution type with adjusted R-squares of 0.50, 0.56, and 0.30, for the TE, SE, and SY constitution types, respectively. In the proposed SHI model, the significant characteristics used in the health assessment consisted of constitution-specific features in accordance with the classic literature and features common to all the constitution types. PMID:23843888
Sado, Lantona; Spaho, Alma; Hotchkiss, David R
Women in Albania receive antenatal care and postnatal care at lower levels than in other countries in Europe. Moreover, there are large socio-economic and regional disparities in maternal health care use. Previous research in low- and middle-income countries has found that women's status within the household can be a powerful force for improving the health, longevity, and mental and physical capacity of mothers and the well-being of children, but there is very little research on this issue in the Balkans. The aim of this paper is to investigate the influence of women's empowerment within the household on antenatal and postnatal care utilization in Albania. The research questions are explored through the use of bivariate and multivariate analyses based on nationally representative data from the 2008-09 Albania Demographic and Health Survey. The linkages between women's empowerment and maternal health care utilization are analyzed using two types of indicators of women's empowerment: decision making power and attitudes toward domestic violence. The outcome variables are indicators of the utilization of antenatal care and postnatal care. The findings suggest that use of maternal health care services is influenced by women's roles in decision-making and the attitudes of women towards domestic violence, after controlling for a number of socio-economic and demographic factors which are organized at individual, household, and community level. The study results suggest that policy actions that increase women's empowerment at home could be effective in helping assure good maternal health.
Su, Dejun; Pratt, William; Stimpson, Jim P; Wong, Rebeca; Pagán, José A
Using data from the 2008 Cross-Border Utilization of Health Care Survey, we examined the relationship between United States (US) health insurance coverage plans and the use of health care services in Mexico by US residents of the US-Mexico border region. We found immigrants were far more likely to be uninsured than their native-born counterparts (63 vs. 27.8 %). Adults without health insurance coverage were more likely to purchase medications or visit physicians in Mexico compared to insured adults. However, adults with Medicaid coverage were more likely to visit dentists in Mexico compared to uninsured adults. Improving health care access for US residents in the southwestern border region of the country will require initiatives that target not only providing coverage to the large uninsured population but also improving access to health care services for the large underinsured population.
Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.
Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…
Longworth, Louise; Rowen, Donna
Quality-adjusted life-years (QALYs) are widely used as an outcome for the economic evaluation of health interventions. However, preference-based measures used to obtain health-related utility values to produce QALY estimates are not always included in key clinical studies. Furthermore, organizations responsible for reviewing or producing health technology assessments (HTAs) may have preferred instruments for obtaining utility estimates for QALY calculations. Where data using a preference-based measure or the preferred instrument have not been collected, it may be possible to "map" or "crosswalk" from other measures of health outcomes. The aims of this study were 1) to provide an overview of how mapping is currently used as reported in the published literature and in an HTA policy-making context, specifically at the National Institute for Health and Clinical Excellence in the United Kingdom, and 2) to comment on best current practice on the use of mapping for HTA more generally. The review of the National Institute for Health and Clinical Excellence guidance found that mapping has been used since first established but that reporting of the models used to map has been poor. Recommendations for mapping in HTA include an explicit consideration of the generalizability of the mapping function to the target sample, reporting of standard econometric and statistical tests including the degree of error in the mapping model across subsets of the range of utility values, and validation of the model(s). Mapping can provide a route for linking outcomes data collected in a trial or observational study to the specific preferred instrument for obtaining utility values. In most cases, however, it is still advantageous to directly collect data by using the preferred utility-based instrument and mapping should usually be viewed as a "second-best" solution.
Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic
The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P < 0.01) increase in the mean proportion of women who made at least one antenatal care (ANC) visit during pregnancy, a 12% (P < 0.05) increase in average ANC visits and an 11% (P < 0.05) increase in the mean proportion of pregnant women who delivered at the facilities. No effects were found for the proportion of pregnant women who made the first ANC visit in the first trimester and the proportion of women who made postpartum care visits. We conclude that user fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important.
Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic
The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P < 0.01) increase in the mean proportion of women who made at least one antenatal care (ANC) visit during pregnancy, a 12% (P < 0.05) increase in average ANC visits and an 11% (P < 0.05) increase in the mean proportion of pregnant women who delivered at the facilities. No effects were found for the proportion of pregnant women who made the first ANC visit in the first trimester and the proportion of women who made postpartum care visits. We conclude that user fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important. PMID:27175033
Deshpande, Aparna; Menon, Ajit; Perri, Matthew; Zinkhan, George
The growth in direct-to-consumer advertising(DTCA)over the past two decades has facilitated the communication of prescription drug information directly to consumers. Data from a 1999 national survey are employed to determine the factors influencing consumers' opinions of the utility of DTC ads for health care decision making. We also analyze whether consumers use DTC ad information in health care decision making and who are the key drivers of such information utilization. The study results suggest that consumers have positive opinions of DTCA utility, varying across demographics and perceptions of certain advertisement features. Specifically, consumers value information about both risks and benefits, but the perception of risk information is more important in shaping opinions of ad utility than the perception of benefit information. Consumers still perceive, however that the quality of benefit information in DTC ads is better than that of risk information. Opinions about ad utility significantly influence whether information from DTC ads is used in health care decision making.
Kramer, Philip A; Chacko, Balu K; George, David J; Zhi, Degui; Wei, Chih-Cheng; Dell'Italia, Louis J; Melby, Spencer J; George, James F; Darley-Usmar, Victor M
Monitoring the bioenergetics of leucocytes is now emerging as an important approach in translational research to detect mitochondrial dysfunction in blood or other patient samples. Using the mitochondrial stress test, which involves the sequential addition of mitochondrial inhibitors to adherent leucocytes, we have calculated a single value, the Bioenergetic Health Index (BHI), which represents the mitochondrial function in cells isolated from patients. In the present report, we assess the BHI of monocytes isolated from the post-operative blood and post-operative pericardial fluid (PO-PCF) from patients undergoing cardiac surgery. Analysis of the bioenergetics of monocytes isolated from patients' PO-PCF revealed a profound decrease in mitochondrial function compared with monocytes isolated from their blood or from healthy controls. Further, patient blood monocytes showed no significant difference in the individual energetic parameters from the mitochondrial stress test but, when integrated into the BHI evaluation, there was a significant decrease in BHI compared with healthy control monocytes. These data support the utility of BHI measurements in integrating the individual parameters from the mitochondrial stress test into a single value. Supporting our previous finding that the PO-PCF is pro-oxidant, we found that exposure of rat cardiomyocytes to PO-PCF caused a significant loss of mitochondrial membrane potential and increased reactive oxygen species (ROS). These findings support the hypothesis that integrated measures of bioenergetic health could have prognostic and diagnostic value in translational bioenergetics.
Blischke, W R; Bush, J W; Kaplan, R M
The method of successive intervals, a procedure for obtaining equal intervals from category data, is applied to social preference data for a health status index. Several innovations are employed, including an approximate analysis of variance test for determining whether the intervals are of equal width, a regression model for estimating the width of the end intervals in finite scales, and a transformation to equalize interval widths and estimate item locations on the new scale. A computer program has been developed to process large data sets with a larger number of categories than previous programs. PMID:1219005
Hou, Su-I; Hsiao, Tun-Jen; Hou, Peng-Hsi
Purpose: This study compared Internet and online health information (OHI) utilization among selected employees age 40-49 and 50-64 years, and examined the influence of age, gender, education, and worksite. Methods: A questionnaire was administered to participants from two worksites in Taiwan. Results: A total of 527 employees completed the survey…
Finlayson, Marcia; Lix, Lisa; Finlayson, Greg; Fong, Terry
This paper examines 16-year trends in the utilization of hospital and physician services by Manitobans aged 75 and more, using data from the Manitoba Population Health Research Data Repository. Trends are examined across five measures of hospital services (separations, short-stay days, long-stay days, cataract surgeries, and hip/knee replacements)…
Evans, Garret D.; Radunovich, Heidi Liss; Cornette, Michelle M.; Wiens, Brenda A.; Roy, Antara
We examined variables associated with treatment engagement in a real-world therapeutic setting. The model of care examined involved school-linked mental health care for children and their families in a rural county. Service utilization characteristics, as well as child- and treatment-specific variables were examined in relation to their impact on…
Mortier, Teresa; Yatczak, Jayne
Understanding student learning in health science professional programs is both timely and relevant and is the focus of this article. "The Table of Learning" by Lee Shulman (2002) provided a tool for an interdisciplinary reflection surrounding student learning in clinical laboratory science and occupational therapy. Utilizing the taxonomy…
Girio, Erin L.
The majority of youth in need of mental health services do not receive intervention as many are not identified as having a problem or their families experience practical or attitudinal barriers that interfere with service utilization. The school environment provides a unique point of access to reach all children, yet this setting has been…
Bender, Donna S.; Skodol, Andrew E.; Dyck, Ingrid R.; Markowitz, John C.; Shea, M. Tracie; Yen, Shirley; Sanislow, Charles A.; Pinto, Anthony; Zanarini, Mary C.; McGlashan, Thomas H.; Gunderson, John G.; Daversa, Maria T.; Grilo, Carlos M.
The authors examined the relationship between ethnicity and treatment utilization by individuals with personality disorders (PDs). Lifetime and prospectively determined rates and amounts of mental health treatments received were compared in over 500 White, African American, and Hispanic participants with PDs in a naturalistic longitudinal study.…
Klotz, Addie L.
The effects of moving the San Fernando Valley State College Student Health Services to a professional medical building two miles off-campus are assessed. Anticipating a series reduction in student utilization, an intensive publicity program was undertaken to make students aware of the service and its new location. Unexpected positive results of…
It was found that several agricultural by-products could be utilized for healthful food products. Three major applications that our research group has been focusing on will be discussed: 1) plant waxes for trans-fat free, low saturated fat-containing margarine and spread products, 2) extracts of cor...
Lipson, Sarah Ketchen; Zhou, Sasha; Wagner, Blake, III; Beck, Katie; Eisenberg, Daniel
This article explores variations in mental health and service utilization across academic disciplines using a random sample of undergraduate and graduate students (N = 64,519) at 81 colleges and universities. We report prevalence of depression, anxiety, suicidality, and self-injury, and rates of help-seeking across disciplines, including results…
Sharif, Iman; Blank, Arthur E.
Objective To test the relationship between child health literacy and body mass index (BMI) -z score in overweight children. Methods Cross-sectional survey of overweight children and parents. Parent and child health literacy was measured by the Short Test of Functional Health Literacy (STOFHLA). Linear regression tested for predictors of childhood BMI z-score, adjusting for confounders. Results Of 171 total children, 107(62%) participated, of whom 78 (73%) had complete data for analysis. Mean child BMI Z-score (SD) was 2.3(0.40); median child age (Inter-quartile range) was 11.5(10–16); 53% were female; 80% were Medicaid recipients. Mean child STOFHLA was 22.9(9.0); mean parental STOFHLA was 29.1(8.6). Child STOFHLA correlated negatively with BMI Z-score (r=−0.37, p=0.0009) and positively with child eating self-efficacy (r=0.40, p<0.0001). After adjusting for confounders, child STOFHLA was independently associated with child BMI Z-score (standardized B=−0.43, p<0.0001). Overall adjusted r-squared for the regression model was 38%. Child STOFHLA contributed 13% to the overall model. Conclusions Child health literacy was negatively correlated with BMI Z-scores in overweight children, suggesting the need to consider health literacy in the intersection between self-efficacy and behavior change when planning interventions that aim to improve child BMI. PMID:19716255
Coles, Emily; Kruger, Estie; Anjrini, Abed Aktam; Tennant, Marc
The aim of this study was to create an Urban Dental Index (UDI) for Perth, Western Australia, adapting a method utilised by the World Health Organisation. Dental health indicators were derived from the 2011 census, standardised on a (0,1) interval, amalgamated using a geometric mean, and mapped to identify dental health inequity. The validity of the UDI was tested by comparison with oral cellulitis data. Dental health disparities were examined using a ratio of the mean of the highest to lowest decile and slope of the eight middle deciles. The robustness of the UDI was tested using indicator correlation, weighting, and systematic indicator removal. There were a high proportion of low UDI census areas outside the inner city. Adult public dental clinics were unevenly distributed across these low UDI areas. The UDI was significantly correlated with oral cellulitis data and had a moderate disparity ratio (1.69) and slope (0.23). All dental indicators were highly correlated, and UDIs calculated with weighted indicators and indicators removed were significantly correlated with the original UDI. These results indicate that the UDI is a robust tool which can be used by policy makers to target dental health initiatives to high-risk areas.
Ladapo, Joseph A; Turakhia, Mintu P; Ryan, Michael P; Mollenkopf, Sarah A; Reynolds, Matthew R
Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p <0.0001). In conclusion, remote monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care.
Kang, Sung-Wan; Xiang, Xiaoling
The objective of this study was to examine the relationship between physical activity and health services utilization and costs among adults aged 18 or older in the U.S. Data came from the Medical Expenditure Panel Survey-Household component from 2007 through 2011 (n=117,361). Regular physical activity was defined as spending half an hour or more in moderate or vigorous physical activity at least three times a week. The following categories of self-reported health services utilization and costs were examined: preventive, office-based, outpatient, inpatient, emergency department, home health, and prescription medicines. The association of physical activity and health services utilization and costs was estimated using two-part models. Adults who engaged in regular physical activity were more likely to use preventive (ORs ranged from 1.06 to 1.34, p<0.05) and office-based services (OR=1.05, 95% CI=1.01-1.10, p<0.05). Combining results from both parts of the two-part models, physically active adults incurred significantly lower utilization of inpatient (0.09 vs 0.12 visit per person), emergency room (0.18 vs 0.19 visit per person), home health care (1.21 vs 1.92 visit per person), and prescription medicines (12.66 vs 13.75 number of prescriptions per person) and spent $27 less per capita expenditures for office-based visits, $351 less for inpatient visits, and $52 less for home health care visits. Promoting regular physical activity may reduce health care costs through decreasing demand for secondary and tertiary care services.
100. Forbes, D., Bennett, N., Biddle, D., Crompton, D., McHugh, T., Elliott, P., et al. (2005). Clinical presentations and treatment outcomes of...concerns), (2) mental health (depression, PTSD, emotional health history), (3) service utilization patterns (use of mental health resources). We...Reportable Outcomes ……………………………………………………………… 25 Conclusion…………………………………………………………………………… 26 References
Courtois, X; Dumoulin, J
Health centres of Idjwi district (Zaire) have been self-financed through the selling of drugs since 1985. Medical care is expensive and its use is low (24 visits per year per 100 inhabitants). In 1989 the medical team tried to reduce the cost of visits by changing the prices of drugs and prescriptions. A limited control was set up to assess this intervention. The study showed that although prescribed drug costs were stabilized compared to inflation, there was no increase in the use of medical care. Moreover, the reduction of drug profit margins for health centres seriously affected the health care institution by causing a drop in income. Six months after the intervention the monthly accounts showed a deficit in 6 centres out of 8. The need for health care centres to be self-financing is a major limiting factor in the use of health care in Idjwi district. There are no easy solutions for health centre managers that satisfy both low-cost access to care and health care self-financing. Some minimal financial participation from the state is required. Only then can the concept of financing health care through the selling of drugs be operational.
Robertson-James, Candace; Nunez, Ana
The health and well-being of incarcerated women is a significant public health concern. Compared with non-incarcerated women, incarcerated women in the United States are more often from minority populations, younger (between the ages of 18 and 34 years), of low socioeconomic status, unemployed and mothers to children under 18 years of age. More…
Shin, Soon Ae; Kim, Hyeongsu; Lee, Kunsei; Lin, Vivian; Liu, George
This study is to estimate the effectiveness of a diabetic case management programme on health-care service utilization. The study population included 6007 as the intervention group and 956,766 as the control group. As the indicators of health-care service utilization, numbers of medical ambulatory consultations, days of medication prescribed and medical expenses for one year were used, and we analysed the claim data of the health insurance from 2005 to 2007. The study population was classified into three subgroups based on the number of medical ambulatory consultations per year before this intervention. In the under-serviced subgroup, the intervention group showed a significant increase in the number of consultations (3.2), days of prescribed medication (66.4) and medical expenses (287,900 KRW) compared with the control group. Conversely, in the over-serviced subgroup, the intervention group showed a less decrease days of prescribed medication (1.6) compared with the control group. This showed that the case management programme led the intervention group to optimize their utilization of health-care services by subgroups. It is necessary to evaluate the appropriateness of health-care usage and clinical outcome to show the direct effectiveness of the case management programme by subgroups.
Denneson, Lauren M; Corson, Kathryn; Helmer, Drew A; Bair, Matthew J; Dobscha, Steven K
We evaluated the impact of brief structured suicidal ideation (SI) assessments on mental health care among new-to-care Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans. National datasets provided military, demographic, and clinical information. For all new-to-care OEF/OIF veterans administered depression screens (PHQ-2: Patient Health Questionnaire-2) and structured SI assessments in primary care or ambulatory mental health settings of three Veterans Affairs (VA) Medical Centers between April 2008 and September 2009 (N=465), generalized estimating equations were used to examine associations between SI and number of subsequent-year specialty mental health visits and antidepressant prescriptions. Approximately one-third of the veterans reported SI. In multivariate models, PTSD and anxiety diagnoses, severe depression symptoms, being married, and SI assessment by a mental health clinician were associated with more mental health visits in the subsequent year. Depression, PTSD, and anxiety diagnoses, and SI assessment by a mental health clinician were associated with receiving antidepressants. Presence of SI did not significantly affect subsequent year mental health utilization when adjusting for diagnostic and clinician variables, but inaugural visits involving mental health clinicians were consistently associated with subsequent mental health care.
Chuk, Amanda; Maloney, Robert; Gawron, Joyce; Skinner, Colin
Health information technology is increasingly utilized within healthcare delivery systems today. Two examples of this type of technology include the capture of patient-specific information within an electronic health record and intravenous medication infusion devices equipped with dose error reduction software known as drug libraries. Automatic integration of these systems, termed intravenous (IV) interoperability, should serve as the goal toward which all healthcare systems work to maximize patient safety. For institutions lacking IV interoperability, we describe a manual approach of querying the electronic health record to incorporate medication administration information with data from infusion device software to optimize drug library settings. This approach serves to maximize utilization of available information to optimize medication safety provided by drug library software.
Chuk, Amanda; Maloney, Robert; Gawron, Joyce; Skinner, Colin
Health information technology is increasingly utilized within healthcare delivery systems today. Two examples of this type of technology include the capture of patient-specific information within an electronic health record and intravenous medication infusion devices equipped with dose error reduction software known as drug libraries. Automatic integration of these systems, termed intravenous (IV) interoperability, should serve as the goal toward which all healthcare systems work to maximize patient safety. For institutions lacking IV interoperability, we describe a manual approach of querying the electronic health record to incorporate medication administration information with data from infusion device software to optimize drug library settings. This approach serves to maximize utilization of available information to optimize medication safety provided by drug library software.
Aljunied, Mariam; Frederickson, Norah
Despite embracing a bio-psycho-social perspective, the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) assessment framework has had limited application to date with children who have special educational needs (SEN). This study examines its utility for educational psychologists’ work with children who have Autism Spectrum Disorders (ASD). Mothers of 40 children with ASD aged eight to 12 years were interviewed using a structured protocol based on the ICF framework. The Diagnostic Interview for Social and Communication Disorder (DISCO) was completed with a subset of 19 mothers. Internal consistency and inter-rater reliability of the interview assessments were found to be acceptable and there was evidence for concurrent and discriminant validity. Despite some limitations, initial support for the utility of the ICF model suggests its potential value across educational, health and care fields. Further consideration of its relevance to educational psychologists in new areas of multi-agency working is warranted. PMID:26157197
Knighton, Andrew J; Savitz, Lucy; Belnap, Tom; Stephenson, Brad; VanDerslice, James
Introduction: Intermountain Healthcare is a fully integrated delivery system based in Salt Lake City, Utah. As a learning healthcare system with a mission of performance excellence, it became apparent that population health management and our efforts to move towards shared accountability would require additional patient-centric metrics in order to provide the right care to the right patients at the right time. Several European countries have adopted social deprivation indices in measuring the impact that social determinants can have on health. Such indices provide a geographic, area-based measure of how socioeconomically deprived residents of that area are on average. Intermountain’s approach was to identify a proxy measure that did not require front-line data collection and could be standardized for our patient population, leading us to the area deprivation index or ADI. This paper describes the specifications and calculation of an ADI for the state of Utah. Results are presented along with introduction of three use cases demonstrating the potential for application of an ADI in quality improvement in a learning healthcare system. Case Description: The Utah ADI shows promise in providing a proxy for patient-reported measures reflecting key socio-economic indicators useful for tailoring patient interventions to improve health care delivery and patient outcomes. Strengths of this approach include a consistent standardized measurement of social determinants, use of more granular block group level measures and a limited data capture burden for front-line teams. While the methodology is generalizable to other communities, results of this index are limited to block groups within the state of Utah and will differ from national calculations or calculations for other states. The use of composite measures to evaluate individual characteristics must also be approached with care. Other limitations with the use of U.S. Census data include use of estimates and missing data
Appukuttan, DP; Vinayagavel, M; Balasundaram, A; Damodaran, LK; Shivaraman, P; Gunasshegaran, K
Background: Oral health has an impact on quality of life hence for research purpose validation of a Tamil version of General Oral Health Assessment Index would enable it to be used as a valuable tool among Tamil speaking population. Aim: In this study, we aimed to assess the psychometric properties of translated Tamil version of General Oral Health Assessment Index (GOHAI-Tml). Subjects and Methods: Linguistic adaptation involved forward and backward blind translation process. Reliability was analyzed using test-retest, Cronbach alpha, and split half reliability. Inter-item and item-total correlation were evaluated using Spearman rank correlation. Convenience sampling was done, and 265 consecutive patients aged 20–70 years attending the outpatient department were recruited. Subjects were requested to fill a self-reporting questionnaire along with Tamil GOHAI version. Clinical examination was done on the same visit. Concurrent validity was measured by assessing the relationship between GOHAI scores and self-perceived oral health and general health status, satisfaction with oral health, need for dental treatment and esthetic satisfaction. Discriminant validity was evaluated by comparing the GOHAI scores with the objectively assessed clinical parameters. Exploratory factor analysis was done to examine the factor structure. Results: Mean GOHAI-Tml was 52.7 (6.8, range 22–60, median 54). The mean number of negative impacts was 2 (2.4, range 0–11, median 1). The Spearman rank correlation for test-retest ranged from 0.8 to 0.9 (P < 0.001) for all the 12 items between visits. The Cronbach alpha for 265 samples was 0.8 suggesting good internal consistency and homogeneity between items. Item scale correlation ranged from 0.4 to 0.8 (P < 0.001). Concurrent and discriminant validity was established. Principal component analysis resulted in extraction of four factors which together accounted for 66.4% (7.9/12) variance. Conclusion: GOHAI-Tml has shown acceptable
Background Mental health is of special importance regarding socioeconomic inequalities in health. On the one hand, mental health status mediates the relationship between economic inequality and health; on the other hand, mental health as an "end state" is affected by social factors and socioeconomic inequality. In spite of this, in examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. As a first attempt in Iran, the objectives of this paper were to measure socioeconomic inequality in mental health, and then to untangle and quantify the contributions of potential determinants of mental health to the measured socioeconomic inequality. Methods In a cross-sectional observational study, mental health data were taken from an Urban Health Equity Assessment and Response Tool (Urban HEART) survey, conducted on 22 300 Tehran households in 2007 and covering people aged 15 and above. Principal component analysis was used to measure the economic status of households. As a measure of socioeconomic inequality, a concentration index of mental health was applied and decomposed into its determinants. Results The overall concentration index of mental health in Tehran was -0.0673 (95% CI = -0.070 - -0.057). Decomposition of the concentration index revealed that economic status made the largest contribution (44.7%) to socioeconomic inequality in mental health. Educational status (13.4%), age group (13.1%), district of residence (12.5%) and employment status (6.5%) also proved further important contributors to the inequality. Conclusions Socioeconomic inequalities exist in mental health status in Iran's capital, Tehran. Since the root of this avoidable inequality is in sectors outside the health system, a holistic mental health policy approach which includes social and economic determinants should be adopted to redress the inequitable distribution of mental health. PMID:22449237
Trump, David H
Self-rated general health is one element of the standard health assessment required of U.S. military service members upon completion of major deployments. A cohort study of 22,229 male U.S. Army and Air Force personnel returning from Europe or Southwest Asia in 2000 used survival analysis methods and Cox proportional hazard models to examine postdeployment self-rated health (SRH) status and subsequent hospitalization, separation, and ambulatory care visits. Self-rated health was fair/poor for 1.5% and good for 20.4%; 11% documented at least one health concern. During 30,433 person-years of follow-up (median, 1.5 person-years), there were 22.8 hospitalizations per 1,000 person-years and 4.0 ambulatory care visits per person-years. After adjustment, deployers with fair/poor SRH had an increased risk for hospitalization (hazard ratio [HRI, 1.6; 95% confidence interval [CI], 1.0,2.7); the risk was lower for those with good SRH (HR, 1.3; 95% CI,1.1,1.5). Deployers with fair/poor SRH health had an increased risk for illness-related ambulatory care visits (HR, 1.8, 95%; CI, 1.6,2.1) and administrative visits (HR, 1.4; 95% CI, 1.1,1.7), but not injury-related visits (HR, 1.2; 95% CI, 0.8,1.7). Self-reported low health status and other health concerns identify military members with higher levels of health care needs following return from major deployments.
Li, Tsung-Hsien; Chang, Chao-Chin; Cheng, I-Jiunn; Lin, Suen-Chuain
Veterinary care plays an influential role in sea turtle rehabilitation, especially in endangered species. Physiological characteristics, hematological and plasma biochemistry profiles, are useful references for clinical management in animals, especially when animals are during the convalescence period. In this study, these factors associated with sea turtle surviving were analyzed. The blood samples were collected when sea turtles remained alive, and then animals were followed up for surviving status. The results indicated that significantly negative correlation was found between buoyancy disorders (BD) and sea turtle surviving (p < 0.05). Furthermore, non-surviving sea turtles had significantly higher levels of aspartate aminotranspherase (AST), creatinine kinase (CK), creatinine and uric acid (UA) than surviving sea turtles (all p < 0.05). After further analysis by multiple logistic regression model, only factors of BD, creatinine and UA were included in the equation for calculating summarized health index (SHI) for each individual. Through evaluation by receiver operating characteristic (ROC) curve, the result indicated that the area under curve was 0.920 ± 0.037, and a cut-off SHI value of 2.5244 showed 80.0% sensitivity and 86.7% specificity in predicting survival. Therefore, the developed SHI could be a useful index to evaluate health status of sea turtles and to improve veterinary care at rehabilitation facilities. PMID:25803431
Li, Tsung-Hsien; Chang, Chao-Chin; Cheng, I-Jiunn; Lin, Suen-Chuain
Veterinary care plays an influential role in sea turtle rehabilitation, especially in endangered species. Physiological characteristics, hematological and plasma biochemistry profiles, are useful references for clinical management in animals, especially when animals are during the convalescence period. In this study, these factors associated with sea turtle surviving were analyzed. The blood samples were collected when sea turtles remained alive, and then animals were followed up for surviving status. The results indicated that significantly negative correlation was found between buoyancy disorders (BD) and sea turtle surviving (p < 0.05). Furthermore, non-surviving sea turtles had significantly higher levels of aspartate aminotranspherase (AST), creatinine kinase (CK), creatinine and uric acid (UA) than surviving sea turtles (all p < 0.05). After further analysis by multiple logistic regression model, only factors of BD, creatinine and UA were included in the equation for calculating summarized health index (SHI) for each individual. Through evaluation by receiver operating characteristic (ROC) curve, the result indicated that the area under curve was 0.920 ± 0.037, and a cut-off SHI value of 2.5244 showed 80.0% sensitivity and 86.7% specificity in predicting survival. Therefore, the developed SHI could be a useful index to evaluate health status of sea turtles and to improve veterinary care at rehabilitation facilities.
Daradkeh, Shaher; Khader, Yousef S
Our aim was to translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into Arabic and assess its validity and reliability for use among people in North Jordan. After translation into Arabic and back-translation to check the translation quality, a total of 288 participants completed the Arabic version of the GOHAI questionnaire. Individual GOHAI items were recoded and summed as originally recommended. The questionnaire sought information about socio-demographic characteristics and self-reported perception of general and oral health. Clinical examination included assessment of periodontal status, and number of decayed teeth, missing teeth, filled teeth and crowned teeth. Reliability, internal consistency, and concurrent, convergent and discriminant validity of GOHAI scores were examined. Mean GOHAI score was 40.9 (SD = 10.6, range: 12 to 60). Cronbach's alpha for the GOHAI score was 0.88, indicating a high degree of internal consistency and homogeneity between the GOHAI items. The test-retest correlation coefficient for add-GOHAI scores was 0.72, indicating good stability. Add-GOHAI scores increased with poorer perceived general and oral health. Convergent validity, construct validity and discriminant validity of the GOHAI were demonstrated. The Arabic translation of the GOHAI demonstrated acceptable validity and reliability when used for people in North Jordan. It could therefore be used as a valuable instrument for measuring oral health-related quality of life for people in this region.
Piovesan, Chaiana; Ardenghi, Thiago Machado; Mendes, Fausto Medeiros; Agostini, Bernardo Antonio; Michel-Crosato, Edgard
The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children's Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children's dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers' associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children's ages, family income, parents' schooling, mothers' participation in their children's school activities, dental caries, and presence of workers' associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.
LIEBSCHUTZ, J. M.; GEIER, J. L.; HORTON, N. J.; CHUANG, C. H.; SAMET, J. H.
We examined interpersonal violence and its association with health care utilization and substance use severity among a cohort of 349 HIV-infected men and women with histories of alcohol problems assessed biannually up to 36 months. Data included demographics, lifetime interpersonal violence histories, age at first violence exposure, recent violence (prior six months), substance use severity and health care utilization (ambulatory visits, Emergency Department (ED) visits, hospitalizations) and adherence to HIV medication. Kaplan-Meier survival curves estimated the proportion of subjects experiencing recent violence. Generalized estimating equation regression models evaluated the relationship between recent violence, utilization and substance use severity over time, controlling for demographics, CD4 counts and depressive symptoms. Subject characteristics included: 79% male; mean age 41 years; 44% black, 33% white and 23% other. Eighty percent of subjects reported lifetime interpersonal violence: 40% physical violence alone, and 40% sexual violence with or without physical violence. First violence occurred prior to age 13 in 46%. Twenty-four (41%) of subjects reported recent violence by 24 and 36 months, respectively. In multivariate analyses, recent violence was associated with more ambulatory visits, ED visits and hospitalizations and worse substance use severity, but not medication adherence. Due to the high incidence and associated increased health care services utilization, violence prevention interventions should be considered for HIV-infected patients with a history of alcohol problems. PMID:16036243
Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.
Context Mexico Purpose Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen’s “model of health services” of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). Findings Results showed that older Mexicans living in the most rural areas (populations of 2500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Conclusions Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health. PMID:21029168
Memon, Zahid; Zaidi, Shehla; Riaz, Atif
Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers. PMID:26925902
Duckett, Jane; Hunt, Kate; Munro, Neil; Sutton, Matt
How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence. PMID:27117483
Merrick, Elizabeth S Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M; Greenfield, Shelly F; McCann, Bernard
New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral health care (MBHC) organization's integrated EAP/MBHC product (N = 1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan, and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of the clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes.
Alemi, Qais; Stempel, Carl; Koga, Patrick Marius; Smith, Valerie; Danis, Didem; Baek, Kelly; Montgomery, Susanne
There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live. PMID:28218688
Alemi, Qais; Stempel, Carl; Koga, Patrick Marius; Smith, Valerie; Danis, Didem; Baek, Kelly; Montgomery, Susanne
There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live.
BOGNER, HILLARY R.; MILLER, STEVEN D.; DE VRIES, HEATHER F.; CHHATRE, SUMEDHA; JAYADEVAPPA, RAVISHANKAR
Background Our aim was to examine the health resource utilization and cost of care associated with heart failure (HF) and diabetes mellitus (DM) for elderly Medicare enrollees. Methods and Results A retrospective case-control design was used to identify 4 groups of elderly patients with HF and DM (n = 498), HF only (n = 1089), DM only (n = 971), and no-HF and no-DM (n = 5438) using an administrative database of a large urban academic health care system. Demographic, diagnostic, health resource utilization, and cost (reimbursement) data were obtained from the Medicare claims database for the years 2000 and 2001. Disease states were identified by ICD-9 codes. Costs and health resource utilization were compared across the groups. The mean total costs were highest for the group with HF and DM ($32,676), and second highest for the HF only group ($22,230). In multivariable models that adjusted for potentially influential covariates, the group with HF and DM had a 3-fold increase in total cost compared with the group without DM and HF (relative total cost = 4.51, 95% confidence interval 3.82–5.31). Conclusions The presence of DM has a substantial influence on the costs for managing older patients with HF. An integrated approach to management may be needed. PMID:20610226
Maruyama, Nobuyuki; Mikami, Bunzo; Utsumi, Shigeru
Seed storage proteins are a major component of mature seeds. They are utilized as protein sources in foods. We designed seed storage proteins containing bioactive peptides based on their three-dimensional structures. Furthermore, to create crops with enhanced food qualities, we developed transgenic crops producing seed storage proteins with bioactive peptides. This strategy promises to prevent lifestyle-related diseases by simple daily food consumption. In this review, we discuss a strategy to develop transgenic crops to improve human health by advanced utilization of seed storage proteins.
Méndez-Lázaro, Pablo; Muller-Karger, Frank E.; Otis, Daniel; McCarthy, Matthew J.; Rodríguez, Ernesto
Increased frequency and length of high heat episodes are leading to more cardiovascular issues and asthmatic responses among the population of San Juan, the capital of the island of Puerto Rico, USA. An urban heat island effect, which leads to foci of higher temperatures in some urban areas, can raise heat-related mortality. The objective of this research is to map the risk of high temperature in particular locations by creating heat maps of the city of San Juan. The heat vulnerability index (HVI) maps were developed using images collected by satellite-based remote sensing combined with census data. Land surface temperature was assessed using images from the Thermal Infrared Sensor flown on Landsat 8. Social determinants (e.g., age, unemployment, education and social isolation, and health insurance coverage) were analyzed by census tract. The data were examined in the context of land cover maps generated using products from the Puerto Rico Terrestrial Gap Analysis Project (USDA Forest Service). All variables were set in order to transform the indicators expressed in different units into indices between 0 and 1, and the HVI was calculated as sum of score. The tract with highest index was considered to be the most vulnerable and the lowest to be the least vulnerable. Five vulnerability classes were mapped (very high, high, moderate, low, and very low). The hottest and the most vulnerable tracts corresponded to highly built areas, including the Luis Munoz International Airport, seaports, parking lots, and high-density residential areas. Several variables contributed to increased vulnerability, including higher rates of the population living alone, disabilities, advanced age, and lack of health insurance coverage. Coolest areas corresponded to vegetated landscapes and urban water bodies. The urban HVI map will be useful to health officers, emergency preparedness personnel, the National Weather Service, and San Juan residents, as it helps to prepare for and to mitigate
Méndez-Lázaro, Pablo; Muller-Karger, Frank E; Otis, Daniel; McCarthy, Matthew J; Rodríguez, Ernesto
Increased frequency and length of high heat episodes are leading to more cardiovascular issues and asthmatic responses among the population of San Juan, the capital of the island of Puerto Rico, USA. An urban heat island effect, which leads to foci of higher temperatures in some urban areas, can raise heat-related mortality. The objective of this research is to map the risk of high temperature in particular locations by creating heat maps of the city of San Juan. The heat vulnerability index (HVI) maps were developed using images collected by satellite-based remote sensing combined with census data. Land surface temperature was assessed using images from the Thermal Infrared Sensor flown on Landsat 8. Social determinants (e.g., age, unemployment, education and social isolation, and health insurance coverage) were analyzed by census tract. The data were examined in the context of land cover maps generated using products from the Puerto Rico Terrestrial Gap Analysis Project (USDA Forest Service). All variables were set in order to transform the indicators expressed in different units into indices between 0 and 1, and the HVI was calculated as sum of score. The tract with highest index was considered to be the most vulnerable and the lowest to be the least vulnerable. Five vulnerability classes were mapped (very high, high, moderate, low, and very low). The hottest and the most vulnerable tracts corresponded to highly built areas, including the Luis Munoz International Airport, seaports, parking lots, and high-density residential areas. Several variables contributed to increased vulnerability, including higher rates of the population living alone, disabilities, advanced age, and lack of health insurance coverage. Coolest areas corresponded to vegetated landscapes and urban water bodies. The urban HVI map will be useful to health officers, emergency preparedness personnel, the National Weather Service, and San Juan residents, as it helps to prepare for and to mitigate
Wanda, Elijah M. M.; Mamba, Bhekie B.; Msagati, Titus A. M.; Msilimba, Golden
Wetlands are major sources of various ecological goods and services including storage and distribution of water in space and time which help in ensuring the availability of surface and groundwater throughout the year. However, there still remains a poor understanding of the range of values of water quality parameters that occur in wetlands either in its impacted state or under natural conditions. It was thus imperative to determine the health of Lunyangwa wetland in Mzuzu City in Malawi in order to classify and determine its state. This study used the Escom's Wetland Classification and Risk Assessment Index Field Guide to determine the overall characteristics of Lunyangwa wetland and to calculate its combined Wetland Index Score. Data on site information, field measurements (i.e. EC, pH, temperature and DO) and physical characteristics of Lunyangwa wetland were collected from March, 2013 to February, 2014. Results indicate that Lunyangwa wetland is a largely open water zone which is dominated by free-floating plants on the water surface, beneath surface and emergent in substrate. Furthermore, the wetland can be classified as of a C ecological category (score = 60-80%), which has been moderately modified with moderate risks of the losses and changes occurring in the natural habitat and biota in the wetland. It was observed that the moderate modification and risk were largely because of industrial, agricultural, urban/social catchment stressors on the wetland. This study recommends an integrated and sustainable management approach coupled with continuous monitoring and evaluation of the health of the wetland for all stakeholders in Mzuzu City. This would help to maintain the health of Lunyangwa wetland which is currently at risk of being further modified due to the identified catchment stressors.
Ruetsch, Charles; Tkacz, Joseph; Kardel, Peter G; Howe, Andrew; Pai, Helen; Levitan, Bennett
Introduction The lack of consistency surrounding the diagnosis of chronic non-cancer pain, treatment approaches, and patient management suggests the need for further research to better characterize the chronic non-cancer pain population. Objective The purpose of this study was to identify distinct trajectories of health care service utilization of chronic non-cancer pain patients and describe the characteristic differences between trajectory groups. Patients and methods This study utilized the MarketScan claims databases. A total of 71,392 patients diagnosed with either low back pain or osteoarthritis between 2006 and 2009 served as the study sample. Each subject’s claims data were divided into three time periods around an initial diagnosis date: pre-period, post-Year 1, and post-Year 2. Subjects were categorized as either high (H) or low (L) cost at each post period, resulting in the creation of four trajectory groups based on the post-Year 1 and 2 cost pattern: H-H, H-L, L-H, and L-L. Multivariate statistical tests were used to predict and discriminate between trajectory group memberships. Results The H-H, L-H, and H-L groups each utilized significantly greater pre-period high-cost venue services, post-Year 1 outpatient services, and post-Year 1 opioids compared to the L-L group (P < 0.001). Additionally, the H-H and L-H groups displayed elevated Charlson comorbidity index scores compared with the L-L group (P < 0.001), with each showing increased odds of having both opioid dependence and cardiovascular disease diagnoses (P < 0.01). Conclusion This study identified patient characteristics among chronic pain patients that discriminated between different levels of post-index high-cost venue service utilization and trajectories of change in the same. With implications for managed care program implementation and resource management, this study highlights results from a developed algorithm that employed a variety of accessible data elements to effectively
Mackey, Tim K; Liang, Bryan A
The appropriate role of innovation and intellectual property (IP) in global public health is a controversial issue. Discussion is one-sided, with potential benefits advocated by industry in stark contrast to condemnation by certain civil society players. WHO's Public Health, Innovation and Intellectual Property Department (PHI) was established to address healthcare resource need for developing countries, assess impact of innovation and IP on access to medicines, explore innovative funding mechanisms for R&D and provide evidence-based policy-making recommendations in response to the changing global health landscape. Importantly, PHI could represent a potential forum to bridge shared, yet often diverse, interests and opportunities between various public and private stakeholders, a crucial issue for ensuring the future viability of WHO.
Adrion, Emily R.; Aucott, John; Lemke, Klaus W.; Weiner, Jonathan P.
Background Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome – a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. Objectives 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. Methods This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Results Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses. Conclusions Lyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care
Boufous, Soufiane; Silove, Derrick; Bauman, Adrian; Steel, Zachary
This study examined levels of disability and use of health services, as a result of psychological distress, across various ethnic groups after taking into account selected sociodemographic factors such as age, gender, education, and employment. We have analyzed data from the 1997-1998 New South Wales Health Survey, Australia. A telephone interview of 35,025 adults aged 16 years and over selected from each of the 17 Health Service Areas in the state. While people from non-English speaking backgrounds were more likely to suffer high levels of disability as a result of psychological distress, they were less likely to utilize health services compared to those from English speaking backgrounds. This was particularly true for those born in Southern and South-East Asia as well as the Middle East and Africa. Further research into the reasons underlying these findings for each ethnic group is warranted.
Dunfield, J F
In recent years health care delivery has placed increased emphasis on patient input. However, much of the research addressing patient satisfaction and quality of care suffers from inherent methodological difficulties, or an agenda determined by the provider, not the consumer. Of particular neglect has been the considerable, and often, preferential use of non-conventional therapy, recently shown to have an enormous presence within the U.S. health care system. This study employs a multidimensional scaling methodology as an explorative tool to examine, from the consumer's viewpoint, the issues that underlie the positive perception of the quality of health care delivery. Three principle dimensions are identified: personal-impersonal doctor patient relationship; scientific vs holistic approach; and the balance of control between doctor patient. Correlation of sociodemographic and broad based health care seeking data with respect to these dimensions furthers understanding of gender bias, and non-conventional therapy utilization. Suggestions for moderation of these attitudes are discussed.
Elo, I T
This article explores the hypothesis that formal education of women influences the use of maternal health-care services in Peru, net of the mother's childhood place of residence, household socioeconomic status and access to health-care services. The findings are consistent with the hypothesis; both cross-sectional and fixed-effects logit models yield quantitatively important and statistically reliable estimates of the positive effect of maternal schooling on the use of prenatal care and delivery assistance. In addition, large differentials were found in the utilization of maternal health-care services by place of residence, suggesting that much greater efforts on the part of the government are required if modern maternal health-care services are to reach women in rural areas.
Jang, Young-Eun; Kim, Chun-Bae; Kim, Nam-Hee
Health insurance reduces the economic burden of diseases and enhances access to medical services. This study compared, among social classes, the utilization of preventive dental service before and after health insurance covered dental scaling. We analyzed time-series secondary data for 3 175 584 participants from 253 survey areas nationwide in the Community Health Survey (2009-2014) in Korea. The weighted proportion of participants who underwent dental scaling was defined as the scaling rate. Data regarding demographic and socioeconomic characteristics were collected. Scaling rates continuously increased over the 6-year period, particularly in 2014. College graduates had significantly higher scaling rates. Monthly income and scaling rate were positively related. Differences by education decreased over time. Differences by income were particularly high between 2012 and 2014. For women, the temporal rate was 2 times higher for professionals than for the unemployed. Despite increased dental scaling rates since the health coverage change in 2013, socioeconomic differences persist.
Background The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease. Methods A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included. Results Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients. Conclusions The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area. PMID:20109189
Ung, Brian L; Mullins, C Daniel
The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability.
Mwangosi, Ibrahim E A T; Kiango, Mary M
A substantial proportion of pregnant women reports experiencing oral health problems during pregnancy. However, most of them perceive that such problems are normal in pregnancy and hence do not seek dentist consultation. The objective of this study was to determine the prenatal oral health experience and the utilization of dental care services among pregnant women attending reproductive and child health clinics in Bariadi District in Tanzania. Data was collected using a questionnaire-guided interview. Key variables were socio-demographic characteristics of pregnant women, oral health experience, and dental visits during pregnancy with reasons and treatment received. A total of 305 pregnant women (mean age=25.7 years) were involved in the study. Most of the listed oral health problems during pregnancy were reported by women with 2+ children. The frequent oral health problems among the pregnant women were bleeding gums (22.6%, N=69), pain in gums (21.6%, N=66), swollen gums (21.3%, N=65), dental pain (30.5, N=93), and tooth decay (25.6%, n=78). However, only 31.8% (N=97) visited a dental clinic for consultation most whom, were those with three or more children (χ²=.682; P=002). The pregnant women who had visited a dentist in the past 12 months were 11.1% (N=34), mostly those aged >24 years and those with informal employment (P<0.05). Curative and preventive treatments were received more significantly by the urban and with formal employment (P<0.01). In conclusion, pregnant women in Bariadi, Tanzania experiences substantial oral health problems for which they do not often utilize dentists for consultation and management during pregnancy. Dentists and other health workers should therefore, intensify dental screening, emphasizing active family and community participation as part of regular prenatal care.
Henkelman, Wallace J.
Research has demonstrated that only a small proportion of individuals in the United States complete advance directives as part of their planning for end-of-life care. This study sought to determine if health literacy is a significant factor in advance directive completion as has been posited by previous researchers. Analysis of the data collected…
Robichaud, Alain; Ménard, Richard; Zaïtseva, Yulia; Anselmo, David
Air quality, like weather, can affect everyone, but responses differ depending on the sensitivity and health condition of a given individual. To help protect exposed populations, many countries have put in place real-time air quality nowcasting and forecasting capabilities. We present in this paper an optimal combination of air quality measurements and model outputs and show that it leads to significant improvements in the spatial representativeness of air quality. The product is referred to as multi-pollutant surface objective analyses (MPSOAs). Moreover, based on MPSOA, a geographical mapping of the Canadian Air Quality Health Index (AQHI) is also presented which provides users (policy makers, public, air quality forecasters, and epidemiologists) with a more accurate picture of the health risk anytime and anywhere in Canada and the USA. Since pollutants can also behave as passive atmospheric tracers, they provide information about transport and dispersion and, hence, reveal synoptic and regional meteorological phenomena. MPSOA could also be used to build air pollution climatology, compute local and national trends in air quality, and detect systematic biases in numerical air quality (AQ) models. Finally, initializing AQ models at regular time intervals with MPSOA can produce more accurate air quality forecasts. It is for these reasons that the Canadian Meteorological Centre (CMC) in collaboration with the Air Quality Research Division (AQRD) of Environment Canada has recently implemented MPSOA in their daily operations.
Jack, Susan M
Epidemiological data, derived from quantitative studies, provide important information about the causes, prevalence, risk correlates, treatment and prevention of diseases, and health issues at a population level. However, public health issues are complex in nature and quantitative research findings are insufficient to support practitioners and administrators in making evidence-informed decisions. Upshur's Synthetic Model of Evidence (2001) situates qualitative research findings as a credible source of evidence for public health practice. This article answers the following questions: (1) where does qualitative research fit within the paradigm of evidence-based practice and (2) how can qualitative research be used by public health professionals? Strategies for using qualitative research findings instrumentally, conceptually, and symbolically are identified by applying Estabrooks' (1999) conceptual structure of research utilization. Different research utilization strategies are illustrated through the use of research examples from the field of work on intimate partner violence against women. Recommendations for qualitative researchers disseminating findings and for public health practitioners/policy makers considering the use of qualitative findings as evidence to inform decisions are provided.
Baker, J R; Riske, B; Drake, J H; Forsberg, A D; Atwood, R; Voutsis, M; Shearer, R
For several decades, US government agencies have partially supported regional networks of Hemophilia Treatment Centers (HTC). HTC multidisciplinary teams provide comprehensive and coordinated diagnosis, treatment, prevention, education, outreach and surveillance services to improve the health of people with genetic bleeding disorders. However, national data are scarce on HTC-patient population trends and services. The aim of the study was to examine national trends over the past 20 years in patient diagnoses, demographics and health services utilization among the Health Resources and Services Administration (HRSA) and Centers for Disease Control and Prevention (CDC)-supported HTC network. Diagnoses, demographics and health services utilization data from 1990 to 2010 were aggregated from all HTCs using the Hemophilia Data Set (HDS). From 1990 to 2010, the HTC population grew 90% from 17 177 to 32 612. HTC patients with von Willebrand's disease increased by 148%, females by 346%, Hispanic patients by 236% and African Americans by 104%. Four thousand and seventy-five deaths were reported. From 2002 to 2010, annual comprehensive evaluations grew 38%, and persons with severe haemophilia on a home intravenous therapy programme rose 37%. In 2010, 46% of patients were less than 18 years vs. 24% for the general US population. The Hemophilia Data Set documents the growth and diversity of the US Hemophilia Treatment Center Network's patient population and services. Despite disproportionate deaths due to HIV, the HTC patient base grew faster than the general US population. The HDS is a vital national public health registry for this rare-disorder population.
Powell, Brent; Conrad, Eric
Purpose: To examine the enhancement of a university health course through the utilization of the CIPP Model as a means to develop an integrated service-learning component. Methods: The CIPP model was utilized in two concurrent semesters of an undergraduate health course in order to design and evaluate the implementation of a drug and alcohol…
Fronstin, Paul; Roebuck, M Christopher
This paper analyzes data from a large employer that enhanced financial incentives to encourage participation in its workplace wellness programs. It examines, first, the effect of financial incentives on wellness program participation, and second, it estimates the impact of wellness program participation on utilization of health care services and spending. The Patient Protection and Affordable Care Act of 2010 (PPACA) allows employers to provide financial incentives of as much as 30 percent of the total cost of coverage when tied to participation in a wellness program. Participation in health risk assessments (HRAs) increased by 50 percentage points among members of unions that bargained in the incentive, and increased 22 percentage points among non-union employees. Participation in the biometric screening program increased 55 percentage points when financial incentives were provided. Biometric screenings led to an average increase of 0.31 annual prescription drug fills, with related spending higher by $56 per member per year. Otherwise, no significant effects of participation in HRAs or biometric screenings on utilization of health care services and spending were found. The largest increase in medication utilization as a result of biometric screening was for statins, which are widely used to treat high cholesterol. This therapeutic class accounted for one-sixth of the overall increase in prescription drug utilization. Second were antidepressants, followed by ACE inhibitors (for hypertension), and thyroid hormones (for hypothyroidism). Biometric screening also led to significantly higher utilization of biologic response modifiers and immunosuppressants. These specialty medications are used to treat autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, and are relatively expensive compared with non-specialty medications. The added spending associated with the combined increase in fills of 0.02 was $27 per member per year--about one-half of the
Takaku, Reo; Bessho, Shun-Ichiro
Although the payment systems of public health insurance vary greatly across countries, we still have limited knowledge of their effects. To quantify the changes from a benefits in kind system to a refund system, we exploit the largest physician strike in Japan since the Second World War. During the strike in 1971 led by the Japan Medical Association (JMA), JMA physicians resigned as health insurance doctors, but continued to provide medical care and even health insurance treatment in some areas. This study uses the regional differences in resignation rates as a natural experiment to examine the effect of the payment method of health insurance on medical service utilization and health outcomes. In the main analysis, aggregated monthly prefectural data are used (N=46). Our estimation results indicate that if the participation rate of the strike had increased by 1% point and proxy claims were refused completely, the number of cases of insurance benefits and the total amount of insurance benefits would have decreased by 0.78% and 0.58%, respectively compared with the same month in the previous year. Moreover, the average amount of insurance benefits per claim increased since patients with relatively less serious diseases might have sought health care less often. Finally, our results suggest that the mass of resignations did not affect death rates.
Suphanchaimat, Rapeepong; Prakongsai, Phusit; Limwattananon, Supon; Mills, Anne
Objectives This study sought to investigate the impact of the Thai “Health Insurance for People with Citizenship Problems” (HI-PCP) on access to care for stateless patients, compared to Universal Coverage Scheme patients and the uninsured, using inpatient utilization as a proxy for impact. Methods Secondary data analysis of inpatient records of Kraburi Hospital, Ranong province, between 2009 (pre-policy) and 2012 (post-policy) was employed. Descriptive statistics and multivariate analysis by difference-in-difference model were performed. Results The volume of inpatient service utilization by stateless patients expanded after the introduction of the HI-PCP. However, this increase did not appear to stem from the HI-PCP per se. After controlling for key covariates, including patients’ characteristics, disease condition, and domicile, there was only a weak positive association between the HI-PCP and utilization. Critical factors contributing significantly to increased utilization were older age, proximity to the hospital, and presence of catastrophic illness. Conclusion A potential explanation for the insignificant impact of the HI-PCP on access to inpatient care of stateless patients is likely to be a lack of awareness of the existence of the scheme among the stateless population and local health staff. This problem is likely to have been accentuated by operational constraints in policy implementation, including the poor performance of local offices in registering stateless people. A key limitation of this study is a lack of data on patients who did not visit the health facility at the first opportunity. Further study of health-seeking behavior of stateless people at the household level is recommended. PMID:27942240
and Utilization of Mental Health Services among National Guard Soldiers PRINCIPAL INVESTIGATOR: Robert J. Ursano RECIPIENT: Henry M...UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Henry M. Jackson Foundation Bethesda, MD 20852 8...Psychiatry Clin Neurosci. 2006;256:299–306. 7. Kaminer D, Grimsund A, Myer L, Stein DJ, Williams DR. Risk for posttraumatic stress disorder associated with
Calabrese, Sarah K; Burke, Sara E; Dovidio, John F; Levina, Olga S; Uusküla, Anneli; Niccolai, Linda M; Heimer, Robert
Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services.
Burke, Sara E.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Heimer, Robert
Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services. PMID:26050155
Vyas, Amita; Turner, Monique; Glick, Sara; Wood, Susan
Background Trends in social media use, including sending/receiving short message service (SMS) and social networking, are constantly changing, yet little is known about adolescent’s utilization and behaviors. This longitudinal study examines social media utilization among Latino youths, and differences by sex and acculturation. Objectives The purpose of this study was to examine Latino adolescents’ social media utilization and behavior over a 16-month period, and to assess whether changes in use differed by sex and acculturation. Methods This study included 555 Latino youths aged 13-19 who completed baseline and 16-month follow-up surveys. Prevalence of social media utilization and frequency, by sex and acculturation categories, was examined using generalized estimating equations. Results Women are more likely to use SMS, but men are significantly more likely to SMS a girl/boyfriend (P=.03). The use of Internet by men and women to research health information increased over time. Facebook use declined over time (P<.001), whereas use of YouTube (P=.03) and Instagram (P<.001) increased, especially among women and more US acculturated youths. Conclusion Social media is ubiquitous in Latino adolescents’ lives and may be a powerful mode for public health intervention delivery. PMID:26420553
Smith-Palmer, Jayne; Bae, Jay P; Boye, Kristina S; Norrbacka, Kirsi; Hunt, Barnaby; Valentine, William J
Background and aims Type 1 diabetes is a chronic condition associated with micro- and macrovascular complications that have a notable impact on health-related quality of life, the magnitude of which can be quantified via the use of utility values. The aim of this review was to conduct a systematic literature review to identify and compare published health state utility values for adults with type 1 diabetes both, with and without diabetes-related complications. Methods Literature searches of the PubMed, EMBASE, and Cochrane Library databases were performed to identify English language studies on adults with type 1 diabetes, published from 2000 onward, reporting utility values for patients with or without diabetes-related complications or assessing the impact of changes in HbA1c or body mass index on quality of life. For inclusion, studies were required to report utilities elicited using validated methods. Results A total of 20 studies were included in the final review that included utility values elicited using the EuroQuol five dimensions questionnaire (n=9), 15D questionnaire (n=2), Quality of Well-Being scale (n=4), time trade-off (n=3), and standard gamble (n=2) methods. For patients with no complications, reported utility values ranged from 0.90 to 0.98. Complications including stroke (reported disutility range, −0.105 to −0.291), neuropathy (range, −0.055 to −0.358), and blindness (range, −0.132 to −0.208) were associated with the largest decrements in utility values. The magnitude of utility values and utility decrements was influenced by the assessment method used. Conclusion Complications lead to impaired health-related quality of life in patients with type 1 diabetes, the magnitude of which is influenced by the method used to determine utilities. There is currently a lack of utility data for certain complications of type 1 diabetes, meaning that many economic evaluations have relied on a combination of type 1 and type 2 diabetes utilities
Sansone, Randy A; Sellbom, Martin; Songer, Douglas A
The current study examined the associations for borderline personality disorder (BPD) and a specific trait of the disorder, self-harm, with mental health care utilization. Our sample consisted of 145 psychiatric inpatients who completed 3 measures of BPD (Personality Diagnostic Questionnaire-4 [PDQ-4], McLean Screening Inventory for borderline personality disorder [MSI-BPD], Structured Clinical Interview for DSM-IV Axis II Disorders-Personality Questionnaire [SCID-II-PQ]) and the Self-Harm Inventory (SHI). In relationship to mental health care utilization, the correlation for the SHI was significantly larger than those for the PDQ-4, MSI-BPD, or SCID-II-PQ. Thus, self-harm was significantly better at detecting mental health care utilization than was the overall BPD construct, which indicates that some of the more severe manifestations of the disorder are the most predictive of impairment in functioning. These findings also call into question whether BPD (and by extension, personality pathology in general) is most useful in these symptom constellations as opposed to focusing on specific maladaptive traits. (PsycINFO Database Record
Roy-Byrne, P P
Generalized anxiety and mixed anxiety-depression have received less attention than the major mood and anxiety disorders ith respect to their possible effects in increasing disability and health care utilization. A review of recent studies, however, indicates that these conditions are prevalent in primary care medical settings and are associated with significant social and occupational disability. Generalized anxiety disorder is also one of the most common diagnoses seen in patients presenting with medically unexplained somatic complaints such as chest pain, irritable bowel symptoms, and hyperventilation and in patients prone to overutilize health care services in general. It is poorly recognized by primary care physicians, possibly due to its chronicity, which may limit the ability of symptoms to "stand out" and be easily detected. However, it is disproportionately present in "high utilizer" samples found to be particularly "frustrating" to their physicians and is accompanied by a high rate of personality disorders, suggesting that maladaptive personality traits and styles of interaction in such patients may also contribute to underrecognition of symptoms by primary care physicians. These preliminary associations between generalized anxiety disorder/mixed anxiety-depression and both disability and increased health care utilization need to be confirmed with carefully designed and controlled studies.
Background It has been shown that gender equity has a positive impact on the everyday activities of people (decision making, income allocation, application and observance of norms/rules) which affect their health. Gender equity is also a crucial determinant of health inequalities at national level; thus, monitoring is important for surveillance of women’s and men’s health as well as for future health policy initiatives. The Gender Equity Index (GEI) was designed to show inequity solely towards women. Given that the value under scrutiny is equity, in this paper a modified version of the GEI is proposed, the MGEI, which highlights the inequities affecting both sexes. Methods Rather than calculating gender gaps by means of a quotient of proportions, gaps in the MGEI are expressed in absolute terms (differences in proportions). The Spearman’s rank coefficient, calculated from country rankings obtained according to both indexes, was used to evaluate the level of concordance between both classifications. To compare the degree of sensitivity and obtain the inequity by the two methods, the variation coefficient of the GEI and MGEI values was calculated. Results Country rankings according to GEI and MGEI values showed a high correlation (rank coef. = 0.95). The MGEI presented greater dispersion (43.8%) than the GEI (19.27%). Inequity towards men was identified in the education gap (rank coef. = 0.36) when using the MGEI. According to this method, many countries shared the same absolute value for education but with opposite signs, for example Azerbaijan (−0.022) and Belgium (0.022), reflecting inequity towards women and men, respectively. This also occurred in the empowerment gap with the technical and professional job component (Brunei:-0.120 vs. Australia, Canada Iceland and the U.S.A.: 0.120). Conclusion The MGEI identifies and highlights the different areas of inequities between gender groups. It thus overcomes the shortcomings of the GEI related to the
Wu, Xiao-Cheng; Prasad, Pinki K.; Landry, Ian; Harlan, Linda C.; Parsons, Helen M.; Lynch, Charles F; Smith, Ashley Wilder; Hamilton, Ann S.; Keegan, Theresa H. M.
Background Existing comorbidity indices were not developed for adolescent and young adults (AYA) 15–39 years of age. The aim of this study was to assess impact of comorbidities on healthcare service needs and health status among AYA cancer survivors using the newly developed AYA HOPE comorbidity index in comparison with the existing indices. Methods Data on comorbid conditions were obtained from medical records and service needs and health status were from a survey of AYA cancer survivors. Prevalence of comorbidities based on the AYA HOPE index. Charlson and NCI indices) were compared. Multivariable logistic regression was employed. Results Of the 485 patients, 14.6% had ≥2 comorbidities based on the AYA HOPE Index. Prevalence of mental illness and obesity/overweight, which were not included in existing indices, were 8.2% and 5.8%, respectively. Prevalence of cardiovascular, endocrine, gastrointestinal and neurologic conditions were higher with the AYA HOPE Index than the other two indices. Forty percent of AYA patients reported service needs, particularly for mental health services (25.2%) and support groups (17.7%). Having ≥2 comorbidities on the AYA index was associated with higher mental health service needs (OR: 2.05; 95% CI 1.10–3.82) adjusting for demographic and clinical factors. Comorbidities were associated with fair/poor self-reported health status. Conclusion The AYA HOPE Index is a more comprehensive comorbidity index for AYA cancer patients than existing indices and the number of comorbidities is associated with service needs and health status. Impact The AYA HOPE index could identify patients’ additional service needs early in therapy. PMID:26420768
Campos, J A D B; Zucoloto, M L; Geremias, R F; Nogueira, S S; Maroco, J
To perform a validation of the Geriatric Oral Health Assessment Index (GOHAI) for complete denture wearers and present a proposal for estimation of perceived oral health. This is a cross-sectional study with non-probabilistic sampling. A total of 211 subjects with a mean age of 62·5 (s.d. = 11·4) years participated, being 169 female. The GOHAI was applied in a personal interview. The construct/convergent/discriminant validity was tested using structural equation modelling. Confirmatory factor analysis was used to verify the fit of three proposals of the GOHAI: three-factor, one-factor and second-order hierarchical models. The stability of the models was evaluated in independent samples. The three-factor model presented an inadequate fit, and items 3, 4 and 9 were removed. The new structure presented an acceptable fit and strong invariance in independent samples. The convergent, discriminant validity and internal consistency were below adequate. The one-factor model presented an adequate fit to the sample. Convergent validity was compromised. A strong invariance of the one-factor model was observed. To calculate the overall scores of the GOHAI factors (three-factor model) or of the oral health perception (one-factor model), a matrix of regression weights for each item in the model was presented as a suggestion. We found an adequate fit of the both structures of the GOHAI for denture wearers, but the three-factor structure was more parsimonious. We suggested considering the weights of the regression model to calculate the overall score of perceived oral health or of its factors in different samples.
Apprill, Amy; Robbins, Jooke; Eren, A. Murat; Pack, Adam A.; Reveillaud, Julie; Mattila, David; Moore, Michael; Niemeyer, Misty; Moore, Kathleen M. T.; Mincer, Tracy J.
serve as a useful index for health and skin disorder monitoring of threatened and endangered marine mammals. PMID:24671052
Apprill, Amy; Robbins, Jooke; Eren, A Murat; Pack, Adam A; Reveillaud, Julie; Mattila, David; Moore, Michael; Niemeyer, Misty; Moore, Kathleen M T; Mincer, Tracy J
as a useful index for health and skin disorder monitoring of threatened and endangered marine mammals.
Hsu, Robert T; Crawford, William W; Klaustermeyer, William B
Emergency hospital utilization rates for asthma remain high despite advances in asthma controller medications and the presence of widely accepted asthma treatment guidelines. To explore this phenomenon, we analyzed administrative data to determine characteristics of patients seen in the emergency department (ED) for asthma. Complete pharmacy and diagnostic coding records were obtained from consecutive adults (aged 19-56 years) treated for asthma in the ED of a closed-network health maintenance organization between April and July of 2002. Subjects were stratified into asthma severity categories (persistent or non-persistent) based on the National Committee for Quality Assurance 2006 Health Plan and Employer Data and Information Set (HEDIS) criteria for persistent asthma. Eighty-one unique patients made a total of 89 ED visits for asthma during the study period. Of the 89 total ED visits for asthma, 44 (49%) occurred in patients that did not meet HEDIS criteria for persistent asthma. Of the 81 unique patients making asthma-related ED visits, 41 (51%) did not meet HEDIS criteria for persistent asthma. Over one-half (51%) of this nonpersistent population were not given either asthma reliever or asthma controller medications during the 12-month period before their index ED visit. Over the 24-month period before their index ED visit, 37% of nonpersistent patients were dispensed neither asthma reliever nor controller medications. Patients that do not meet HEDIS criteria for persistent asthma account for a substantial percentage of asthma-related ED visits. These patients have a history of low use of asthma medications before their ED visit.
Peng, X; Sun, P; Novick, D; Andrews, J; Sun, S
Objectives To compare health care utilization of duloxetine initiators and pregabalin initiators among fibromyalgia patients in a real-world setting. Methods A retrospective cohort study was conducted based on a US national commercial health claims database (2006–2009). Fibromyalgia patients who initiated duloxetine or pregabalin in 2008, aged 18–64 years, and who maintained continuous health insurance coverage 1 year before and 1 year after initiation were assigned to duloxetine or pregabalin cohorts on the basis of their initiated agent. Patients who had pill coverage of the agents over the course of 90 days preceding the initiation were excluded. The two comparative cohorts were constructed using propensity score greedy match methods. Descriptive analysis and paired t-test were performed to compare health care utilization rates in the postinitiation year and the changes of these rates from the preinitiation year to the postinitiation year. Results Both matched cohorts (n=1,265 pairs) had a similar mean initiation age (49–50 years), percentage of women (87%–88%), and prevalence of baseline comorbid conditions (neuropathic pain other than diabetic peripheral neuropathic pain, low back pain, cardiovascular disease, hypertension, headache or migraine, and osteoarthritis). In the preinitiation year, both cohorts had similar inpatient, outpatient, and medication utilization rates (inpatient, 15.7%–16.1%; outpatient, 100.0%; medication, 97.9%–98.7%). The utilization rates diverged in the postinitiation year, with the pregabalin cohort using more fibromyalgia-related inpatient care (3.2% versus 2.2%; P<0.05), any inpatient care (19.3% versus 16.8%; P<0.05), and fibromyalgia-related outpatient care (62.1% versus 51.8%; P<0.05). From the preinitiation period to the postinitiation period, the duloxetine cohort experienced decreases in certain utilization rates, whereas the pregabalin cohort had increases (percentage of patients with a fibromyalgia
Background Uganda implemented health sector reforms to make services more accessible to the population. An assessment of the likely impact of these reforms is important for informing policy. This paper describes the changes in utilization of health services that occurred among the poor and those in rural areas between 2002/3 and 2005/6 and associated factors. Methods Secondary data analysis was done using the socio-economic component of the Uganda National Household Surveys 2002/03 and 2005/06. The poor were identified from wealth quintiles constructed using an asset based index derived from Principal Components Analysis (PCA). The probability of choice of health care provider was assessed using multinomial logistic regression and multi-level statistical models. Results The odds of not seeking care in 2005/6 were 1.79 times higher than in 2002/3 (OR = 1.79; 95% CI 1.65 - 1.94). The rural population experienced a 43% reduction in the risk of not seeking care because of poor geographical access (OR = 0.57; 95% CI 0.48 - 0.67). The risk of not seeking care due to high costs did not change significantly. Private for profit providers (PFP) were the major providers of services in 2002/3 and 2005/6. Using PFP as base category, respondents were more likely to have used private not for profit (PNFP) in 2005/6 than in 2002/3 (OR = 2.15; 95% CI 1.58 - 2.92), and also more likely to use public facilities in 2005/6 than 2002/3 (OR = 1.31; 95% CI 1.15 - 1.48). The most poor, females, rural residents, and those from elderly headed households were more likely to use public facilities relative to PFP. Conclusion Although overall utilization of public and PNFP services by rural and poor populations had increased, PFP remained the major source of care. The odds of not seeking care due to distance decreased in rural areas but cost continued to be an important barrier to seeking health services for residents from poor, rural, and elderly headed households. Policy makers should consider
Lilford, Richard J.
Objective To examine the independent contribution of individual, community and state-level factors to health care service utilization for children with acute childhood illnesses in Nigeria. Materials and methods The study was based on secondary analyses of cross-sectional population-based data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel logistic regression models were applied to the data on 6,427 under-five children who used or did not use health care service when they were sick (level 1), nested within 896 communities (level 2) from 37 states (level 3). Results About one-quarter of the mothers were between 15 and 24 years old and almost half of them did not have formal education (47%). While only 30% of the children utilized health service when they were sick, close to 67% lived in the rural area. In the fully adjusted model, mothers with higher education attainment (Adjusted odds ratio [aOR] = 1.63; 95% credible interval [CrI] = 1.31–2.03), from rich households (aOR = 1.76; 95% CrI = 1.35–2.25), with access to media (radio, television or magazine) (aOR = 1.18; 95% CrI = 1.08–1.29), and engaging in employment (aOR = 1.18; 95% CrI = 1.02–1.37) were significantly more likely to have used healthcare services for acute childhood illnesses. On the other hand, women who experienced difficulty getting to health facilities (aOR = 0.87; 95% CrI = 0.75–0.99) were less likely to have used health service for their children. Conclusions Our findings highlight that utilization of healthcare service for acute childhood illnesses was influenced by not only maternal factors but also community-level factors, suggesting that public health strategies should recognise this complex web of individual composition and contextual composition factors to guide provision of healthcare services. Such interventions could include: increase in female school enrolment, provision of interest-free loans for small and medium scale enterprises, introduction of
Schlander, M; Trott, G-E; Schwarz, O
In the German region of Nordbaden, 5% of children (aged 7-12 years) and 1.3% of adolescents (aged 13-19 years) were diagnosed with attention deficit hyperactivity disorder (ADHD) in 2003. About two thirds of these patients were not seen by a physician specialized in psychiatry. Now the National Association of Statutory Health Insurance Physicians in Germany (Kassenaerztliche Bundesvereinigung, KBV) has developed a proposal for the integrated provision of care for these patients, combining a guidelines-oriented multidisciplinary approach with a system of quality assurance. Against this background, currently available ADHD-related data are presented, covering epidemiology, comorbidity and differential diagnosis, health care utilization, and cost of illness. According to administrative data analyses from Nordbaden, direct medical costs for patients with ADHD, from the perspective of statutory health insurance (SHI), exceed those of matched controls by a factor of >2.5. On this basis, ADHD-related expenditures of the German SHI may be estimated at around EUR 260 million in 2003, and almost certainly will have continued to grow further since. In addition to this, a diagnosis of ADHD is associated with substantial indirect cost. Although the literature on the burden of ADHD is incomplete, it seems plausible that the cost of illness might be comparable to that reported for alcohol and addiction disorders. Thus we anticipate an increasing relevance of formal health economic evaluations of health care programs offered to patients with ADHD.
Torrance, G W; Boyle, M H; Horwood, S P
A four-attribute health state classification system designed to uniquely categorize the health status of all individuals two years of age and over is presented. A social preference function defined over the health state classification system is required. Standard multi-attribute utility theory is investigated for the task, problems are identified and modifications to the standard method are proposed. The modified methods is field tested in a survey research project involving 112 home interviews. Results are presented and discussed in detail for both the social preference function and the performance of the modified method. A recommended social preference function is presented, complete with a range of uncertainty. The modified method is found to be applicable to the task--no insurmountable difficulties are encountered. Recommendations are presented, based on our experience, for other investigators who may be interested in reapplying the method in other studies.
Frost, Susan A.; Goebel, Kai; Trinh, Khanh V.; Balas, Mark J.; Frost, Alan M.
Increasing turbine up-time and reducing maintenance costs are key technology drivers for wind turbine operators. Components within wind turbines are subject to considerable stresses due to unpredictable environmental conditions resulting from rapidly changing local dynamics. Systems health management has the aim to assess the state-of-health of components within a wind turbine, to estimate remaining life, and to aid in autonomous decision-making to minimize damage. Advanced adaptive controls can provide the mechanism to enable optimized operations that also provide the enabling technology for Systems Health Management goals. The work reported herein explores the integration of condition monitoring of wind turbine blades with contingency management and adaptive controls. Results are demonstrated using a high fidelity simulator of a utility-scale wind turbine.
White, Ryen W; Horvitz, Eric
Objective To better understand the relationship between online health-seeking behaviors and in-world healthcare utilization (HU) by studies of online search and access activities before and after queries that pursue medical professionals and facilities. Materials and methods We analyzed data collected from logs of online searches gathered from consenting users of a browser toolbar from Microsoft (N=9740). We employed a complementary survey (N=489) to seek a deeper understanding of information-gathering, reflection, and action on the pursuit of professional healthcare. Results We provide insights about HU through the survey, breaking out its findings by different respondent marginalizations as appropriate. Observations made from search logs may be explained by trends observed in our survey responses, even though the user populations differ. Discussion The results provide insights about how users decide if and when to utilize healthcare resources, and how online health information seeking transitions to in-world HU. The findings from both the survey and the logs reveal behavioral patterns and suggest a strong relationship between search behavior and HU. Although the diversity of our survey respondents is limited and we cannot be certain that users visited medical facilities, we demonstrate that it may be possible to infer HU from long-term search behavior by the apparent influence that health concerns and professional advice have on search activity. Conclusions Our findings highlight different phases of online activities around queries pursuing professional healthcare facilities and services. We also show that it may be possible to infer HU from logs without tracking people's physical location, based on the effect of HU on pre- and post-HU search behavior. This allows search providers and others to develop more robust models of interests and preferences by modeling utilization rather than simply the intention to utilize that is expressed in search queries. PMID
Thorpe, Maree G.; Milte, Catherine M.; Crawford, David; McNaughton, Sarah A.
The Dietary Guideline Index, a measure of diet quality, was updated to reflect the 2013 Australian Dietary Guidelines. This paper describes the revision of the index (DGI-2013) and examines its use in older adults. The DGI-2013 consists of 13 components reflecting food-based daily intake recommendations of the Australian Dietary Guidelines. In this cross-sectional study, the DGI-2013 score was calculated using dietary data collected via an 111-item food frequency questionnaire and additional food-related behaviour questions. The DGI-2013 score was examined in Australian adults (aged 55–65 years; n = 1667 men; 1801 women) according to sociodemographics, health-related behaviours and BMI. Women scored higher than men on the total DGI-2013 and all components except for dairy. Those who were from a rural area (men only), working full-time (men only), with lower education, smoked, did not meet physical activity guidelines, and who had a higher BMI, scored lower on the DGI-2013, highlighting a group of older adults at risk of poor health. The DGI-2013 is a tool for assessing compliance with the Australian Dietary Guidelines. We demonstrated associations between diet quality and a range of participant characteristics, consistent with previous literature. This suggests that the DGI-2013 continues to demonstrate convergent validity, consistent with the original Dietary Guideline Index. PMID:26978399
Li, Li; Lin, Guo-Zhen; Liu, Hua-Zhang; Guo, Yuming; Ou, Chun-Quan; Chen, Ping-Yan
The validity of using the Air Pollution Index (API) to assess health impacts of air pollution and potential modification by individual characteristics on air pollution effects remain uncertain. We applied distributed lag non-linear models (DLNMs) to assess associations of daily API, specific pollution indices for PM10, SO2, NO2 and the weighted combined API (APIw) with mortality during 2003-2011 in Guangzhou, China. An increase of 10 in API was associated with a 0.88% (95% confidence interval (CI): 0.50, 1.27%) increase of non-accidental mortality at lag 0-2 days. Harvesting effects appeared after 2 days' exposure. The effect estimate of API over lag 0-15 days was statistically significant and similar with those of pollutant-specific indices and APIw. Stronger associations between API and mortality were observed in the elderly, females and residents with low educational attainment. In conclusion, the API can be used to communicate health risks of air pollution.
Koh, W-P; Yuan, J-M; Wang, R; Lee, H-P; Yu, M C
Background: Smokers with low body mass index (BMI) may be more susceptible to lung cancer. Methods: We prospectively examined the association between baseline BMI and lung cancer risk in the Singapore Chinese Health Study, a cohort of 63 257 Chinese enrolled between 1993 and 1998. Results: After adjustment for smoking intensity and duration, BMI was inversely associated with risk of lung cancer among current smokers (P for trend=0.0004). Current smokers at different dosage of smoking with low BMI had significantly higher risk for lung cancer than those with high BMI. Hazard ratios (95% confidence intervals) of lung cancer for heavy smokers with BMI of ⩾28, 24–<28, 20–<24, and <20 kg m−2 were 6.37 (2.10–19.30), 9.01 (5.04–16.10), 8.53 (6.35–11.5), and 11.12 (6.60–18.70), respectively, as compared with nonsmokers. BMI had no modifying effects on lung cancer risk among nonsmokers and former smokers. Conclusion: Smokers with lower BMI may experience an enhanced risk of lung cancer. The findings have significant public-health implication given the increase in smoking prevalence in developing countries, where people still have relatively low BMI. PMID:20010947
Waterman, Pamela D.; Spasojevic, Jasmina; Li, Wenhui; Maduro, Gil; Van Wye, Gretchen
Objectives. We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring. Methods. We used New York City data centered around 2010 to assess cross-sectional associations at the census tract and community district levels, for (1) diverse ICE measures plus the US poverty rate, with (2) infant mortality, premature mortality (before age 65 years), and diabetes mortality. Results. Point estimates for rate ratios were consistently greatest for the novel ICE that jointly measured extreme concentrations of income and race/ethnicity. For example, the census tract–level rate ratio for infant mortality comparing the bottom versus top quintile for an ICE contrasting low-income Black versus high-income White equaled 2.93 (95% confidence interval [CI] = 2.11, 4.09), but was 2.19 (95% CI = 1.59, 3.02) for low versus high income, 2.77 (95% CI = 2.02, 3.81) for Black versus White, and 1.56 (95% CI = 1.19, 2.04) for census tracts with greater than or equal to 30% versus less than 10% below poverty. Conclusions. The ICE may be a useful metric for public health monitoring, as it simultaneously captures extremes of privilege and deprivation and can jointly measure economic and racial/ethnic segregation. PMID:26691119
Loeb, Stacy; Sokoll, Lori J.; Broyles, Dennis L.; Bangma, Chris H.; van Schaik, Ron H.N.; Klee, George G.; Wei, John T.; Sanda, Martin G.; Partin, Alan W.; Slawin, Kevin M.; Marks, Leonard S.; Mizrahi, Isaac A.; Shin, Sanghyuk S.; Cruz, Amabelle B.; Chan, Daniel W.; Roberts, William L.; Catalona, William J.
Purpose Reported prostate-specific antigen (PSA) values may differ substantially between assays with the Hybritech and World Health Organization (WHO) standardization. [-2]proPSA (p2PSA) and the Beckman Coulter prostate health index (phi) are newly approved serum markers, which are associated with prostate cancer risk and aggressiveness. Our objective was to study the influence of assay standardization on these markers. Materials and Methods PSA, % free PSA (%fPSA), and p2PSA were measured using the Hybritech calibration in 892 men undergoing prostate biopsy from a prospective multicenter study. Phi was calculated as: [p2PSA/ fPSA) × (square root of PSA)]. Performance characteristics of phi for prostate cancer detection were then determined using re-calculated WHO calibration PSA values. Results The median phi was significantly higher in men with prostate cancer compared to those with negative biopsies using the WHO values (47.4 vs 39.8, p<0.001). Phi offered improved discrimination of prostate cancer detection on biopsy (AUC 0.704) compared to %fPSA or total PSA using the WHO calibration. Conclusions Phi can be calculated using Hybritech or WHO standardized assays, and significantly improved the prediction of biopsy outcome over %fPSA or PSA alone. PMID:23206426
Langellier, Brent A; Chen, Jie; Vargas-Bustamante, Arturo; Inkelas, Moira; Ortega, Alexander N
It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006–2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., income) and (2) those attributable to differences in group-specific regression coefficients that measure the health-care ‘return’ Latino, White, and Black children receive on these characteristics. In the United States, Latino children are less likely than Whites to have a usual source of care, receive at least one preventive care visit, and visit a doctor, and are more likely to have delayed care. The return on sociodemographic characteristics explains 20–30% of the disparity between Latino and White children in the usual source of care, delayed care, and doctor visits and 40–50% of the disparity between Latinos and Blacks in emergency department use and preventive care. Much of the health-care disadvantage experienced by Latino children would persist if Latinos had the sociodemographic characteristics as Whites and Blacks. PMID:25395597
Chou, Chiu-Fang; Johnson, Pamela Jo; Blewett, Lynn A
We examined indicators of health status and healthcare utilization according to immigration status to assess the 'healthy immigrant effect' for Chinese adults. Data for Chinese in Taiwan (n = 15,549) were from the 2001 Taiwan National Health Interview Survey (NHIS). Data for U.S.-born Chinese (n = 964) and Chinese Immigrants in the U.S. (n = 253) were from the 1998-2004 U.S. NHIS. We used multivariate logistic regression to estimate the adjusted odds of perceived poor health, having ever smoked, and past year emergency room visits according to immigration status. For Chinese immigrants, more years in the U.S. were associated with lower odds of reporting poor health (OR = 0.4; 95% CI = 0.2-0.8) and past-year emergency room use (OR = 0.5; 95% CI = 0.3-0.9). Compared with recent Chinese immigrants (<5 years in U.S.), Chinese in Taiwan had higher odds of reporting poor health (OR = 6.2; 95% CI = 3.2-12.1) and having ever smoked (OR = 1.6; 95% CI = 1.1-2.5). Our results suggest that those who migrate have better health profiles than those who do not migrate. However, recent Chinese immigrants were not significantly different than U.S.-born Chinese.
Suther, Sandra; Battle, Arrie M; Battle-Jones, Felecia; Seaborn, Cynthia
Minority racial and ethnic groups are at higher risk for developing type 2 diabetes. These groups also experience more severe complications from diabetes and have higher mortality rates as a result of the disease, such as cardiovascular disease, amputation and kidney failure. Underserved rural ethnically disparate populations benefit from health education outreach efforts that are conveyed and translated by specially-trained community health ambassadors. Project H.I.G.H. (Helping Individuals Get Healthy) was developed to target the priority areas of type 2 diabetes and cardiovascular disease. Utilizing trained community health ambassadors, CDC's The Road to Health Toolkit as well as New Beginnings: A Discussion Guide for Living Well with Diabetes was used as a model for a community-based educational program. The overall goal of Project H.I.G.H was to implement and evaluate: (1) a coordinated, behavior-focused, family-centered, community-based educational program and; (2) a client service coordination effort resulting in improved health outcomes (BMI, Glucose Levels, BP) for individuals with type 2 diabetes and cardiovascular disease in Gadsden County, Florida. Overall, Project H.I.G.H. was very successful in its first year at motivating participants to delay or prevent diabetes and/or cardiovascular disease or at the very least to start taking better care of their health.
Bonin, Jean-Pierre; Fournier, Louise; Blais, Régis; Perreault, Michel; White, Noé Djawn
The objective of this cohort study is to describe the service utilization by clients of homeless resources in Quebec and Montreal (Canada) over a 5-year period. Participants (N = 426) were recruited from a survey conducted in 1999 about clients' utilization of resources intended for homeless people in Montreal and Quebec. Data analyzed in this study were also drawn from three administrative databanks managed by the Quebec health care system. Results revealed that: (1) in general, mental health services are less used than physical health services; (2) generally, women, older persons, nonhomeless persons, and persons with mental health problems utilized proportionately more health services; and (3) participants involved in this study tend to continue using services over years in a system where health services are free. These findings are discussed in terms of long-term service utilization by clients of homeless resources.
Christensen, Lisa Bøge; Petersen, Poul Erik; Bastholm, Annelise; Lone, Laurberg
The objectives of the study were: 1) to describe the choice of dental care system among 16-year-olds, 2) to describe the utilization of dental services among 16-17-year-olds enrolled in either public or private dental care systems, and to compare the dental services provided by the alternative systems. The study comprised 1,245 adolescents from 3 municipalities; the historical cohort study design was applied; and data were collected from dental records (public dental service) and dental claims (private practice). At age 16, 12% preferred being enrolled in the private practice system, while 88% remained in the public dental care system. During the 2-year study period the attendance rate was 99% for the public system, while 90% attended the private practice system (P< 0.001). Preventive dental services were provided more frequently by the public than the private system (P< 0.001). Despite the fact that the economic barrier was eliminated a lower attendance rate was observed for patients transferred to the private practice system.
Olafsdottir, Sigrun; Pescosolido, Bernice A
In the 1990s, sociologists began to rethink the failure of utilization models to explain whether and why individuals accessed formal treatment systems. This effort focused on reconceptualizing the underlying assumptions and processes that shaped utilization patterns. While we have built a better understanding of how social networks structure pathways to care and how disadvantaged sociocultural groups face substantial barriers to treatment, we have less understanding of the larger cultural context in which individuals recognize and respond to symptoms. Drawing from recent innovations in the sociology of culture, we develop the concept of "cultural mapping" to describe if and how individuals discriminate among different available sources of formal treatment. Using data from the 1996 Mental Health Module of the General Social Survey, we compare Americans' willingness to recommend providers in the general medical and specialty mental health sectors. The results indicate that, despite unrealistically high levels of endorsement, individuals do discriminate between providers based on their evaluation of the problem, underlying causes, and likely consequences. While perceived severity leads individuals to suggest any type of formal care, problems attributed to biological causes are directed to general or specialty medical providers (doctors, psychiatrists, and hospitals); those matching symptoms for schizophrenia or seen as eliciting violence are allocated to the specialty mental health sector (psychiatry, mental hospital); and those seen as being caused by stress are sent to nonmedical mental health providers (i.e., counselors). These findings help to explain inconsistencies in previous utilization studies, and they suggest the critical importance of maintaining a dialogue between medical sociology and the sociology of culture.
Obare, Francis; Warren, Charlotte; Njuki, Rebecca; Abuya, Timothy; Sunday, Joseph; Askew, Ian; Bellows, Ben
This paper examines community-level association between exposure to the reproductive health vouchers programme in Kenya and utilization of services. The data are from a household survey conducted among 2527 women (15-49 years) from voucher and comparable non-voucher sites. Analysis entails cross-tabulations with Chi-square tests and significant tests of proportions as well as estimation of multi-level logit models to predict service utilization by exposure to the programme. The results show that for births occurring after the voucher programme began, women from communities that had been exposed to the programme since 2006 were significantly more likely to have delivered at a health facility and to have received skilled care during delivery compared with those from communities that had not been exposed to the programme at all. There were, however, no significant differences in the timing of first trimester utilization of antenatal care (ANC) and making four or more ANC visits by exposure to the programme. In addition, poor women were significantly less likely to have used safe motherhood services (health facility delivery, skilled delivery care and postnatal care) compared with their non-poor counterparts regardless of exposure to the programme. Nonetheless, a significantly higher proportion of poor women from communities that had been exposed to the programme since 2006 used the services compared with their poor counterparts from communities that had not been exposed to the programme at all. The findings suggest that the programme is associated with increased health facility deliveries and skilled delivery care especially among poor women. However, it has had limited community-level impact on the first trimester timing of antenatal care use and making four or more visits, which remain a challenge despite the high proportion of women in the country that make at least one antenatal care visit during pregnancy.
Hernández-Quevedo, Cristina; Jiménez-Rubio, Dolores
The increasing proportion of immigrants in Spanish society is placing pressure on the National Health Care System to accommodate the needs of this population group while keeping costs under control. In the year 2000, a law was approved in Spain according to which all people, regardless of their nationality, are entitled to use health care services under the same conditions as Spanish citizens, provided that they are registered in the local population census. However, empirical evidence about differences in health status and health care utilization between the immigrant and the Spanish population is insufficient. This paper uses the 2003 and 2006 Spanish National Health Surveys to explore the existence of inequalities in health and in the access to health services for the immigrant population living in Spain, relative to that of Spaniards. Our results show that there are different patterns in the level of health and the medical care use between the national and the foreign population in Spain: while immigrants' self-reported health relative to that of the Spanish population depends upon individual nationality, all immigrants, regardless of their nationality, seem to face barriers of entry to specialized care. Further research is needed to understand the nature of these barriers in order to design more effective health policies.
Shuval, Hillel I.
The practice of waste water utilization has grown considerably in recent years, owing to the growing demand for water for agricultural, industrial and domestic purposes. Such utilization presents certain problems in respect of the quality of the reclaimed water, on account of the presence of certain trace chemicals in the waste waters to be re-used. The presence of these trace chemicals may have important consequences in the agricultural or industrial utilization of waste waters, but from the public health point of view it is in the re-use of waste waters for domestic purposes that their presence has most importance, owing to their possible toxic effects. This paper discusses the public health significance of trace chemicals in water, with special reference to some of the newer complex synthetic organic compounds that are appearing in ever-increasing numbers in industrial wastes. Current information on the acute and chronic toxicity of these substances is reviewed and related to possible methods of treatment of waste waters. In conclusion, the author points out that the problem of trace chemicals is not confined only to direct waste-water reclamation projects, but arises in all cases where surface waters polluted with industrial wastes are used as a source of domestic supply. PMID:13988826
Seiber, Eric E; Hotchkiss, David R; Rous, Jeffrey J; Berruti, Andrés A
Does the utilization of modern maternal and child health (MCH) services influence subsequent contraceptive use? The answer to this question holds important implications for proposals which advocate MCH and family planning service integration. This study uses data from the 1995/6 Guatemalan Demographic Health Survey and its 1997 Providers Census to test the influence of MCH service utilization on individual contraceptive use decisions. We use a full-information maximum likelihood regression model to control for unobserved heterogeneity. This model produces estimates of the MCH effect, independent of individual women's underlying receptiveness to MCH and contraceptive messages. The results of the analysis indicate that the intensity of MCH service use is indeed positively associated with subsequent contraceptive use among Guatemalan women, even after controlling for observed and unobserved individual- , household- , and community-level factors. Importantly, this finding holds even after controlling for the unobserved factors that 'predispose' some women to use both types of services. Simulations reveal that, for these Guatemalan women, key determinants such as age and primary schooling work indirectly through MCH service use to increase contraceptive utilization.
Magana, Sandy; Smith, Matthew J.
This study examined health behaviors, utilization, and access to care among older Latina and Black American mothers who co-reside with a child with developmental disabilities. Using data from the National Health Interview Survey National Center for Health Statistics (2005a), we compared Latina and Black American caregivers to similar women who did…
Leyva-Flores, Rene; Servan-Mori, Edson; Infante-Xibille, Cesar; Pelcastre-Villafuerte, Blanca Estela; Gonzalez, Tonatiuh
Objective To analyze the relationship between primary health care utilization and extended health insurance coverage under the Seguro Popular (SP) among Mexican indigenous people. Methodology A cross-sectional analysis was conducted using data from the Mexican National Nutrition Survey 2012 (n = 194,758). Quasi-experimental matching methods and nonlinear regression probit models were used to estimate the influence of SP on primary health care utilization. Results 25% of the Mexican population reported having no health insurance coverage, while 59% of indigenous versus 35% of non-indigenous reported having SP coverage. Health problems were reported by 13.9% of indigenous vs. 10.5% of non-indigenous; of these, 52.8% and 57.7% respectively, received primary health care (p<0.05). Economic barriers were the most frequent reasons for not using primary health care services. The probability of utilizing primary health care services was 11.5 percentage points higher (p<0.01) for indigenous SP affiliates in comparison with non-indigenous, in similar socioeconomic conditions. Conclusion Socioeconomic conditions, not ethnicity per-se, determine whether people utilize primary health care services. Therefore, SP can be conceived as a public policy strategy which acts as a social buffer by enhancing health care utilization regardless of ethnicity. Further analysis is required to explore the potential gaps as a result of SP coverage among socially vulnerable groups. PMID:25099399
Di Chiro, G.; Hatazawa, J.; Katz, D.A.; Rizzoli, H.V.; De Michele, D.J.
Seventeen patients with intracranial meningiomas were studied with positron emission tomography and fluorine-18-2-fluorodeoxyglucose (PET-FDG) to assess the glucose utilization of these tumors. Four meningiomas followed for 3-5 years after PET-FDG and surgery showed no evidence of recurrence. These tumors had significantly lower glucose utilization rates (1.9 mg/dl/min +/- 1.0) than 11 recurrent or regrowing meningiomas (4.5 mg/dl/min +/- 1.96). The glucose metabolic rates of meningiomas correlated with tumor growth, as estimated from changes in tumor size on repeated computed tomographic scans. Histopathologically, a syncytial (atypical) meningioma had the highest glucose utilization rate, followed by a papillary meningioma and an angioblastic meningioma. Individual transitional and syncytial (typical) meningiomas showed marked differences in glucose metabolism despite similar microscopic appearance. Glucose utilization rate appears to be at least as reliable as histologic classification and other proposed criteria for predicting the behavior and recurrence of intracranial meningiomas.
Schweikert, Bernd; Hahmann, Harry; Leidl, Reiner
Background The valid and reliable measurement of health service utilization, productivity losses and consequently total disease-related costs is a prerequisite for health services research and for health economic analysis. Although administrative data sources are usually considered to be the most accurate, their use is limited as some components of utilization are not systematically captured and, especially in decentralized health care systems, no single source exists for comprehensive utilization and cost data. The aim of this study was to develop and test a questionnaire for the measurement of disease-related costs for patients after an acute cardiac event (ACE). Methods To design the questionnaire, the literature was searched for contributions to the assessment of utilization of health care resources by patient-administered questionnaires. Based on these findings, we developed a retrospective questionnaire appropriate for the measurement of disease-related costs over a period of 3 months in ACE patients. Items were generated by reviewing existing guidelines and by interviewing medical specialists and patients. In this study, the questionnaire was tested on 106 patients, aging 35–65 who were admitted for rehabilitation after ACE. It was compared with prospectively measured data; selected items were compared with administrative data from sickness funds. Results The questionnaire was accepted well (response rate = 88%), and respondents completed the questionnaire in an average time of 27 minutes. Concordance between retrospective and prospective data showed an intraclass correlation (ICC) ranging between 0.57 (cost of medical intake) and 0.9 (hospital days) with the other main items (physician visits, days off work, medication) clustering around 0.7. Comparison between self-reported and administrative data for days off work and hospitalized days were possible for n = 48. Respective ICCs ranged between 0.92 and 0.94, although differences in mean levels were
Lu, Chu-Hong; Luo, Zhong-Cheng; Wang, Jia-Ji; Zhong, Jian-Hu; Wang, Pei-Xi
Objectives: The number of rural-to-urban migrant workers has been increasing rapidly in China over recent decades, but there is a scarcity of data on health-related quality of life (HRQOL) and health service utilization among Chinese rural-to-urban migrant workers in comparison to local urban residents. We aimed to address this question. Methods: This was a cross-sectional study of 2315 rural-to-urban migrant workers and 2347 local urban residents in the Shenzhen-Dongguan economic zone (China) in 2013. Outcomes included HRQOL (measured by Health Survey Short Form 36) and health service utilization (self-reported). Results: Compared to local urban residents, rural-to-urban migrant workers had lower scores in all domains of HRQOL, and were more likely to report chronic illnesses (9.2% vs. 6.0%, adjusted OR = 1.62, 95% CI 1.28–2.04) and recent two-week morbidity (21.3% vs. 5.0%, adjusted OR = 5.41, 95% CI 4.26–6.88). Among individuals who reported sickness in the recent two weeks, migrant workers were much less likely to see a doctor (32.7% vs. 66.7%, adjusted OR = 0.21, 95% CI 0.13–0.36). Conclusions: Chinese rural-to-urban migrant workers have lower HRQOL, much more frequent morbidity, but are also much less likely to see a doctor in times of sickness as compared to local urban residents, indicating the existence of significant unmet medical care needs in this population. PMID:25689996
Blais, Rebecca K; Hoerster, Katherine D; Malte, Carol; Hunt, Stephen; Jakupcak, Matthew
Many veterans return from deployment with posttraumatic stress disorder (PTSD), but most attend only a limited number of mental health care visits. Although global PTSD relates to seeking mental health care, it is unclear whether specific features of PTSD inform the low rates of mental health care utilization. This study examined PTSD cluster severities of avoidance, reexperiencing, dysphoria, and hyperarousal as predictors of intention to seek mental health care and prospective treatment utilization. US veterans with at least subthreshold PTSD (N = 189) completed a PTSD symptom measure and indicated whether they intended to seek mental health care. Prospective Department of Veterans Affairs mental health care utilization was extracted from the medical record. At the bivariate level, each cluster was positively associated with a positive intention to seek mental health care and prospective treatment utilization. In multivariate models, however, dysphoria severity (OR = 1.16, 95% CI [1.06, 1.26]) was uniquely and positively correlated with intention to seek mental health care, whereas higher avoidance severity (IRR = 0.86, 95% CI [0.76, 0.98]) predicted lower treatment utilization, and higher reexperiencing severity (IRR = 1.07, 95% CI [1.01, 1.14]) predicted greater treatment utilization. It is critical to tailor interventions to target specific features of PTSD and to meet patients where they are.
Schmitt, Susan K; Phibbs, Ciaran S; Piette, John D
This study examined whether substance abuse patients who live farther from their source of outpatient mental health care were less likely to obtain aftercare following an inpatient treatment episode. For those patients who did receive aftercare, distance was evaluated as a predictor of the volume of care received. A national sample of 33,952 veterans discharged from Department of Veterans Affairs (VA) inpatient substance abuse treatment programs was analyzed using a two-part choice model utilizing logistic and linear regression. Patients living farther from their source of outpatient mental health care were less likely to obtain aftercare following inpatient substance abuse treatment. Patients who traveled 10 miles or less were 2.6 times more likely to obtain aftercare than those who traveled more than 50 miles. Only 40% of patients who lived more than 25 miles from the nearest aftercare facility obtained any aftercare services. Patients who received aftercare services had fewer visits if they lived farther from their source of aftercare. Lack of geographic access (distance) is a barrier to outpatient mental health care following inpatient substance abuse treatment, and influences the volume of care received once the decision to obtain aftercare is made. Aftercare services must be geographically accessible to ensure satisfactory utilization.
Story, William T
This study examines the association between social capital and the utilization of antenatal care, professional delivery care, and childhood immunizations using a multilevel analytic sample of 10,739 women who recently gave birth and 7403 children between one and five years of age in 2293 communities and 22 state-groups from the 2005 India Human Development Survey. Exploratory factor analysis was used to create and validate six social capital measures that were used in multilevel logistic regression models to examine whether each form of social capital had an independent, contextual effect on health care use. Results revealed that social capital operated at the community level in association with all three care-seeking behaviors; however, the results differed based on the type of health care utilized. Specifically, components of social capital that led to heterogeneous bridging ties were positively associated with all three types of health care use, whereas components of social capital that led to strong bonding ties were negatively associated with the use of preventive care, but positively associated with professional delivery care.
Feldman, Steven R.; Vallejos, Quirina M.; Quandt, Sara A.; Fleischer, Alan B.; Schulz, Mark R.; Verma, Amit; Arcury, Thomas A.
Context Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing healthcare resources. Purpose Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods 304 migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and healthcare utilization over a single agricultural season. Self-reported and dermatologist-diagnosed skin condition data were collected at baseline and at up to four follow-up assessments. Medical visit rates were compared to national norms. Findings Self-reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self-treatment for skin conditions was common, including use of non-prescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year. Conclusions The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self-treatment. Clinic-based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates. PMID:19166568
Narain, Kimberly; Bitler, Marianne; Ponce, Ninez; Kominski, Gerald; Ettner, Susan
The Personal Responsibility Work Opportunity and Reconciliation Act (PRWORA) of 1996 imposed time limits on the receipt of welfare cash benefits and mandated cash benefit sanctions for failure to meet work requirements. Many studies examining the health implications of PRWORA have found associated declines in health insurance coverage and healthcare utilization among single mothers but no impact of PRWORA on health outcomes. A limitation of this literature is that most studies cover a time period before time limits were implemented in all states and also before individuals began actually timing out. This work builds on previous studies by exploring this research question using data from the Survey of Income and Program Participation that covers a time period after all states have implemented time limits (1991-2009). We use a difference-in-differences study design that exploits variability in eligibility for cash welfare benefits by marital status and state-level variation in timing of PRWORA implementation to identify the effect of PRWORA. Using ordinary least square regression models, controlling for state-level and federal policies, individual-level demographics and state and year fixed-effects, we find that PRWORA leads to 7 and 5 percentage point increases in self-reported poor health and self-reported disability among white single mothers without a diploma, respectively.
Singh, Prashant Kumar; Singh, Lucky
This study examines the association between age cohort and utilization of maternal health care services in India, before and after adjusting for individual, household and contextual factors. Using data from the Demographic and Health Survey 2005-06, women were classified into three distinct age cohorts based on their age at childbirth: 15-24, 25-34 and 35-49 years. Binary logistic regression models were applied to assess the influence of women's age cohort on receiving full antenatal care (ANC) and skilled birth attendance (SBA). The analytical sample included the women who delivered their most recent birth at any time in the 5 years preceding the survey. Women belonging to the younger age cohort were found to be disadvantaged in receiving full ANC, whereas increasing age of women was negatively associated with receiving SBA. Low level of education, low mass media exposure, low autonomy, belonging to deprived social groups, poor economic status and residence in the central region were found to be major constraining factors in receiving full ANC and SBA for women in India. The findings support the need for 'age-sensitive' interventions that tailor programmes and incentives to women's health care needs through the reproductive life-stage. Urgent efforts are needed to ensure that women who are illiterate and those belonging to low autonomy and low socioeconomic groups receive the recommended maternal health care benefits.
Marc, David T; Zhang, Rui; Beattie, James; Gatewood, Laël C; Khairat, Saif S
As part of the Open Government Initiative, the United States federal government published datasets to increase collaboration, transparency, consumer participation, and research, and are available online at HealthData.gov. Currently, HealthData.gov does not adequately support the accessibility goal of the Open Government Initiative due to issues of retrieving relevant data because of inadequately cataloguing and lack of indexing with a standardized terminology. Given the commonalities between the HealthData.gov and MEDLINE metadata, Medical Subject Headings (MeSH) may offer an indexing solution, but there needs to be a formal evaluation of the efficacy of MeSH for covering the dataset concepts. The purpose of this study was to determine if MeSH adequately covers the HealthData.gov concepts. The noun and noun phrases from the HealthData.gov metadata were extracted and mapped to MeSH using MetaMap. The frequency of no exact, partical and no matches with MeSH terms were determined. The results of this study revealed that about 70% of the HealthData.gov concepts partially or exactly matched MeSH terms. Therefore, MeSH may be a favorable terminology for indexing the HealthData.gov datasets.
Dayan, Nivi; Shvartzman, Pesach
Immigrants differ in morbidity and mortality characteristics, as well as health services and preventative medicine utilization, compared with the non-immigrant population. As the Length of stay in the host country increases, these patterns become similar to the Local population, due to the acculturation process. Immigrant women's prenatal care is often partial and inadequate, usually occurring late in pregnancy, their contraceptive use is lower and the rate of abortions is higher. They have less screening tests for cancer detection, are diagnosed at advanced stages and their survival and cure probabilities are lower Facilitators and barriers to immigrant women's health behaviors include cultural beliefs and perceptions, length of stay in the host country, degree of acculturation, Language barriers, accessibility, primary physician involvement, role burdens, knowledge and awareness. Ethiopian women experienced a sharp transition in a variety of life aspects following their immigration to Israel. Studies show that Ethiopian women's health and health behavior are typical to those encountered among immigrant women. Their birth patterns are becoming similar to local women as their years in Israel increase, and veteran's patterns are closer to the local population. Data regarding contraceptive use is lacking; the abortion rate is four times higher in comparison with Israeli-born Jewish women, and preventive medicine, referral and early detection rates for cancer are lower. Ethiopian immigrant women in Israel are at high risk regarding their health. Understanding the underlying causes, the changes that occur as time in Israel increases, and identifying the accessibility barriers to services experienced by these women, will assist in planning cultural and needs sensitive services, including health promotion programs.
Kantor, Viktoria; Knefel, Matthias; Lueger-Schuster, Brigitte
Many trauma survivors seem to be reluctant to seek professional help. The aim of the current review was to synthesize relevant literature, and to systematically classify trauma survivors' perceived barriers and facilitators regarding mental health service utilization. The systematic search identified 19 studies addressing military personnel and 17 studies with trauma survivors of the general population. The data analysis revealed that the most prominent barriers included concerns related to stigma, shame and rejection, low mental health literacy, lack of knowledge and treatment-related doubts, fear of negative social consequences, limited resources, time, and expenses. Perceived facilitators lack attention in research, but can be influential in understanding mental health service use. Another prominent finding was that trauma survivors face specific trauma-related barriers to mental health service use, especially concerns about re-experiencing the traumatic events. Many trauma survivors avoid traumatic reminders and are therefore concerned about dealing with certain memories in treatment. These perceived barriers and facilitators were discussed regarding future research and practical implications in order to facilitate mental health service use among trauma survivors.
Yuchi, Weiran; Yao, Jiayun; McLean, Kathleen E.; Stull, Roland; Pavlovic, Radenko; Davignon, Didier; Moran, Michael D.; Henderson, Sarah B.
Fine particulate matter (PM2.5) generated by forest fires has been associated with a wide range of adverse health outcomes, including exacerbation of respiratory diseases and increased risk of mortality. Due to the unpredictable nature of forest fires, it is challenging for public health authorities to reliably evaluate the magnitude and duration of potential exposures before they occur. Smoke forecasting tools are a promising development from the public health perspective, but their widespread adoption is limited by their inherent uncertainties. Observed measurements from air quality monitoring networks and remote sensing platforms are more reliable, but they are inherently retrospective. It would be ideal to reduce the uncertainty in smoke forecasts by integrating any available observations. This study takes spatially resolved PM2.5 estimates from an empirical model that integrates air quality measurements with satellite data, and averages them with PM2.5 predictions from two smoke forecasting systems. Two different indicators of population respiratory health are then used to evaluate whether the blending improved the utility of the smoke forecasts. Among a total of six models, including two single forecasts and four blended forecasts, the blended estimates always performed better than the forecast values alone. Integrating measured observations into smoke forecasts could improve public health preparedness for smoke events, which are becoming more frequent and intense as the climate changes.
Tataw, David B; Bazargan-Hejazi, Shahrzad
The aim of this paper is to evaluate and report the impact of the Health Services Utilization Improvement Model (HUIM) on utilization and satisfaction with care, as well as knowledge regarding prevention, detection, and treatment of asthma, diabetes, tuberculosis, and child injury among low income health services consumers. HUIM outcomes data shows that the coupling of parental education and ecological factors (service linkage and provider orientation) impacts the health services utilization experience of low income consumers evidenced by improved self-efficacy (knowledge and voice), and satisfaction with care from a child's regular provider. Participation in HUIM activities also improved the low income consumer's knowledge of disease identification, self-care and prevention.
Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An
Purpose: To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. Methods: A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences…
Kenny, Avi; Basu, Gaurab; Ballard, Madeleine; Griffiths, Thomas; Kentoffio, Katherine; Niyonzima, Jean Bosco; Sechler, G. Andrew; Selinsky, Stephen; Panjabi, Rajesh R.; Siedner, Mark J.; Kraemer, John D.
Background This study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa. Methods Cluster–sample survey data collected in 2012 in a very rural southeastern Liberian population were analyzed to determine associations between quartiles of GPS–measured distance from the nearest health facility and the odds of maternal (ANC, facility–based delivery, and PNC) and child (deworming and care seeking for ARI, diarrhea, and fever) service use. We estimated associations by fitting simple and multiple logistic regression models, with standard errors adjusted for clustered data. Findings Living in the farthest quartile was associated with lower odds of attending 1–or–more ANC checkup (AOR = 0.04, P < 0.001), 4–or–more ANC checkups (AOR = 0.13, P < 0.001), delivering in a facility (AOR = 0.41, P = 0.006), and postnatal care from a health care worker (AOR = 0.44, P = 0.009). Children living in all other quartiles had lower odds of seeking facility–based fever care (AOR for fourth quartile = 0.06, P < 0.001) than those in the nearest quartile. Children in the fourth quartile were less likely to receive deworming treatment (AOR = 0.16, P < 0.001) and less likely (but with only marginal statistical significance) to seek ARI care from a formal HCW (AOR = 0.05, P = 0.05). Parents in distant quartiles more often sought ARI and diarrhea care from informal providers. Conclusions Within a rural Liberian population, distance is associated with reduced health care uptake. As Liberia rebuilds its health system after Ebola, overcoming geographic disparities, including through further
Tatsumi, Kazuhiro; Tanaka, Hidekazu; Yamawaki, Kouhei; Ryo, Keiko; Omar, Alaa Mabrouk Salem; Fukuda, Yuko; Norisada, Kazuko; Matsumoto, Kensuke; Onishi, Tetsuari; Gorcsan, John; Yoshida, Akihiro; Kawai, Hiroya; Hirata, Ken-ichi
The strain delay index is reportedly a marker of dyssynchrony and residual myocardial contractility. The aim of this study was to test the hypothesis that a relatively simple version of the strain dyssynchrony index (SDI) can predict response to cardiac resynchronization therapy (CRT) and that combining assessment of radial, circumferential, and longitudinal SDI can further improve the prediction of responders. A total of 52 patients who underwent CRT were studied. The SDI was calculated as the average difference between peak and end-systolic strain from 6 segments for radial and circumferential SDI and 18 segments for longitudinal SDI. Conventional dyssynchrony measures were assessed by interventricular mechanical delay, the Yu index, and radial dyssynchrony by speckle tracking strain. Response was defined as a ≥15% decrease in end-systolic volume after 3 months. Of the individual parameters, radial SDI ≥6.5% was the best predictor of response to CRT, with sensitivity of 81%, specificity of 81%, and an area under the curve of 0.87 (p <0.001). Circumferential SDI ≥3.2% and longitudinal SDI ≥3.6% were also found to be predictive of response to CRT, with areas under the curve of 0.81 and 0.80, respectively (p <0.001). Moreover, radial, circumferential, and longitudinal SDI at baseline were correlated with reduction of end-systolic volume with CRT. In addition, the response rate in patients with 3 positive SDIs was 100%. In contrast, rates in patients with either 1 or no positive SDIs were 42% and 22%, respectively (p <0.005 and p <0.001 vs 3 positive SDIs). In conclusion, the SDI can successfully predict response to CRT, and the combined approach leads to more accurate prediction than using individual parameters.
Dodd, Warren; King, Nia; Humphries, Sally; Little, Matthew; Dewey, Cate
In Tamil Nadu, India, improvements have been made toward developing a high-quality, universally accessible healthcare system. However, some rural residents continue to confront significant barriers to obtaining healthcare. The primary objective of this study was to investigate self-reported morbidity, health literacy, and healthcare preferences, utilization, and experiences in order to identify priority areas for government health policies and programs. Drawing on 66 semi-structured interviews and 300 household surveys (including 1693 individuals), administered in 26 rural villages in Tamil Nadu's Krishnagiri district, we found that the prevalence of self-reported major health conditions was 22.3%. There was a large burden of non-communicable and chronic diseases, and the most common major morbidities were: connective tissue problems (7.6%), nervous system and sense organ diseases (5.0%), and circulatory and respiratory diseases (2.5%). Increased age and decreased education level were associated with higher odds of reporting most diseases. Low health literacy levels resulted in individuals seeking care only once pain interfered with daily activities. As such, individuals' health-seeking behaviour depended on which strategy was believed to result in the fastest return to work using the fewest resources. Although government facilities were the most common healthcare access point, they were mistrusted; 48.8% and 19.2% of respondents perceived inappropriate treatment protocols and corruption, respectively, at public facilities. Conversely, 93.3% of respondents reported high treatment cost as the main barrier to accessing private facilities. Our results highlight that addressing the chronic and non-communicable disease burdens amongst rural populations in this context will require health policies and village-level programs that address the low health literacy and the issues of rural healthcare accessibility and acceptability.
Gianoukakis, Andrew G; Flores, Natalia M; Pelletier, Corey L; Forsythe, Anna; Wolfe, Gregory R; Taylor, Matthew H
Background Patients with differentiated thyroid cancer (DTC) often respond well to treatment but some become refractory to radioactive iodine (RAI) treatment, and treatment options are limited. Despite the humanistic and economic burden RAI refractory disease imposes on patients, published research concerning treatment patterns and health care resource utilization is sparse. Methods Data were collected from an online retrospective chart review study in the US and five European Union (EU) countries (France, Germany, Italy, Spain, and UK) with physicians recruited from an online panel. Physicians (N=211) provided demographics, disease history, treatment information, and health care resource utilization for one to four of their patients with radioactive iodine refractory differentiated thyroid cancer (RR-DTC). Results The majority of the patients with RR-DTC (N=623) were female (56%), and their mean age was 58.2 years. In this sample, 63.2% had papillary thyroid cancer and 57.0% were in Stage IV when deemed RAI refractory. Patients with RR-DTC experienced regional recurrence in the thyroid bed/central neck area (25.3%) and had distant metastatic disease (53.6%). At the time data were collected, 50.7% were receiving systemic treatment. Of those, 78.5% were on first-line treatment and 62.7% were receiving multikinase inhibitors. Regional differences for prescribed treatments were observed; the US was more likely to have patients receiving multikinase inhibitors (79.2%) compared with UK (41.2%) and Italy (17.1%). Additional details regarding treatment patterns and resource utilization are discussed. Conclusion The current study aimed to obtain a greater understanding of RR-DTC treatment globally. These results can assist in the development and implementation of treatment guidelines and ultimately enhance the care of patients with RR-DTC. PMID:27313476
Basu, Sanjay; Rehkopf, David H; Siddiqi, Arjumand; Glymour, M Maria; Kawachi, Ichiro
We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health.
Luk, Lauren J.; Steele, Toby O.; Mace, Jess C.; Soler, Zachary M.; Rudmik, Luke; Smith, Timothy L.
Background A health utility value represents an individual’s preference for living in a specific health state and is used in cost-utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS). Methods The Medical Outcomes Study Short Form-6D (SF-6D) was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n=40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n=152). Patients observed through treatment crossover to ESS were also evaluated (n=20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures ANOVA. Results Treatment crossover patients were found to have a significantly higher prevalence of previous sinus surgery compared to medical management (χ2=6.91; p=0.009) and surgical intervention (χ2=8.11; p=0.004) subgroups. Mean baseline utility value for the medical therapy cohort was significantly better compared to the ESS cohort (0.76[0.12] versus 0.70[0.15]; p=0.023). Significant improvement in health utility was reported in the ESS cohort (F(2)=37.69; p<0.001), while values remained stable, without significant improvement, in both the medical therapy cohort (F(2)=0.03; p=0.967) and treatment crossover cohort (F(2)=2.36; p=0.115). Conclusions Patients electing continued medical management report better baseline health utility compared to patients electing ESS. Patients electing ESS demonstrate significant improvement in health utility while those electing continued medical management demonstrate stable health utility over 12 months. PMID:26140502
Aminpour, Farzaneh; Sadoughi, Farahnaz; Ahamdi, Maryam
Many projects on developing Electronic Health Record (EHR) systems have been carried out in many countries. The current study was conducted to review the published data on the utilization of open source EHR systems in different countries all over the world. Using free text and keyword search techniques, six bibliographic databases were searched for related articles. The identified papers were screened and reviewed during a string of stages for the irrelevancy and validity. The findings showed that open source EHRs have been wildly used by source limited regions in all continents, especially in Sub-Saharan Africa and South America. It would create opportunities to improve national healthcare level especially in developing countries with minimal financial resources. Open source technology is a solution to overcome the problems of high-costs and inflexibility associated with the proprietary health information systems. PMID:24672566
Salinas, Jennifer J
Objective To assess changes in preventive screening utilization in older Mexicans, pre- and post-Seguro Popular. Materials and methods Data from the Mexican Health and Aging Study (MHAS/Enasem) 2001 and 2012 were used. Logistic and ordinary least squares regression adjusted models were used to predict preventive care in 2012 by insurance status categories in 2001-2012, as the focus explanatory variable. Results Participants who were uninsured in 2001 and had Seguro Popular in 2012 were significantly more likely to be tested for diabetes, high blood pressure and receive a tetanus shot than the continually uninsured. Conclusions While disparities in preventive screening between the insured and uninsured continue to exist in Mexico, Seguro Popular seems to have provided better access to health services to prevent chronic and infectious diseases for the otherwise uninsured population. PMID:26172237
Yarova, Lyubov A; Krassen Covan, Eleanor; Fugate-Whitlock, Elizabeth
In this mixed methods study, researchers explored what conditions influence women's use of professional health care services, and how sociocultural environments and acculturation affect utilization of health care services. We recruited 15 women in the Ukraine, 15 women who immigrated from the former Soviet Union, and 10 female U.S. citizens. Data include open-ended interviews, a "general information" questionnaire, and the Language, Identity and Behavioral Acculturation scale. Acculturation levels and length of residency in the United States were not consistent predictors of health-seeking behaviors for immigrants. The stronger predictor of health beliefs and health related behaviors among all participants was their mothers' health beliefs and health related behaviors.
Su, Dejun; Richardson, Chad; Wen, Ming; Pagán, José A
Objective To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. Data and Methods This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Principal Findings Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. Conclusions The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.–Mexico border region. PMID:21158855
Peacock, Stuart J; Richardson, Jeff R J; Carter, Rob; Edwards, Diana
Programme budgeting and marginal analysis (PBMA) is becoming an increasingly popular tool in setting health service priorities. This paper presents a novel multi-attribute utility (MAU) approach to setting health service priorities using PBMA. This approach includes identifying the attributes of the MAU function; describing and scaling attributes; quantifying trade-offs between attributes; and combining single conditional utility functions into the MAU function. We illustrate the MAU approach using a PBMA case study in mental health services from the Community Health Sector in metropolitan South Australia.
... ARTS AND THE HUMANITIES Notice of Proposed Information Collection Requests: Heritage Health Index II on... Foundation for the Arts and the Humanities. ACTION: Notice, request for comments, collection of information... of digital conservation. The design of the HHI II will be a repeated cross- sectional web survey of...
Solbakken, S M; Meyer, H E; Stigum, H; Søgaard, A J; Holvik, K; Magnus, J H; Omsland, T K
Self-perceived health, smoking, and body mass index measured years before the hip fracture predicted excess post-hip fracture mortality, and even hip fracture patients with the most favorable levels of these risk factors had higher mortality than subjects who did not fracture.
Sun, Angela; Zhang, Jian; Tsoh, Janice; Wong-Kim, Evaon; Chow, Edward
To increase the awareness and practice of breast health guidelines, a media-based education campaign on breast health was launched among immigrant Chinese community in San Francisco. The media campaign included airing two public service announcements (PSAs) on Chinese television and radio stations and publishing the same message in Chinese newspapers during 2000. Seven-hundred-ten face-to-face interviews were conducted with women who were recruited from various settings in the city of San Francisco to evaluate the impact of the campaign. Survey participants were asked to describe the content of the PSAs. Having viewed the PSA was significantly associated with the ability to identify all four guidelines (OR = 1.96; 95% CI: 1.35-2.85), knowing how to perform breast self-exam (BSE; OR = 2.25; 95% CI: 1.53-3.29), having performed BSE within the past month (OR = 3.12; 95% CI: 2.05-4.74), and having a clinical breast exam (CBE; OR = 2.98; 95% CI: 1.82-4.90) and mammogram (MAM; OR = 1.97; 95% CI: 1.16-3.36) in the past year. The study findings support that a media campaign utilizing PSAs is effective in improving knowledge of breast health guidelines, teaching Chinese women how to (BSEs), and increasing breast health practices.
García-Moya, Irene; Morgan, Antony
Twenty years have passed since the publication of the seminal paper 'The salutogenic model as a theory to guide health promotion' (Health Promot Int 1996; 11: :11-18.), in which Antonovsky proposed salutogenesis and its central construct sense of coherence as a way of boosting the theoretical basis for health promotion activities. Since then there has been a notable amount of conceptual and empirical work carried out to further explore its significance. The aim of this paper is to critically assess the current theoretical status of salutogenesis and its utility to advance effective health promotion practice for young people. The assessment was carried out in the context of contemporary international policy agendas on well-being. An analytic framework was developed using the previous literature on the definition and function of theory. This organizing framework comprised four criteria: description, explanation, prediction and measurability. The paper concludes with a perspective on the status of salutogenesis as a theory and how it can be further developed. Specifically, the critical assessment highlighted that salutogenesis has been subjected to considerable empirical testing over the last few decades resulting in convincing evidence of the relevance and subsequent advancement of the idea. However, less emphasis seems to have been placed on a systematic process of testing and iteration to develop its theoretical basis. The paper identifies a number of aspects that should be developed to support the progression of salutogenesis to the next level. A research-practice cycle approach is proposed that can facilitate that important next step.
Yong, Mei; Nasterlack, Michael; Pluto, Rolf-Peter; Elmerich, Kathrin; Karl, Dorothee; Knauth, Peter
Two forms of continuously forward rotating 12-h shift schedules exist at BASF's Ludwigshafen site. These shift schedules were compared with a daytime working system to investigate potential differential effects on employee's health status assessed with the Work Ability Index (WAI). In the 3 x 12 system, a 12-h day shift is followed 24 h later by a 12-h night shift, and after a day off the employee returns to the day shift. The 4 x 12 schedule follows the same pattern except that there are 2 days off between the night and next day shift. A total of 924 participants (278 3 x 12 and 321 4 x 12 shiftworkers and 325 day workers) were recruited. A self-administered questionnaire was used to obtain information about shiftwork schedule, demographic characteristics, and lifestyle and social factors, and the WAI was applied. The outcomes of interest were the WAI sum score and its seven dimensions. In examining the relationship with the WAI categories, a Proportional Odds Model (POM) was used to identify the potential determinants. Logistic regression models were used to estimate the impact of age on single dimensions of WAI after adjustment for potential confounding factors. Increasing age and obesity (BMI > or = 30) were the only significant determinants of poorer WAI. Although a positive association was found linking the second WAI dimension (work ability in relation to job demands) with age, an inverse association was demonstrated consistently between age and the third and fourth WAI dimensions, i.e., number of diagnosed diseases and estimated work impairment due to disease, after adjustment for potential confounders. The age-dependency was moderate overall, but seemed to be stronger among shift- than day workers, although this difference did not reach statistical significance. There was no significant differential impact of the working time systems on the WAI sum score or on the individual WAI dimensions. Thus, there is no indication of an excessive adverse health impact
Turci, Silvana Rubano Barretto; Guilam, Maria Cristina Rodrigues; Câmara, Maria Clara Coelho
This article examines and interprets the trends of epidemiological production in Brazil in the Public Health context. CAPES indicators from 2001 to 2006 were used as database. We analyzed 26 programs and select the 10 major ones to analyze their bibliographic production in indexed journals. It was observed that the total production of epidemiological articles accounted for 40% of production in Public Health and 55% of the production was published in international journals, especially Cadernos de Saúde Pública, Revista de Saúde Pública and Ciência & Saúde Coletiva. The most prevalent themes were public health nutrition, maternal and infant health and, infectious diseases, particularly AIDS. Environmental e worker's heath, oral health, violence and health of the elderly have been ratified as objects of study for the discipline, while meta-analysis and geoprocessing appear as a useful tool for health services. We conclude that the epidemiological production tends to increase in indexed publications, covering various topics and a wide spectrum of relevant issues to Brazilian health policy.
James, Carole; MacKenzie, Lynette
Functional Capacity Evaluations (FCE's) are used within the occupational rehabilitation arena with the aim of assessing an individual's functional abilities in relation to work tasks. Therapists use a variety of different FCE's, both standardized and non standardized. This study aimed to investigate therapists' views on the clinical utility of FCE's in general and to identify if these differed between professional groups. A cross sectional study design was used. Health professionals who conduct FCE's and who worked for WorkCover accredited rehabilitation providers in NSW were surveyed. Surveys were returned from 79 participants working for 65 different rehabilitation providers. Of those who replied, 82\\% (n=63) were occupational therapists, 13% (n=10) physiotherapists and 5% (n=5) exercise physiologists. The mean years of professional experience was 10.9 years and the mean years of FCE experience was 5.3 years. Data were analyzed using STATA [v8.0] and the clinical utility of FCE's was considered relating to: usefulness & relevance; adaptability and flexibility; therapist perceived requirements and issues in practice. No differences were found related to the clinical utility of FCE's between professional groups or years of professional experience. The results suggest consistency and similarities in how FCE's are currently used in practice across NSW (Australia). Limitations of this study and areas for further research are suggested.
Lee, Sungkyu; Matejkowski, Jason; Han, Woojae
Using a nationally representative sample, this study examined the extent to which the utilization of various mental health services was associated with racial-ethnic identity among people with major affective disorders who have a criminal history. Approximately 33.7 % of the sample received any type of mental health services in a given year. Multivariate models indicated that married Blacks and Latinos were less likely to use specialty mental health care than their white counterparts. To provide equitable mental health treatment for vulnerable subgroups of this population, mental health professionals should account for the heterogeneity of mental health care in diverse cultural contexts.
Bray, Jeremy; Cowell, Alex; Hinde, Jesse
Objective This systematic review and meta-analysis examines the effect of screening and brief intervention (SBI) on outpatient, emergency department (ED), and inpatient health care utilization outcomes. Much of the current literature speculates that SBI provides cost savings through reduced health care utilization, but no systematic review or meta-analysis examines this assertion. Method Publications were abstracted from online journal collections and targeted Web searches. The systematic review included any publications that examined the association between SBI and health care utilization. Each publication was rated independently by two study authors and assigned a consensus methodological score. The meta-analysis focused on those studies examined in the systematic review, but it excluded publications that had incomplete data, low methodological quality, or a cluster randomized design. Results Systematic review results suggest that SBI has little to no effect on inpatient or outpatient health care utilization, but it may have a small, negative effect on ED utilization. A random effects meta-analysis using the Hedges method confirms the ED result for SBI delivered across settings (SMD = −.06, I-squared = 13.9%) but does not achieve statistical significance (CI: −0.15, 0.03). Conclusions SBI may reduce overall health care costs, but more studies are needed. Current evidence is inconclusive for SBI delivered in ED and non-ED hospital settings. Future studies of SBI and health care utilization should report the estimated effects and variance, regardless of the effect size or statistical significance. PMID:21263359
Mathias, Jason Scott; Agrawal, Ankit; Feinglass, Joe; Cooper, Andrew J; Baker, David William; Choudhary, Alok
Objective Incorporating accurate life expectancy predictions into clinical decision making could improve quality and decrease costs, but few providers do this. We sought to use predictive data mining and high dimensional analytics of electronic health record (EHR) data to develop a highly accurate and clinically actionable 5 year life expectancy index. Materials and methods We developed the index using EHR data for 7463 patients ≥50 years old with ≥1 visit(s) in 2003 to a large, academic, multispecialty group practice. We extracted 980 attributes from the EHRs of the practices and affiliated hospitals. Correlation feature selection with greedy stepwise search was used to find the attribute subset with best average merit. Rotation forest ensembling with alternating decision tree as underlying classifier was used to predict 5 year mortality. Model performance was compared with the modified Charlson Comorbidity Index and the Walter life expectancy method. Results Within 5 years of the last visit in 2003, 838 (11%) patients had died. The final model included 24 attributes: two demographic (age, sex), 10 comorbidity (eg, cardiovascular disease), one vital sign (mean diastolic blood pressure), two medications (loop diuretic use, digoxin use), six laboratory (eg, mean albumin), and three healthcare utilization (eg, the number of hospitalizations 1 year prior to the last visit in 2003). The index showed very good discrimination (c-statistic 0.86) and outperformed comparators. Conclusions The EHR based index successfully distinguished adults ≥50 years old with life expectancy >5 years from those with life expectancy ≤5 years. This information could be used clinically to optimize preventive service use (eg, cancer screening in the elderly). PMID:23538722
Goldman, Matthew L.; Ghorob, Amireh; Hessler, Danielle; Yamamoto, Russell; Thom, David H.; Bodenheimer, Thomas
PURPOSE A randomized controlled trial found that patients with diabetes had lower HbA1c levels after 6 months of peer health coaching than patients who did not receive coaching. This paper explores whether the peer coaches in that trial, all low-income patients with diabetes, mastered and utilized an evidence-based health coaching training curriculum. The curriculum included 5 core features: ask-tell-ask, closing the loop, know your numbers, behavior-change action plans, and medication adherence counseling. METHODS This paper includes the results of exams administered to trainees, exit surveys performed with peer coaches who completed the study and those who dropped out, observations of peer coaches meeting with patients, and analysis of in-depth interviews with peer coaches who completed the study. RESULTS Of the 32 peer coach trainees who completed the training, 71.9% lacked a college degree; 25.0% did not graduate from high school. The 26 trainees who passed the exams attended 92.7% of training sessions compared with 80.6% for the 6 trainees who did not pass. Peer coaches who completed the study wanted to continue peer coaching work and had confidence in their abilities despite their not consistently employing the coaching techniques with their patients. Quotations describe coaches’ perceptions of the training. CONCLUSIONS Of low-income patients with diabetes who completed the evidenced-based health coaching training, 81% passed written and oral exams and became effective peer health coaches, although they did not consistently use the techniques taught. PMID:26304970
Background Malaria and other communicable diseases remain major threats in developing countries. In Cambodia, village malaria workers (VMWs) have been providing malaria control services in remote villages to cope with the disease threats. In 2009, the VMW project integrated child health services into the original malaria control services. However, little has been studied about the utilization of VMWs’ child health services. This study aimed to identify determinants of caregivers’ VMW service utilization for childhood illness and caregivers’ knowledge of malaria management. Methods A cross-sectional study was conducted in 36 VMW villages of Kampot and Kampong Thom provinces in July-September 2012. An equal number of VMW villages with malaria control services only (M) and those with malaria control plus child health services (M+C) were selected from each province. Using structured questionnaires, 800 caregivers of children under five and 36 VMWs, one of the two VMWs who was providing VMW services in each study village were interviewed. Results Among the caregivers, 23% in M villages and 52% in M+C villages utilized VMW services for childhood illnesses. Determinants of caregivers’ utilization of VMWs in M villages included their VMWs’ length of experience (AOR = 11.80, 95% confidence interval [CI] = 4.46-31.19) and VMWs’ service quality (AOR = 2.04, CI = 1.01-4.11). In M+C villages, VMWs’ length of experience (AOR = 2.44, CI = 1.52-3.94) and caregivers’ wealth index (AOR = 0.35, CI = 0.18-0.68) were associated with VMW service utilization. Meanwhile, better service quality of VMWs (AOR = 3.21, CI = 1.34-7.66) and caregivers’ literacy (AOR = 9.91, CI = 4.66-21.05) were positively associated with caregivers’ knowledge of malaria management. Conclusions VMWs’ service quality and length of experience are important determinants of caregivers’ utilization of VMWs’ child health services and their knowledge of malaria management. Caregivers are
Best, Benjamin D.; Doney, Scott C.; Katona, Steven K.; McLeod, Karen L.; Rosenberg, Andrew A.; Samhouri, Jameal F.
Management of marine ecosystems increasingly demands comprehensive and quantitative assessments of ocean health, but lacks a tool to do so. We applied the recently developed Ocean Health Index to assess ocean health in the relatively data-rich US west coast region. The overall region scored 71 out of 100, with sub-regions scoring from 65 (Washington) to 74 (Oregon). Highest scoring goals included tourism and recreation (99) and clean waters (87), while the lowest scoring goals were sense of place (48) and artisanal fishing opportunities (57). Surprisingly, even in this well-studied area data limitations precluded robust assessments of past trends in overall ocean health. Nonetheless, retrospective calculation of current status showed that many goals have declined, by up to 20%. In contrast, near-term future scores were on average 6% greater than current status across all goals and sub-regions. Application of hypothetical but realistic management scenarios illustrate how the Index can be used to predict and understand the tradeoffs among goals and consequences for overall ocean health. We illustrate and discuss how this index can be used to vet underlying assumptions and decisions with local stakeholders and decision-makers so that scores reflect regional knowledge, priorities and values. We also highlight the importance of ongoing and future monitoring that will provide robust data relevant to ocean health assessment. PMID:24941007
Umeh, Kalu Nnena; Nasir, Sambo M.; Suleiman, Idris Hadejia
The essence of primary health care is the provision of essential health services and commodities to individuals and communities using available, acceptable and sustainable resources. However, there has been a growing lack of confidence by the populace as evidenced by poor utilization of the services. This study sought to identify the predominant barriers affecting the utilization of primary health care services in Batsari Local Government in Katsina State, Nigeria. A cluster of 630 households was surveyed in the catchment of the 21 health primary health facilities. A catchment been defined as a household located within 5 km of a primary health center. Using a three digit randomly generated numbers a household was selected. Once selected the start house and twenty-nine contiguous houses were visited. a total of 630 households were surveyed. In all households, questions were asked on the predominant health problems, as well as the major determinants of access and utilization of primary health care services .The results were computed and analyzed using the Statistical Package for Social Sciences software SPSS. Version 17.0. The findings from all the respondents (n=630) showed that majority of the people preferred to seek care from the patent medicine stores (53.63%) as against only 7.6% who utilized the primary health care services. The commonest reasons why respondents do not utilize these services were lack of essential drugs, high cost of services as well as inadequate infrastructure in primary healthcare facilities. The study has highlighted some of the multiple factors affecting the utilization of primary healthcare services. It is expected that these findings will guide policy makers in improving healthcare delivery particularly where the need is greatest - at the grassroots - in line with the national health policy and national health strategic development plan. PMID:28299102
Eichler, Tilly; Hoffmann, Wolfgang; Hertel, Johannes; Richter, Steffen; Wucherer, Diana; Michalowsky, Bernhard; Dreier, Adina; Thyrian, Jochen René
Background: Little is known about the proportion and the characteristics of community-dwelling people with dementia (PWD) living alone in Germany. Objectives: To analyze the prevalence of PWD living alone (with and without the support of an informal caregiver) and socio-demographical and clinical characteristics as well as health and nursing care utilization associated with living alone. Methods: DelpHi-MV (Dementia: Life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, randomized controlled intervention trial. The present analyses are based on baseline data of 511 patients (≥70 years, community-dwelling) who had screened positive for dementia (DemTect <9). Results: N = 251 (51%) of the patients lived alone. PWD living alone were statistically significantly more often female, older, and more often widowed than those not living alone. About 9% of the patients (n = 24) were not supported by any informal caregiver. Regarding the clinical variables (cognitive and functional impairment, depression, falls, number of drug-related problems, malnutrition, quality of life), there were no statistically significant group differences. Patients living alone utilized professional services such as home care, help with medication, home-delivered meals, or housekeeping assistance significantly more often. Multivariate analyses confirmed these findings. Conclusion:Our results reveal the high proportion of PWD living alone in Germany. PWD living alone did not seem to be at an increased health risk. Our findings indicate that living alone with dementia is possible. In order to ensure the sufficient provision of health and nursing care services for PWD living alone, providers should consider the present results for future planning. PMID:27031480
Hall, G B
Deinstitutionalization of mental health care has been in progress in many countries for over a quarter of a century. A comprehensive and detailed literature has evolved focussing on this process and its implications for alternative forms of combatting the incidence of mental illness. Most notably, literature has concentrated on the need for community-based mental health services both to prevent hospitalization in the first place and to ease the return of the hospital patient into the outside environment. In this paper the evolution of such a community-based system in metropolitan Auckland, New Zealand is discussed. More specifically, the focus is on the utilization of four community-based centres, with a view to plan better growth or reduction of service provision. Two dimensions of centre use, spatial and sociodemographic, are analysed and incorporated into four predictive models that, with appropriate refinement, can be used to determine the likely level of centre use in unserviced parts of the metropolitan area. Distance of individuals from centre locations is shown to be a significant factor in affecting use for three suburban primary prevention and intervention centres, whilst distance is non-significant for an inner-city aftercare facility. Also, various combinations of socio-demographic variables, reflecting service-specific needs for specific groups in the population, are shown to contribute significantly to predicting centre use. The paper presents the results against a policy backdrop in New Zealand where community mental health services are very much experimental in nature. The results reaffirm the importance of community mental health care in fulfilling an important need in society that health care administrators should take seriously in future policy developments.
Lyles, Emily; Akhu‐Zaheya, Laila; Burton, Ann; Weiss, William
Summary Background With over one million Syrian refugee children in the region, we undertook this study to characterize care‐seeking behaviors and health service utilization for child refugees with the aim of informing humanitarian programming for non‐camp settings in Jordan. Methods A survey of Syrian refugees living outside of camps in Jordan was conducted using a 125 × 12 cluster design with probability proportional to size sampling to obtain a representative sample. The questionnaire focused on access to health services, including a module on care seeking for children. Results Care seeking was high with 90.9% of households with a child less than 18 years seeking medical care the last time it was needed. Households most often sought care for children in the public sector (54.6%), followed by private (36.5%) and charity sectors (8.9%). Among child care seekers, 88.6% were prescribed medication during the most recent visit, 90.6% of which obtained the medication. Overall, 49.4% of households reported out‐of‐pocket expenditures for either the consultation or prescribed medications at the most recent visit (mean $US21.1 and median $US0). Conclusions Syrian refugees had good access to care for their sick children at the time of the survey; however, this has likely deteriorated since the survey because of the withdrawal of free access for refugees. The number of refugees in Jordan and relative accessibility of care has resulted in a large burden on the health system; the Jordanian government will require additional support if current levels of health access are to be maintained for Syrian refugees. © 2016 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd. PMID:26799158
Pfeil-McCullough, E. K.; Bain, D.
Subsidence from longwall coal mining impacts the surface and sub-surface hydrology in overlying areas. During longwall mining, coal is completely removed in large rectangular panels and the overlying rock collapses into the void. Though the hydrologic impacts of longwall mine subsidence on overlying vegetation have been studied in more arid systems, in humid-temperate regions these effects are not well understood. In particular, it is not clear how longwall mining will impact water availability to forests. To explore potential impacts, a geospatial analysis of tree canopy water content using Landsat satellite imagery of southwestern Pennsylvania was carried out. The normalized difference moisture index (NDMI) derived from Landsat imagery was applied to expose patterns of vegetation water stress, which were then compared across a temporal gradient of mined panels. NDMI values associated with panels from 2000 through 2014 were assessed within September 2014 Landsat NDMI imagery and compared to a population of pixels un-impacted by mining. This study elucidates mining impacts to forest canopies and the landscape features driving patterns of tree canopy moisture content in southwestern, PA.
Background Incorporation of information communication technology in health care has gained wide acceptance in the last two decades. Developing countries are also incorporating information communication technology into the health system including the implementation of electronic medical records in major hospitals and the use of mobile health in rural community-based health interventions. However, the literature on the level of knowledge and utilization of information communication technology by health professionals in those settings is scarce for proper implementation planning. Objective The objective of this study is to assess knowledge, computer utilization, and associated factors among health professionals in hospitals and health institutions in Ethiopia. Methods A quantitative cross-sectional study was conducted on 554 health professionals working in 7 hospitals, 19 primary health centers, and 10 private clinics in the Harari region of Ethiopia. Data were collected using a semi-structured, self-administered, and pre-tested questionnaire. Descriptive and logistic regression techniques using SPSS version 16.0 (IBM Corporation) were applied to determine the level of knowledge and identify determinants of utilization of information communication technology. Results Out of 554 participants, 482 (87.0%) of them responded to the questionnaire. Among them, 90 (18.7%) demonstrated good knowledge of computers while 142 (29.5%) demonstrated good utilization habits. Health professionals who work in the primary health centers were found to have lower knowledge (3.4%) and utilization (18.4%). Age (adjusted odds ratio [AOR]=3.06, 95% CI 0.57-5.37), field of study (AOR=3.08, 95% CI 1.65-5.73), level of education (AOR=2.78, 95% CI 1.43-5.40), and previous computer training participation (AOR=3.65, 95% CI 1.62-8.21) were found to be significantly associated with computer utilization habits of health professionals. Conclusions Computer knowledge and utilization habits of health
Holman, E Alison; Silver, Roxane Cohen
The September 11, 2001 terrorist attacks (9/11) presented a unique opportunity to assess the physical health impact of collective stress in the United States. This study prospectively examined rates of physical ailments and predictors of health care utilization in a U.S. nationally representative sample over three years following the attacks. A sample of adults (N = 2592) completed a survey before 9/11/01 that assessed MD-diagnosed physical and mental health ailments. Follow-up surveys were administered at one (N = 1923), two (N = 1576), and three (N = 1950) years post-9/11 to assess MD-diagnosed physical health ailments (e.g., cardiovascular, endocrine) and health care utilization. Reports of physical ailments increased 18% over three years following 9/11. 9/11-related exposure, lifetime and post-9/11 stress, MD-diagnosed depression/anxiety, smoking status, age, and female gender predicted increased incidence of post-9/11 ailments, after controlling for pre-9/11 health. After adjusting for covariates (demographics, somatization, smoking status, pre-9/11 mental and physical health, lifetime and post-9/11 stress, and degree of 9/11-related exposure), increases in MD-diagnosed cardiovascular, endocrine, gastrointestinal, and hematology-oncology ailments predicted greater utilization of health care services over two years. After the collective stress of 9/11, rates of physical ailments increased and predicted greater health care utilization in a U.S. national sample.
Butt, Thomas; Crossland, Michael D; West, Peter; Orr, Shepley W; Rubin, Gary S
Background/aims The National Institute for Health and Care Excellence (NICE) has recommended the use of ranibizumab for neovascular age-related macular degeneration (AMD) and for diabetic macular oedema (DMO) as part of its health technology appraisal process. In the economic evaluations of both interventions, utility values were derived from members of the general public wearing contact lenses with a central opacity that was meant to simulate the blind spot experienced by many patients with advanced retinal disease. This paper tests the validity of the contact lens simulation, and finding it to be invalid, explores the impact on prior economic evaluations. Methods Visual acuity, contrast sensitivity and visual fields were assessed with and without simulation lenses in five healthy subjects with normal vision. Results We identified important differences between the contact lens simulation and vision loss experienced by patients with AMD. The contact lens simulator did not cause the central scotoma which is characteristic of late-stage AMD and which leads to severe difficulty with everyday activities such as reading or recognising faces and objects. The contact lens instead caused a reduction in retinal illumination experienced by the subjects as a general dimming across the retina. Conclusions A contact lens with a central opacity does not simulate a central scotoma. The clinical differences between simulated and actual AMD suggest there has been an underestimation of the severity of AMD health states. This brings into question the validity of the economic evaluations of treatments for AMD and DMO used by NICE. PMID:25351679
Hom, Melanie A; Stanley, Ian H; Schneider, Matthew E; Joiner, Thomas E
Research has demonstrated that military service members are at elevated risk for a range of psychiatric problems, and mental health services use is a conduit to symptom reduction and remission. Nonetheless, there is a notable underutilization of mental health services in this population. This systematic review aimed to identify and critically examine: (1) rates of service use; (2) barriers and facilitators to care; and (3) programs and interventions designed to enhance willingness to seek care and increase help-seeking behaviors among current military personnel (e.g., active duty, National Guard, Reserve). Overall, 111 peer-reviewed articles were identified for inclusion. Across studies, the rate of past-year service use among service members with mental health problems during the same time frame was 29.3% based on weighted averages. Studies identified common barriers to care (e.g., concerns regarding stigma, career impact) and facilitators to care (e.g., positive attitudes toward treatment, family/friend support, military leadership support) among this population. Although programs (e.g., screening, gatekeeper training) have been developed to reduce these barriers, leverage facilitators, and encourage service use, further research is needed to empirically test the effectiveness of these interventions in increasing rates of service utilization. Critical areas for future research on treatment engagement among this high-risk population are discussed.
Saha, Debasish; Akinsola, Adebayo; Sharples, Katrina; Adeyemi, Mitchell O.; Antonio, Martin; Imran, Sayeed; Jasseh, Momodou; Hossain, Mohammad J.; Nasrin, Dilruba; Kotloff, Karen L.; Levine, Myron M.; Hill, Philip C.
Diarrheal disease causes ∼1.34 million deaths per year among children under 5 years of age globally. We conducted a Health Care Utilization and Attitudes Survey of 1,012 primary caregivers of children aged 0–11, 12–23, and 24–59 months randomly selected from a Demographic Surveillance population in rural Gambia. Point prevalence of diarrhea was 7.7% (95% confidence interval [CI] = 6.1–9.8); 23.3% had diarrhea within the previous 2 weeks. Caregivers of 81.5% of children with diarrhea sought healthcare outside their home, but only 48.4% of them visited a health center. Only 17.0% (95% CI = 12.1–23.2) of children with diarrhea received oral rehydration solution (ORS) at home. Abbreviated surveys conducted on six occasions over the subsequent 2 years showed no change in prevalence or treatment-seeking behavior. Diarrhea remains a significant problem in rural young Gambian children. Encouraging care-seeking behavior at health centers and promoting ORS use can reduce mortality and morbidity in this population. PMID:23629926
Saha, Debasish; Akinsola, Adebayo; Sharples, Katrina; Adeyemi, Mitchell O; Antonio, Martin; Imran, Sayeed; Jasseh, Momodou; Hossain, Mohammad J; Nasrin, Dilruba; Kotloff, Karen L; Levine, Myron M; Hill, Philip C
Diarrheal disease causes ∼1.34 million deaths per year among children under 5 years of age globally. We conducted a Health Care Utilization and Attitudes Survey of 1,012 primary caregivers of children aged 0-11, 12-23, and 24-59 months randomly selected from a Demographic Surveillance population in rural Gambia. Point prevalence of diarrhea was 7.7% (95% confidence interval [CI] = 6.1-9.8); 23.3% had diarrhea within the previous 2 weeks. Caregivers of 81.5% of children with diarrhea sought healthcare outside their home, but only 48.4% of them visited a health center. Only 17.0% (95% CI = 12.1-23.2) of children with diarrhea received oral rehydration solution (ORS) at home. Abbreviated surveys conducted on six occasions over the subsequent 2 years showed no change in prevalence or treatment-seeking behavior. Diarrhea remains a significant problem in rural young Gambian children. Encouraging care-seeking behavior at health centers and promoting ORS use can reduce mortality and morbidity in this population.
Odegaard, Andrew O.; Koh, Woon-Puay; Yu, Mimi C.; Yuan, Jian-Min
OBJECTIVES To examine the association between body mass index (BMI) and incident colorectal cancer across the spectrum of BMI, including underweight, because detailed prospective cohort data on this topic in Asians is scarce, as is data on underweight (BMI < 18.5 kg/m2) in any population RESEARCH DESIGN AND METHODS Analysis of the Singapore Chinese Health Study included 51,251 men and women ages 45–74 years enrolled in 1993–1998 and followed up through 2007. Incident cancer cases and deaths among cohort members were identified through record linkage and 980 cases were identified. Cox regression models were used to investigate the association of baseline BMI with risk of incident colorectal cancer during mean 11.5 years of follow-up. RESULTS A significant U-shaped, quadratic association was observed between BMI and colon cancer risk, with increased risk in BMI’s ≥27.5 and < 18.5 kg/m2. The association was more pronounced in never-smokers; and most prominent when further limiting the sample to those free of diabetes and cases with greater than five years of follow up. Localized cases had a more pronounced association in BMI’s ≥27.5, whereas advanced cases had a more pronounced association in BMI’s < 18.5 kg/m2. No association was found in relation to rectal cancer risk. The association was also stronger among subjects aged 65 years and above. CONCLUSIONS BMI displays a U-shaped, quadratic association with colon cancer risk in this Chinese population in Southeast Asia. PMID:21815135
Leung, Ying-Ying; Allen, John Carson; Noviani, Maria; Ang, Li-Wei; Wang, Renwei; Yuan, Jian-Min; Koh, Woon-Puay
Purpose Data on the association between body mass index (BMI) and risk of knee osteoarthritis (KOA) are sparse for Asian populations who are leaner than Western populations. We evaluated the association between BMI and risk of total knee replacement (TKR) due to severe KOA among Chinese in Singapore. Methods We used data from the Singapore Chinese Health Study, a population based prospective cohort of 63,257 Chinese men and women, aged 45–74 years at enrollment from 1993 to 1998. Information on height, weight, diet and lifestyle factors were obtained via in-person interviews. TKR cases for severe KOA were identified via linkage with the nationwide hospital discharge database through 2011. Cox regression and weighted least squares regression were used in the analysis. Results The mean BMI among cohort participants was 23.1 kg/m2, and more than two-thirds had BMI below 25 kg/m2. A total of 1,649 had TKR attributable to severe KOA. Risk of TKR increased in a strong dose-dependent manner with increasing BMI throughout the 15–32 kg/m2 range and became less clear at BMI > 32 kg/m2. In the BMI range 16–27 kg/m2, there was a 27% increase in TKR risk for each unit increase in BMI (p for trend < 0.001). Compared to BMI 19–20 kg/m2, the risk estimates of TKR were all statistically significant with increasing unit of BMI ≥ 21 kg/m2. Results were similar for men and women. Conclusion Our results provided evidence for a constant mechanical mechanism underlying BMI and KOA initiation and/or progression. PMID:25450848
Nabenishi, Hisashi; Yamazaki, Atusi
We evaluated the relationship between the temperature-humidity index (THI) and health and growth performance in Japanese black calves in Japan. Data were collected from medical records of 19,313 Japanese black calves aged up to 3 months for correlation analysis with THI from July 2008 to June 2011. Data were also collected on the market weights of 57,144 Japanese black calves, and we calculated the body weight gain (BWG) of each calf based on body weight and age in days at the calf market. Analysis for the relationship between disease incidence and THI demonstrated a negative correlation (r = -0.54, p < 0.01). In addition, the mean disease incidence at THI of ≤50 was significantly higher than that at THI of ≥71. Analysis for the relationship between growth performance in calves and THI revealed that a lower THI during the month of birth was associated with a lower BWG at the calf market and that BWG with THI of ≤70 was significantly lower than that with THI of ≥71 (p < 0.05). In contrast, a higher mean THI during the third month after birth was associated with a lower BWG at the calf market, and BWG with THI of >75 was significantly lower than that with THI of ≤50 or THI ranging from 56 to 60 (p < 0.05). These results indicate that Japanese black calves are susceptible to a cold environment immediately after birth, whereas they are susceptible to a heat environment 3 months after birth.
Di Carlo, Marco; Lato, Valentina; Di Matteo, Andrea; Carotti, Marina; Salaffi, Fausto
The Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is an inclusive questionnaire, able to describe the total impairments and restrictions due to axial spondyloarthritis (axSpA). Considering the relationship between ASAS HI and the Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, the aim of this study is to establish the ASAS HI cut-off values for functioning categories employing the ASDAS-CRP disease activity states in axSpA patients. ASAS HI and ASDAS-CPR were obtained from 140 consecutive axSpA patients, divided in the four ASDAS-CRP disease activity categories. High and very high disease activity were considered together. The ASAS HI cut-offs were obtained from the arithmetic mean, rounded off to the closest whole number, of the 75th percentile mean value of a lower rank and the 25th percentile mean value of the adjacent higher rank. This approach was applied in the transition from inactive disease and moderate disease activity, and in the transition from moderate disease activity and high/very high disease activity. Twenty-three patients were classified as having inactive disease, 36 were classified as having moderate disease activity, and 81 were in a high/very high disease activity state. Using the approach of the 75th-25th percentile mean values of adjacent disease activity states, the ASAS HI cut-offs resulted: ≤4 to dinstinguish a normal functioning, >4 and ≤8 to distinguish a moderate impairment of functioning, and >8 to distinguish a severe impairment of functioning. ASAS HI seems a reliable tool to define functioning categories in patients with axSpA.
Basham, Chandra; Denneson, Lauren M.; Millet, Lisa; Shen, Xun; Duckart, Jonathan; Dobscha, Steven K.
Oregon Violent Death Reporting System data were linked with Veterans Affairs (VA) administrative data to identify and describe veterans who completed suicide in Oregon from 2000 to 2005 (n = 968), and to describe their VA health care utilization in the year prior to death. Twenty-two percent had received health care in the VA system. Of these, 57%…
Lin, Jin-Ding; Hung, Wen-Jiu; Lin, Lan-Ping; Lai, Chia-Im
There were not many studies to provide information on health access and health utilization of people with autism spectrum disorders (ASD). The present study describes a general profile of hospital admission and the medical cost among people with ASD, and to analyze the determinants of medical cost. A retrospective study was employed to analyze…
Parish, Susan; Magana, Sandra; Rose, Roderick; Timberlake, Maria; Swaine, Jamie G.
This study examines access to, utilization of, and quality of health care for Latino children with autism and other developmental disabilities. We analyze data from the National Survey of Children with Special Health Care Needs (N = 4,414 children with autism and other developmental disabilities). Compared with White children, Latino children with…
Yang, Sook Ja; Chee, Yeon Kyung
This study aimed to develop and examine the psychometric properties of the Health Literacy Index for Female Marriage Immigrants (HLI-FMI). Study participants were 282 women who migrated to Korea from Asian countries to marry and had a mean age of 33.24 years and had immigrated a mean of 5.58 years ago. Data were collected between March 2013 and May 2013. An initial 31 preliminary items were developed based on literature reviews and focus group interviews, including three constructs of health literacy: skills (print, numeracy), tasks (access, understand, appraise, apply), and health contexts (health promotion and disease prevention, health care maintenance and treatment, health system navigation). Exploratory factor analyses of the HLI-FMI yielded 12 items in two factors: Access-Understand Health Literacy (seven items) and Appraise-Apply Health Literacy (five items; Cronbach's alpha = 0.74). Criterion validity was supported through a significant correlation with the Rapid Estimate of Adult Literacy in Medicine-Short Form. Guided by a classical test theory and item response theory, item difficulty and discrimination were within acceptable ranges. HLI-FMI scores were positively associated with participant education and Korean proficiency. The HLI-FMI appears to be the first valid and reliable comprehensive health literacy measure for evaluating health literacy in Korean female marriage immigrants.
Although the distance factor has been identified as key in the utilization of health services in rural areas of developing countries, it has been analysed without recourse to related factors of travel time and transport cost. Also, the influence of distance on vulnerable groups in utilization has not been an object of survey by researchers. This paper addresses the impact of distance on utilization, and how distance compares with travel time and transport cost that are related to it in the utilization of health services in the Ahafo-Ano South (rural) district in Ghana. The study, a cross-sectional survey, also identifies the position of distance among other important factors of utilization. A sample of 400, drawn through systematic random technique, was used for the survey. Data were analysed using the regression model and some graphic techniques. The main instruments used in data collection were formal (face-by-face) interview and a questionnaire. The survey finds that distance is the most important factor that influences the utilization of health services in the Ahafo-Ano South district. Other key factors are income, service cost and education. The effect of travel time on utilization reflects that of distance and utilization. Recommendations to reduce distance coverage, improve formal education and reduce poverty have been made.
Background The incidence of macrovascular complications and morbidities associated to metabolic syndrome are increasing in patients with type 1 diabetes mellitus (T1DM). The combination of T1DM with features of insulin resistance similar to that of type 2 diabetes (T2DM), sometimes called “double diabetes”, has been associated with central obesity. Since the most methods to accurately detect body fat and insulin resistance are not readily available, we propose that certain indirect indexes for detecting obesity as waist-to-height ratio, waist circumference and body mass index, may be useful when screening for metabolic syndrome in patients with T1DM. Methods We performed a transversal evaluation (clinical and biochemical) in all the patients of the T1DM Clinic (n = 120). We determined the presence of metabolic syndrome according to the Joint Statement Criteria by the American Heart Association/ National Heart Lung and Blood Institute and the International Diabetes Federation and the utility of certain anthropometric indexes for predicting double diabetes was evaluated. Results Thirty seven percent of the patients were considered to have metabolic syndrome using these criteria (n = 30). These patients were significantly older (p = 0.002), have a higher glycated hemoglobin (p = 0.036), cholesterol (p < 0.012) and triglyceride concentration (p < 0.01) as well as body mass index (p = 0.004), waist circumference (p = 0.01) and waist-to-height ratio (p < 0.01) than the group without metabolic syndrome. Also their c-HDL is lower (p < 0.01). A value of 0.52 for waist-to-height ratio correctly classified the largest number of patients (68% of correctly classified) well as the waist circumference (66% of correctly classified) with an adequate specificity and sensibility. Meanwhile the most precise body mass index value only classified correctly to 61% of patients. Conclusion Our data show that waist circumference and waist
Hoyt D’Anna, Laura; Nguyen, Hannah-Hanh D.; Reynolds, Grace L.; Fisher, Dennis G.; Janson, Michael; Chen, Cristy; Malotte, C. Kevin
We examined the prevalence of and associations between sexual orientation-based verbal harassment and reported utilization of health services across levels of sexual orientation in a diverse sample of adult recipients of Los Angeles County-funded HIV-related health and social services. Thirty-two percent reported they had experienced verbal harassment, the majority (80.3%) of whom identified as lesbian, gay, orbisexual. Those who reported being verbally harassed received significantly more services overall than those who were not verbally harassed, and service utilization varied by sexual orientation. These findings inform future efforts to identify and assess social discrimination in health and social service settings. PMID:23044662
Johnson, Barbara H; Bonafede, Machaon M; Watson, Crystal
Objectives The mean lifetime cost of ischemic stroke is approximately $140,048 in the United States, placing stroke among the top 10 most costly conditions among Medicare beneficiaries. The objective of this study was to describe the health-care resource utilization and costs in the year following hospitalization for acute ischemic stroke (AIS). Methods This retrospective claims analysis quantifies utilization and costs following inpatient admission for AIS among the commercially insured and Medicare beneficiaries in the Truven Health databases. Patients who were 18 years or older and continuously enrolled for 12 months before and after an AIS event occurring (index) between January 2009 and December 2012 were identified. Patients with AIS in the year preindex were excluded. Demographic and clinical characteristics were evaluated at admission and in the preindex, respectively. Direct costs, readmissions, and inpatient length of stay (LOS) were described in the year postindex. Results The eligible populations comprised 20,314 commercially insured patients and 31,037 Medicare beneficiaries. Average all-cause costs were $61,354 and $44,929 (commercial and Medicare, respectively) in the first year after the AIS. Approximately 50%–55% of total 12-month costs were incurred between day 31 and day 365 following the incident AIS. One quarter (24.6%) of commercially insured patients and 38.8% of Medicare beneficiaries were readmitted within 30 days with 16.6% and 71.7% (commercial and Medicare, respectively) of those having a principal diagnosis of AIS. The average AIS-related readmission length of stay was nearly three times that of the initial hospitalization for both commercially insured patients (3.8 vs 10.8 days) and Medicare beneficiaries (4.0 vs 10.8 days). Conclusion In addition to the substantial costs of the initial hospitalization of an AIS, these costs double within the year following this event. Given the high cost associated with AIS, new interventions
Choi, YoonJoung; Bird, Sandra
Abstract Objective To systematically review the public health literature to assess trends in the use of Demographic and Health Survey (DHS) data for research from 1984 to 2010 and to describe the relationship between data availability and data utilization. Methods The MEASURE DHS web site was searched for information on all population-based surveys completed under the DHS project between 1984 and 2010. The information collected included the country, type of survey, survey design, fieldwork period and certain special features, such as inclusion of biomarkers. A search of PubMed was also conducted to identify peer-reviewed articles published during 2010 that analysed DHS data and included an English-language abstract. Trends in data availability and in the use of DHS data for research were assessed through descriptive, graphical and bivariate linear regression analyses. Findings In total, 236 household surveys under the DHS project were completed across 84 countries during 2010. The number of surveys per year has remained constant, although the scope of the survey questions has expanded. The inclusion criteria were met by 1117 peer-reviewed publications. The number of publications has increased progressively over the last quarter century, with an average annual increment of 4.3 (95% confidence interval, CI: 3.2–5.3) publications. Trends in the number of peer-reviewed publications based on the use of DHS data were highly correlated with trends in funding for health by the Government of the United States of America and globally. Conclusion Published peer-reviewed articles analysing DHS data, which have increased progressively in number over the last quarter century, have made a substantial contribution to the public health evidence base in developing countries. PMID:22893744
Jha, R; Berrocoso, J D
Although dietary fiber (DF) negatively affects energy and nutrient digestibility, there is growing interest for the inclusion of its fermentable fraction in pig diets due to their functional properties and potential health benefits beyond supplying energy to the animals. This paper reviews some of the relevant information available on the role of different types of DF on digestion of nutrients in different sections of the gut, the fermentation process and its influence on gut environment, especially production and utilization of metabolites, microbial community and gut health of swine. Focus has been given on DF from feed ingredients (grains and coproducts) commonly used in pig diets. Some information on the role DF in purified form in comparison with DF in whole matrix of feed ingredients is also presented. First, composition and fractions of DF in different feed ingredients are briefly reviewed. Then, roles of different fractions of DF on digestion characteristics and physiological functions in the gastrointestinal tract (GIT) are presented. Specific roles of different fractions of DF on fermentation characteristics and their effects on production and utilization of metabolites in the GIT have been discussed. In addition, roles of DF fermentation on metabolic activity and microbial community in the intestine and their effects on intestinal health are reviewed and discussed. Evidence presented in this review indicates that there is wide variation in the composition and content of DF among feed ingredients, thereby their physico-chemical properties in the GIT of swine. These variations, in turn, affect the digestion and fermentation characteristics in the GIT of swine. Digestibility of DF from different feed ingredients is more variable and lower than that of other nutrients like starch, sugars, fat and CP. Soluble fractions of DF are fermented faster, produce higher amounts of volatile fatty acid than insoluble fractions, and favors growth of beneficial microbiota
Croen, Lisa A.; Najjar, Daniel V.; Ray, G. Thomas; Lotspeich, Linda; Bernal, Pilar
Objective: Data on the current costs of medical services for children with autism spectrum disorders are lacking. Our purpose for this study was to compare health care utilization and costs of children with and without autism spectrum disorders in the same health plan. Patients and Methods: Participants included all 2- to 18-year-old children with…
Bice-Wigington, Tiffany; Huddleston-Casas, Catherine
Using structural equation modeling, this study examined the mesosystemic processes among rural low-income women, and how these processes subsequently influenced self-reported health. Acknowledging the behavioral processes inherent in utilization of health care and formal social support services, this study moved beyond a behavioral focus by…
Ngugi, Anthony K.; Agoi, Felix; Mahoney, Megan R.; Lakhani, Amyn; Mang’ong’o, David; Nderitu, Esther; Armstrong, Robert; Macfarlane, Sarah
Background and methods Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services. Results and conclusions 1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05–0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of
Sein, Kyi Kyi
This study aimed to identify maternal care services utilization among ever married female youths (15-24 years) in Kyimyindaing Township, Yangon, Myanmar. A quantitative cross-sectional survey was conducted. A total of 196 ever married females who had delivered at least one child were included. Multistage sampling was employed. Face to face interviews using a structured questionnaire were carried out. Respondents were asked about their maternal care services utilization at the last pregnancy. Bivariate and logistic regression analyses were applied to determine the factors associated with utilization of maternal care services. Overall 96% of respondents received antenatal care (ANC) at least once and 79% had at least 4 ANC visits. The mean number of antenatal visits increased with women's education level. The majority received late ANC regardless of residence, age, education and family income. Nearly 39% delivered at home, especially in rural areas and 79% of home deliveries were attended by traditional birth attendants (TBAs). Only 56.6% of women received at least one postnatal care visit. Inadequate postnatal care (<6 times) was identified (82.6%). Place of residence, women's education and ANC frequency were the key determinants for a delivery place and postnatal care. Despite relatively high antenatal care attendance, most women practiced home deliveries and received inadequate postnatal care. Maternal health services need to be focused on rural women and women with little or no education. Quality ANC should be the entry point of safe delivery and postnatal care. Further intensification of information, education and communication activities on "safe motherhood" is needed.
Obaid, Jannah M; Bailey, Ginger; Wheeler, Heidi; Meyers, Laura; Medcalf, Sharon J; Hansen, Keith F; Sanger, Kristine K; Lowe, John J
Rural communities face barriers to disaster preparedness and considerable risk of disasters. Emergency preparedness among rural communities has improved with funding from federal programs and implementation of a National Incident Management System. The objective of this project was to design and implement disaster exercises to test decision making by rural response partners to improve regional planning, collaboration, and readiness. Six functional exercises were developed and conducted among three rural Nebraska (USA) regions by the Center for Preparedness Education (CPE) at the University of Nebraska Medical Center (Omaha, Nebraska USA). A total of 83 command centers participated. Six functional exercises were designed to test regional response and command-level decision making, and each 3-hour exercise was followed by a 3-hour regional after action conference. Participant feedback, single agency debriefing feedback, and regional After Action Reports were analyzed. Functional exercises were able to test command-level decision making and operations at multiple agencies simultaneously with limited funding. Observations included emergency management jurisdiction barriers to utilization of unified command and establishment of joint information centers, limited utilization of documentation necessary for reimbursement, and the need to develop coordinated public messaging. Functional exercises are a key tool for testing command-level decision making and response at a higher level than what is typically achieved in tabletop or short, full-scale exercises. Functional exercises enable evaluation of command staff, identification of areas for improvement, and advancing regional collaboration among diverse response partners. Obaid JM , Bailey G , Wheeler H , Meyers L , Medcalf SJ , Hansen KF , Sanger KK , Lowe JJ . Utilization of functional exercises to build regional emergency preparedness among rural health organizations in the US. Prehosp Disaster Med. 2017;32(2):1-7.
Wang, Tiankai; Biedermann, Sue
Long-term care (LTC) is an important sector in the healthcare industry; however, the adoption of electronic health record (EHR) systems in LTC facilities lags behind that in other sectors of healthcare. This study examines the adoption and utilization of EHRs in LTC facilities in Texas and identifies the barriers preventing implementation of EHRs. A survey instrument was mailed to all Texas LTC facilities between October 2010 and March 2011. The survey found that in Texas, 39.5 percent of LTC facilities have fully or partially implemented EHR systems and 15 percent of LTC facilities have no plans to adopt EHRs yet. There is significant variation in the use of EHR functionalities across the LTC facilities in Texas. In the LTC facilities, the administrative functions of EHRs have been more widely adopted and are more widely utilized than the clinical functions of EHRs. Among the clinical functions adopted, the resident assessment, physician orders, care management plan, and census management are the leading functions used by the LTC facilities in Texas. Lack of capital resources is still the greatest barrier to EHR adoption and implementation. Policy makers, vendors, LTC administrators, educators, and researchers should make more effort to improve EHR adoption in LTC facilities.
Price, James I; Bohara, Alok K
Armed conflicts, which primarily occur in low- and middle-income countries, have profound consequences for the health of affected populations, among them a decrease in the utilization of maternal health care services. The quantitative relationship between armed conflict and maternal health care utilization has received limited attention in the public health literature. We evaluate this relationship for a particular type of health care service, antenatal care, in Nepal. Using count regression techniques, household survey data and sub-national conflict data, we find a negative correlation between the number of antenatal care visits and incidents of conflict-related violence within a respondent's village development committee. Specifically, we find that under high-intensity conflict conditions women receive between 0.3 and 1.5 fewer antenatal care check-ups. These findings imply that maternal health care utilization is partially determined by characteristics of the social environment (e.g. political instability) and suggest health care providers need to revise maternal health strategies in conflict-affected areas. Strategies may include decentralization of services, maintaining neutrality among factions, strengthening community-based health services and developing mobile clinics.
Although health literacy has been a public health priority area for more than a decade, the relationship between health literacy and dietary quality has not been thoroughly explored. This study, evaluates health literacy skills in relation to Healthy Eating Index (HEI) scores and sugar-sweetened bev...
Spolsky, V W; Marcus, M; Coulter, I D; Der-Martirosian, C; Atchison, K A
Disease varies in different populations based on sociodemographic variables, and there is limited understanding of this interaction. The purpose of this methodological study was to determine the validity of the Oral Health Status Index, a disease-based index, on a Hispanic population by comparing it with the NIDCR epidemiological measures of disease, with the addition of demographic and behavioral variables. The epidemiologic data were collected according to the criteria defined by the NIDCR, including: a modified Decayed Missing Filled Surfaces Index, gingival inflammation, calculus, and destructive periodontal disease measures. The demographic and behavioral variables were gathered from 240 interviews with Hispanic adults in two community clinics. Bivariate analysis was used to determine relationships between the descriptive epidemiologic, demographic, and behavioral variables and the Oral Health Status Index (OHSI). There were statistically significant differences (p < 0.05) in mean OHSI scores among the demographic variables age, education, income, and place of birth; and the behavioral variables alcohol consumption, flossing, and acculturation. Multiple regression analysis with the OHSI as the dependent variable showed that the statistically significant (p < 0.001) epidemiologic predictors were: percentage of Decayed Teeth/Decayed, Filled Teeth; Number of Replaced Teeth/Missing Teeth; and millimeters of mesial attachment loss. These collectively explained 47.49% of the variance in the regression. The addition of demographic variables to the epidemiologic regression identified age (p < 0.05), gender (p < 0.01), and place of birth (p < 0.01) as significant predictors that explained an additional 4.12% of the variance, collectively bringing the total explained variance to 51.61%. The behavioral variables did not contribute significantly to predicting the OHSI regression score. The Oral Health Status Index in this study is validated by its correlation with both
Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh
Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or
Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh
Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or
Dias-da-Costa, Juvenal S; Gigante, Denise P; Horta, Bernardo L; Barros, Fernando C; Victora, Cesar G
OBJECTIVE To describe the pattern of health services utilization by young adults. METHODS Longitudinal study in Pelotas (Southern Brazil), in which the individuals were identified at birth in 1982 and followed up until 23 years of age. The outcome was defined by information collected about visits to health professionals that were attended in the year before the interview, between 2004 and 2005. The places where the visits occurred were categorized as public, private or belonging to health plan systems. Descriptive analyses were carried out for utilization and type of health service. Poisson Regression was employed in the adjusted analysis. RESULTS Of the interviewees, 72.0% visited health professionals in the year before the interview; 86.2% (95% CI 84.7;87.7) of the women and 59.3% (95% CI 57.3;61.3) of the men. Even when gynecological visits were excluded, the women still attended more visits than the men, 68.4% (95% CI 66.4;70.4). Health services utilization was more frequent among interviewees of better socioeconomic level. A difference of lower use in relation to non-white skin color was observed only among male youths. There were differences regarding the type of professional visited by men and women and also according to family income. Men and women used more frequently the public system, the health plan system and, in a smaller proportion, the private system. CONCLUSIONS The socioeconomic situation influenced the utilization and the type of health service, with men and women classified as “poor at the moment”, which indicates lower utilization of services. Such socioeconomic differences may indicate difficulties in the access to the health system. PMID:19142345
Background Frequent illness and injury among workers with high body mass index (BMI) can raise the costs of employee healthcare and reduce workforce maintenance and productivity. These issues are particularly important in vocational settings such as the military, which require good physical health, regular attendance and teamwork to operate efficiently. The purpose of this study was to compare the incidence of injury and illness, absenteeism, productivity, healthcare usage and administrative outcomes among Australian Defence Force personnel with varying BMI. Methods Personnel were grouped into cohorts according to the following ranges for (BMI): normal (18.5 − 24.9 kg/m2; n = 197), overweight (25–29.9 kg/m2; n = 154) and obese (≥30 kg/m2) with restricted body fat (≤28% for females, ≤24% for males) (n = 148) and with no restriction on body fat (n = 180). Medical records for each individual were audited retrospectively to record the incidence of injury and illness, absenteeism, productivity, healthcare usage (i.e., consultation with medical specialists, hospital stays, medical investigations, prescriptions) and administrative outcomes (e.g., discharge from service) over one year. These data were then grouped and compared between the cohorts. Results The prevalence of injury and illness, cost of medical specialist consultations and cost of medical scans were all higher (p < 0.05) in both obese cohorts compared with the normal cohort. The estimated productivity losses from restricted work days were also higher (p < 0.05) in the obese cohort with no restriction on body fat compared with the normal cohort. Within the obese cohort, the prevalence of injury and illness, healthcare usage and productivity were not significantly greater in the obese cohort with no restriction on body fat compared with the cohort with restricted body fat. The number of restricted work days, the rate of re-classification of Medical Employment
Mendoza, Karla; Ulloa, Arianna; Saavedra, Nayelhi; Galván, Jorge
Objective To analyze factors associated with and predicting Mexican women seeking primary care mental health services (PCMHS) and provide suggestions to increase PCMHS utilization. Method We administered a questionnaire to (N = 456) female patients in Mexico City primary care clinics. We conducted chi-square analyses of seeking PCMHS and: socio-demographic variables, perceptions of and experiences with PCMHS. Our results and literature review guided our logistic regression model. Results Women referred to a mental health provider (MHP; [OR] = 10.81, 95% CI = 3.59–32.51), whose coping mechanisms included talking to a MHP (OR = 5.53, CI = 2.10–14.53), whose primary worry is loneliness (OR = 8.15, CI = 1.20–55.10), and those who follow doctor’s orders; were more likely to seek PCMHS (OR = 0.28, CI = 0.09–0.92). Conclusions Primary care providers play a fundamental role in women’s decisions to seek PCMHS. Proper referrals to PCMHS should be encouraged. PMID:27856559
Brown, George R.; Shipherd, PhD, Jillian C.; Kauth, Michael; Piegari, Rebecca I.; Bossarte, Robert M.
Objectives. We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. Methods. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009–2011) of suicide-related events among all VHA users to examine suicide risk. Results. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. Conclusions. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care. PMID:23947310
Busch, Susan H; Duchovny, Noelia
With the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Medicaid eligibility ceased to be tied to receipt of cash assistance. Since then, states have had a growing number of opportunities to expand health coverage to low-income working families beyond previous AFDC limits. As of 2001, 20 states have raised income eligibility limits for parents to or beyond 100% of the Federal Poverty Level. First, we use the Current Population Survey to study the effect of states' expansions on the insurance rates of adults and to estimate the crowd-out of private insurance. We find that eligible adults living in a state that expanded coverage are more likely to be insured. We find a take-up rate of 14.8%. Our results suggest that 24% of this increase is due to a reduction in private coverage. Next, we use the Behavioral Risk Factor Surveillance System to examine changes in health care utilization. We find that these expansions increased cancer-screening rates. Of previously uninsured mothers not receiving cancer screening, 29% now receive these screens. Finally, our results indicate the expansions decreased the likelihood that a parent needed to see a doctor but did not because of cost.
Yang, Sook Ja; Chee, Yeon Kyung; An, Jisook; Park, Min Hee; Jung, Sunok
The purpose of this study was to obtain an independent evaluation of the factor structure of the 12-item Health Literacy Index for Female Marriage Immigrants (HLI-FMI), the first measure for assessing health literacy for FMIs in Korea. Participants were 250 Asian women who migrated from China, Vietnam, and the Philippines to marry. The HLI-FMI was originally developed and administered in Korean, and other questionnaires were translated into participants' native languages. The HLI-FMI consisted of 2 factors: (1) Access-Understand Health Literacy (7 items) and (2) Appraise-Apply Health Literacy (5 items); Cronbach's α = .73. Confirmatory factor analysis indicated adequate fit for the 2-factor model. HLI-FMI scores were positively associated with time since immigration and Korean proficiency. Based on classical test theory and item response theory, strong support was provided for item discrimination and item difficulty. Findings suggested that the HLI-FMI is an easily administered, reliable, and valid scale.
Villatoro, Alice P.; Morales, Eduardo S.; Mays, Vickie M.
Considering the central role of familismo in Latino culture, it is important to assess the extent to which familismo affects mental health help-seeking. This study examined the role of behavioral familismo, the level of perceived family support, in the use of mental health services of Latinos in the United States. Data come from the National Latino and Asian American Study (NLAAS), a representative household survey examining the prevalence of mental disorders and services utilization among Latinos and Asian Americans. Analyses were limited to Latino adults with a clinical need for mental health services, indexed by meeting DSM–IV diagnostic criteria for any mood, anxiety, or substance use disorder during the past 12 months (N = 527). One-third of Latinos with a clinical need used any type of service in the past year, including specialty mental health, general medical, and informal or religious services. High behavioral familismo was significantly associated with increased odds of using informal or religious services, but not specialty or medical services. Self-perceived need and social perceptions of need for care within close networks (i.e., told by family/friends to seek professional help) also were significant predictors of service use. These results carry important implications toward expansions of the mental health workforce in the informal and religious services settings. PMID:24999521
Zhang, Dongming; Roderer, Nancy K; Huang, Guang; Zhao, Xin
One of the important procedures during the operation of an Institutional Repository System (IRS) is to categorize and index the submitted digital objects. Based on current practice, human catalogers are frequently involved in this process to make accurate categorization. Funded by NLM development grant, we are developing an UMLS-based indexing tool. The tool will be integrated or plug-in into most IRS, and categorize and assign MeSH headings and keywords to text-based digital objects automatically.
Xie, Lin; Wang, Li; Joyce, Andrew; Vick, Catherine; Brigham, Janet; Kariburyo, Furaha; Baser, Onur; Murrelle, Lenn
Abstract Objective Develop a risk index to estimate the likelihood of life‐threatening respiratory depression or overdose among medical users of prescription opioids. Subjects, Design, and Methods A case‐control analysis of administrative health care data from the Veterans’ Health Administration identified 1,877,841 patients with a pharmacy record for an opioid prescription between October 1, 2010 and September 30, 2012. Overdose or serious opioid‐induced respiratory depression (OSORD) occurred in 817. Ten controls were selected per case (n = 8,170). Items for an OSORD risk index (RIOSORD) were selected through logistic regression modeling, with point values assigned to each predictor. Modeling of risk index scores produced predicted probabilities of OSORD; risk classes were defined by the predicted probability distribution. Results Fifteen variables most highly associated with OSORD were retained as items, including mental health disorders and pharmacotherapy; impaired drug metabolism or excretion; pulmonary disorders; specific opioid characteristics; and recent hospital visits. The average predicted probability of experiencing OSORD ranged from 3% in the lowest risk decile to 94% in the highest, with excellent agreement between predicted and observed incidence across risk classes. The model's C‐statistic was 0.88 and Hosmer–Lemeshow goodness‐of‐fit statistic 10.8 (P > 0.05). Conclusion RIOSORD performed well in identifying medical users of prescription opioids within the Veterans’ Health Administration at elevated risk of overdose or life‐threatening respiratory depression, those most likely to benefit from preventive interventions. This novel, clinically practical, risk index is intended to provide clinical decision support for safer pain management. It should be assessed, and refined as necessary, in a more generalizable population, and prospectively evaluated. PMID:26077738
Background There is growing interest by funding bodies and researchers in assessing the impact of research on real world policy and practice. Population health monitoring surveys provide an important source of data on the prevalence and patterns of health problems, but few empirical studies have explored if and how such data is used to influence policy or practice decisions. Here we provide a case study analysis of how the findings from an Australian population monitoring survey series of children’s weight and weight-related behaviors (Schools Physical Activity and Nutrition Survey (SPANS)) have been used, and the key facilitators and barriers to their utilization. Methods Data collection included semi-structured interviews with the chief investigators (n = 3) and end-users (n = 9) of SPANS data to explore if, how and under what circumstances the survey findings had been used, bibliometric analysis and verification using documentary evidence. Data analysis involved thematic coding of interview data and triangulation with other data sources to produce case summaries of policy and practice impacts for each of the three survey years (1997, 2004, 2010). Case summaries were then reviewed and discussed by the authors to distil key themes on if, how and why the SPANS findings had been used to guide policy and practice. Results We found that the survey findings were used for agenda setting (raising awareness of issues), identifying areas and target groups for interventions, informing new policies, and supporting and justifying existing policies and programs across a range of sectors. Reported factors influencing use of the findings were: i) the perceived credibility of survey findings; ii) dissemination strategies used; and, iii) a range of contextual factors. Conclusions Using a novel approach, our case study provides important new insights into how and under what circumstances population health monitoring data can be used to influence real world policy and practice
Background A total of 12.7 million Mexicans reside as migrants in the United States, of whom only 45% have health insurance in this country while access to health insurance by migrants in Mexico is fraught with difficulties. Health insurance has been shown to impact the use of health care in both countries. This paper quantifies hospitalizations by migrants who return from the US seeking medical care in public and private hospitals in the US-Mexico border area and in communities of origin. The proportion of bed utilization and the proportion of hospitalizations in Mexico out of the total expected by migrants in the US were estimated. Methods The universe included 48 Ministry of Health and 47 private hospitals serving municipalities of high or very high migration in Mexico, where 17% of remittance-receiving households are located, as well as 15 public and 159 private hospitals in 10 Mexican cities along the border with the US. Hospitals were sampled through various methods to include 27% of beds. Patients and staff were interviewed and data triangulated to quantify migrants that returned to Mexico seeking medical care. Official hospital discharge statistics and secondary data from migration databases and published statistics were analyzed to identify bed occupancy, general migrant hospitalization rates and the size of the migrant population that maintains close relationships with households in communities of origin. Results Up to 1609 migrants were admitted to public hospitals (76.6%) and 492 to private hospitals (23.4%) serving municipalities of high and very high migration intensity in 2008. Up to 0.90% of public hospital capacity was used. In the border area up to 908 and 2416 migrants were admitted to public (27.3%) and private (72.7%) hospitals, respectively. Up to 1.18% of public hospital capacity was used. Between 2.4% and 20.4% of the expected hospitalization needs of migrants with dependent households are satisfied through these services. The most common
Ali, Askal Ayalew; Xiao, Hong; Tawk, Rima; Campbell, Ellen; Semykina, Anastasia; Montero, Alberto J.; Diaby, Vakaramoko
Background The selection of the most appropriate treatment combinations requires the balancing of benefits and harms of these treatment options as well as the patients’ preferences for the resulting outcomes. Objective This research aimed at estimating and comparing the utility weights between elderly women with early stage hormone receptor positive (HR+) breast cancer receiving a combination of radiotherapy and hormonal therapy after breast conserving surgery (BCS) and those receiving a combination of BCS and hormonal therapy. Methods The Surveillance, Epidemiology, and End Results (SEER) linked with Medicare Health Outcomes Survey (MHOS) was used as the data source. Health utility weights were derived from the VR-12 health-related quality of life instrument using a mapping algorithm. Descriptive statistics of the sample were provided. Two sample t-tests were performed to determine potential differences in mean health utility weights between the two groups after propensity score matching. Results The average age at diagnosis was 72 vs. 76 years for the treated and the untreated groups, respectively. The results showed an inverse relationship between the receipt of radiotherapy and age. Patients who received radiotherapy had, on average, a higher health utility weight (0.70; SD = 0.123) compared with those who did not receive radiotherapy (0.676; SD = 0.130). Only treated patients who had more than two comorbid conditions had significantly higher health utility weights compared with patients who were not treated. Conclusions The mean health utility weights estimated for the radiotherapy and no radiotherapy groups can be used to inform a comparative cost-effectiveness analysis of the treatment options. However, the results of this study may not be generalizable to those who are outside a managed care plan because MHOS data is collected on managed care beneficiaries. PMID:27819160
Background Community health workers are widely used to provide care for a broad range of health issues. Since 2003 the government of Ethiopia has been deploying specially trained new cadres of community based health workers named health extension workers (HEWs). This initiative has been called the health extension program. Very few studies have investigated the role of these community health workers in improving utilization of maternal health services. Methods A cross sectional survey of 725 randomly selected women with under-five children from three districts in Northern Ethiopia. We investigated women’s utilization of family planning, antenatal care, birth assistance, postnatal care, HIV testing and use of iodized salt and compared our results to findings of a previous nat