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Sample records for health utility index

  1. Multi-attribute preference functions. Health Utilities Index.

    PubMed

    Torrance, G W; Furlong, W; Feeny, D; Boyle, M

    1995-06-01

    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.

  2. The Health Utilities Index (HUI): concepts, measurement properties and applications.

    PubMed

    Horsman, John; Furlong, William; Feeny, David; Torrance, George

    2003-10-16

    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.

  3. Health utility indexes in patients with acute coronary syndromes

    PubMed Central

    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

    2016-01-01

    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

  4. How robust is the Health Utilities Index Mark 2 utility function?

    PubMed

    Wang, Qinan; Furlong, William; Feeny, David; Torrance, George; Barr, Ronald

    2002-01-01

    The utility function for the Health Utilities Index Mark 2 (HUI2) system is based on preference measurements from a random sample of parents with exclusion of inconsistent respondents. Would results without exclusions or from a different group of parents have differed? Scores were obtained from parents of patients (n = 59) undergoing treatment for cancer. Mean scores from the 2 sets of parents were compared:parents of patients and parents from the general population. Three multiattribute utility functions were estimated. Mean scores for HUI2 states using the functions were compared. Most differences in mean scores between different groups were not statistically significant (P < 0.05). Differences in parameter estimates among the 3 utility functions were 0.05 or less. The exponent on the power function for the parent-of-patient group was 2.16, within 6% of that for random sample parents. The intraclass correlation between scores for 144 health states derived from the random-sample-parents and parents-of-patients functions was 0.99; the mean difference per state in scores was 0.018. The HUI2 scoring function generalizes well in that different groups of parents give similar results. The HUI2 scoring function is robust in that the functions without and with exclusions generate scores that are very close in value.

  5. Validation and application of health utilities index in Chinese subjects with down syndrome.

    PubMed

    Mok, Winnie Ka Yan; Wong, Wilfred Hing-Sang; Mok, Gary Tsz Kin; Chu, Yoyo Wing Yiu; Ho, Frederick Ka Wing; Chow, Chun Bong; Ip, Patrick; Chung, Brian Hon-Yin

    2014-10-14

    The objectives of the study were (1) to validate the Chinese version of Health Utilities Index (HUI-Ch); (2) to examine the Health-related Quality of Life (HRQoL) of Chinese subjects with Down syndrome (DS); and (3) to study the impact of chronic health conditions on HRQoL of Chinese with DS. The multiple choice questionnaire for scoring Health Utilities Index Mark 2 (HUI2) and Health Utilities Index Mark 3 (HUI3) was translated and validated. In addition to the HRQoL scores from HUI2 and HUI3, proxy-data on socio-demographics, and 10 common chronic health conditions for people with DS were collected and analyzed. Data analysis involves multiple imputation and multiple regression analysis to predict variations in HRQoL in relation to different factors. Lastly, a gradient interval was constructed on the number of chronic health conditions in relation to HRQoL. HUI-Ch was validated according to standard guidelines. People with DS were found to have a lower HRQoL as compared to the general population, with the majority categorized as moderate or severe on the scale. Behavioral and hearing problems on HUI2, and hearing problems on HUI3 were found to be statistically significant predictors of a lower HRQoL score. A significant gradient relationship existed showing when the number of health problems increased, the HRQoL scores decreased. HUI-Ch is a valid instrument to assess HRQoL. It can have broad application in Chinese subjects with DS including the study of the impact of different chronic health conditions on their quality of life. The quantifiable nature of HUI-Ch will facilitate longitudinal study on the well-being of subjects with DS and evaluation of effectiveness of intervention programs in the near future.

  6. The construct validity of the Health Utilities Index Mark 3 in assessing mental health in population health surveys.

    PubMed

    Feeny, David; Huguet, Nathalie; McFarland, Bentson H; Kaplan, Mark S

    2009-05-01

    To examine the construct validity of the Health Utilities Index Mark 3 (HUI3) by exploring relationships among several well-recognized measures of mental health, the K6 and the Composite International Diagnostic Interview (CIDI), and the HUI3 in a large, nationally representative sample of community-dwelling subjects. Known-group comparisons were also included in the validation process. We specified a priori hypotheses about the expected degree of association between the measures. Correlation coefficients of <0.1 were defined as negligible, 0.1 to <0.3 as small, 0.3 to <0.5 as medium, and > or =0.5 as large. Data from the Statistics Canada National Population Health Survey (NPHS) Cycle 2 (1996/97) for respondents 20 years of age or older (n = 66,435) were used to test the a priori hypotheses. In 58.1% of cases, predictions of association were correct. Predictions were off by one category in 38.9% of cases and a priori predictions were off by two categories in 3.0% of cases. Our results provide evidence supporting the cross-sectional construct validity of the HUI3 emotion and HUI3 in a nationally representative sample of the community-dwelling population. The results also provide further evidence of the cross-sectional construct validity of the HUI3 in assessing population health.

  7. The construct validity of the Health Utilities Index Mark 3 in assessing mental health in population health surveys

    PubMed Central

    Huguet, Nathalie; McFarland, Bentson H.; Kaplan, Mark S.

    2013-01-01

    Purpose To examine the construct validity of the Health Utilities Index Mark 3 (HUI3) by exploring relationships among several well-recognized measures of mental health, the K6 and the Composite International Diagnostic Interview (CIDI), and the HUI3 in a large, nationally representative sample of community-dwelling subjects. Known-group comparisons were also included in the validation process. Methods We specified a priori hypotheses about the expected degree of association between the measures. Correlation coefficients of <0.1 were defined as negligible, 0.1 to <0.3 as small, 0.3 to <0.5 as medium, and ≥0.5 as large. Data from the Statistics Canada National Population Health Survey (NPHS) Cycle 2 (1996/97) for respondents 20 years of age or older (n = 66,435) were used to test the a priori hypotheses. Results In 58.1% of cases, predictions of association were correct. Predictions were off by one category in 38.9% of cases and a priori predictions were off by two categories in 3.0% of cases. Conclusions Our results provide evidence supporting the cross-sectional construct validity of the HUI3 emotion and HUI3 in a nationally representative sample of the community-dwelling population. The results also provide further evidence of the cross-sectional construct validity of the HUI3 in assessing population health. PMID:19277898

  8. Utility-Theoretic Indexing.

    ERIC Educational Resources Information Center

    Wilson, Patrick

    1979-01-01

    Responds to W. S. Cooper's article on utility-theoretic indexing (Journal of the American Society for Information Science, v29 n3) and posits that the method's claim to predictive success rests solely on its appeal to the consequences of decisions. (FM)

  9. Utilizing the School Health Index to Build Collaboration between a University and an Urban School District

    ERIC Educational Resources Information Center

    Butler, James; Fryer, Craig S.; Reed, Ernestine A.; Thomas, Stephen B.

    2011-01-01

    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…

  10. Utilizing the School Health Index to Build Collaboration between a University and an Urban School District

    ERIC Educational Resources Information Center

    Butler, James; Fryer, Craig S.; Reed, Ernestine A.; Thomas, Stephen B.

    2011-01-01

    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…

  11. Utilizing the School Health Index to Foster University and Community Engagement

    ERIC Educational Resources Information Center

    King, Kristi McClary

    2010-01-01

    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…

  12. 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

    PubMed Central

    Rashidi, Amir Adel; Anis, Aslam H; Marra, Carlo A

    2006-01-01

    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

  13. Comparison of scores derived from the box score-11 scale and the pain attribute of the health utilities index-3.

    PubMed

    Iskedjian, Michael; Jaszewski, Barbara; Desjardins, Olivier

    2011-01-01

    Pain is widespread, but has not yet been the focus of measurement in terms of patient preferences. This type of measure is needed for pharmacoeconomic analyses of pain medications. Our objective was to compare scores from the Box Score (BS)-11 scale and the pain attribute of the Health Utilities Index (HUI)-3. English- and/or French-speaking adult patients (aged ≥ 18 years) were recruited from pain clinics in four Canadian metropolitan areas (Toronto, Ottawa, Edmonton, Vancouver). Those providing informed consent completed both pain scales, assessing their average pain level over the previous 4 weeks. Kendall's Tau-b was calculated between score sets. Answers provided by patients were then used to determine the proportions of each of the BS-11 scores that mapped onto each of the five HUI-3 pain scores. Six of the 516 completed questionnaires had missing information, leaving 510 for analysis. The average age of patients was 49.5 ± 11.9 years; 70% were female. Tau-b was reasonably large and statistically significant between the scales (τ = 0.685; p < 0.001). No patients had zero scores on BS-11, and two patients scored 1, yielding inconclusive results for that score. Eight of the remaining nine BS-11 scores mapped ≥ 60% onto HUI-3 pain scores. BS-11 scores 2 and 10 had the best mapping (88% and 94%, respectively). BS-11 scores can be mapped onto the pain attribute of the HUI-3 with a high degree of correlation.

  14. Using Health Utility Index (HUI) for measuring the impact on health-related quality of Life (HRQL) among individuals with chronic diseases.

    PubMed

    Mo, Frank; Choi, Bernard C K; Li, Felix C K; Merrick, Joav

    2004-08-27

    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

  15. Estimation of a valuation function for a diabetes mellitus-specific preference-based measure of health: the Diabetes Utility Index.

    PubMed

    Sundaram, Murali; Smith, Michael J; Revicki, Dennis A; Miller, Lesley-Ann; Madhavan, Suresh; Hobbs, Gerry

    2010-01-01

    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

  16. Evaluation of Geographic Indices Describing Health Care Utilization.

    PubMed

    Kim, Agnus M; Park, Jong Heon; Kang, Sungchan; Kim, Yoon

    2017-01-01

    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. 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. 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. Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

  17. Evaluation of Geographic Indices Describing Health Care Utilization

    PubMed Central

    Park, Jong Heon

    2017-01-01

    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

  18. Burnout and health care utilization.

    PubMed

    Jackson, C N; Manning, M R

    1995-01-01

    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.

  19. Patient Related Outcomes-BODE (PRO-BODE): A composite index incorporating health utilization resources predicts mortality and economic cost of COPD in real life.

    PubMed

    Dal Negro, R W; Celli, B R

    2017-10-01

    Multidimensional scores were proposed for defining COPD outcomes, but without any incorporation of the economic COPD cost to clinical indices. using mortality as an outcome, the hypothesis that adding total health care cost to the BODE index would better predict mortality in COPD was investigated. 275 COPD patients were surveyed. Anthropometrics, lung function, the BODE and the Charlson Comorbidity Index were determined. History of exacerbations, ER visits, hospitalizations and mortality were also determined over the next three years, being their rates graded and added to the BODE index according to a simple algorithm. The novel PRO-BODE index ranged 0-10 points; its relationship to annual total COPD cost and survival was assessed by linear regression analysis. total COD cost showed the highest relationship with survival (r = -0.58), even higher than that of age and of BODE index (r = -0.28 and r = -0.21, respectively). The integrated Pro-BODE score proved proportional to the cost of care and inversely proportional to the length of survival. Pro-BODE is a novel composite index which helps in predicting in real life the impact of COPD over three years, both in terms of patients' survival and of COPD economic burden. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Equity in health care utilization in Chile

    PubMed Central

    2013-01-01

    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

  1. Equity in health care utilization in Chile.

    PubMed

    Núñez, Alicia; Chi, Chunhuei

    2013-08-12

    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.

  2. Suicide among veterans in 16 states, 2005 to 2008: comparisons between utilizers and nonutilizers of Veterans Health Administration (VHA) services based on data from the National Death Index, the National Violent Death Reporting System, and VHA administrative records.

    PubMed

    Katz, Ira R; McCarthy, John F; Ignacio, Rosalinda V; Kemp, Janet

    2012-03-01

    We sought to compare suicide rates among veterans utilizing Veterans Health Administration (VHA) services versus those who did not. Suicide rates from 2005 to 2008 were estimated for veterans in the 16 states that fully participated in the National Violent Death Reporting System (NVDRS), using data from the National Death Index, NVDRS, and VHA records. Between 2005 and 2008, veteran suicide rates differed by age and VHA utilization status. Among men aged 30 years and older, suicide rates were consistently higher among VHA utilizers. However, among men younger than 30 years, rates declined significantly among VHA utilizers while increasing among nonutilizers. Over these years, an increasing proportion of male veterans younger than 30 years received VHA services, and these individuals had a rising prevalence of diagnosed mental health conditions. The higher rates of suicide for utilizers of VHA among veteran men aged 30 and older were consistent with previous reports about which veterans utilize VHA services. The increasing rates of mental health conditions in utilizers younger than 30 years suggested that the decreasing relative rates in this group were related to the care provided, rather than to selective enrollment of those at lower risk for suicide.

  3. Suicide Among Veterans in 16 States, 2005 to 2008: Comparisons Between Utilizers and Nonutilizers of Veterans Health Administration (VHA) Services Based on Data From the National Death Index, the National Violent Death Reporting System, and VHA Administrative Records

    PubMed Central

    Katz, Ira R.; Ignacio, Rosalinda V.; Kemp, Janet

    2012-01-01

    Objectives. We sought to compare suicide rates among veterans utilizing Veterans Health Administration (VHA) services versus those who did not. Methods. Suicide rates from 2005 to 2008 were estimated for veterans in the 16 states that fully participated in the National Violent Death Reporting System (NVDRS), using data from the National Death Index, NVDRS, and VHA records. Results. Between 2005 and 2008, veteran suicide rates differed by age and VHA utilization status. Among men aged 30 years and older, suicide rates were consistently higher among VHA utilizers. However, among men younger than 30 years, rates declined significantly among VHA utilizers while increasing among nonutilizers. Over these years, an increasing proportion of male veterans younger than 30 years received VHA services, and these individuals had a rising prevalence of diagnosed mental health conditions. Conclusions.The higher rates of suicide for utilizers of VHA among veteran men aged 30 and older were consistent with previous reports about which veterans utilize VHA services. The increasing rates of mental health conditions in utilizers younger than 30 years suggested that the decreasing relative rates in this group were related to the care provided, rather than to selective enrollment of those at lower risk for suicide. PMID:22390582

  4. Competency Index. [Health Technology Cluster.

    ERIC Educational Resources Information Center

    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…

  5. Competency Index. [Health Technology Cluster.

    ERIC Educational Resources Information Center

    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…

  6. The Healthy Class of 2010: Utilization of the School Health Index to Build Collaboration Between a University and an Urban School District

    PubMed Central

    Fryer, Craig S.; Reed, Ernestine A.; Thomas, Stephen B.

    2014-01-01

    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 challenges and opportunities this type of collaboration can pose. METHODS The SHI and selected collaboration principles were used to facilitate partnership and increase stakeholder buy-in, which led to developing and implementing an eight year health promotion campaign, The Healthy Class of 2010 (HC 2010). RESULTS The focus on planning brought together key stakeholders and allowed for HC 2010 programming to take place despite the competing demands on the schools. The SHI allowed for input from stakeholders to develop campaign activities and inform school- and district-wide policy. Universities and school districts desiring to develop and implement school-based, adolescent health promotion programs should: 1) identify the hierarchical structure of the school district; 2) establish credibility for the program and the university staff; 3) emphasize the benefits to all partners; 4) maintain a cooperative partnership with teachers and administrators; 5) appreciate the need for planning; and, 6) provide as many resources as possible to on an already overburdened school system. CONCLUSIONS Promoting healthy behaviors among students is an important part of the fundamental mission of schools. HC 2010 underscored the significance of collaboration using the SHI in the development and implementation of this health promotion campaign with input from students, teachers, administrators and university partners. PMID:22070509

  7. Translation and cultural adaptation of Health Utilities Index (HUI) Mark 2 (HUI2) and Mark 3 (HUI3) with application to survivors of childhood cancer in Brazil.

    PubMed

    Shimoda, Sandra; de Camargo, Beatriz; Horsman, John; Furlong, William; Lopes, Luiz Fernando; Seber, Adriana; Barr, Ronald D

    2005-06-01

    There are few publications reporting health-related quality of life (HRQL) in developing nations. Most instruments measuring HRQL have been developed in English-speaking countries. These instruments need to be culturally adapted for use in non-English-speaking countries. The HUI2 and HUI3 are generic, preference-based systems for describing health status and HRQL. Developed in Canada, the systems have been translated into more than a dozen languages and used worldwide in hundreds of studies of clinical and general populations. The Brazilian-Portuguese translation of the HUI systems was supervised by senior HUInc staff having experience with both the HUI systems and translations. The process included two independent forward translations of the multi-attribute health status classification systems and related questionnaires, consensus between translators on a forward translation, back-translation by two independent translators of the forward translation, and review of the back-translations by original developers of the HUI. The final questionnaires were tested by surveying a sample of convenience of 50 patients recruited at the Centro de Tratamento e Pesquisa-Hospital do Cancer in São Paulo, Brazil. Fifty patients were enrolled in the study. No assessor, patient or nurse or physician, reported problems answering the HUI questionnaires. No significant differences were found in mean overall HUI2 or HUI3 utility scores among types of assessors. Variability in scores are similar to those from other studies in Latin America and Canada. Test results provide preliminary evidence that the Brazilian-Portuguese translation is acceptable, understandable, reliable and valid for assessing health-status and HRQL among survivors of cancer in childhood in Brazil.

  8. Demonstration of optical interference filters utilizing tunable refractive index layers.

    PubMed

    Poxson, David J; Mont, Frank W; Schubert, Martin F; Kim, Jong Kyu; Cho, Jaehee; Schubert, E Fred

    2010-11-08

    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.

  9. Health care utilization, socioeconomic factors and child health in India.

    PubMed

    Bhargava, Alok; Guntupalli, Aravinda M; Lokshin, Michael

    2011-11-01

    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.

  10. Utility-Theoretic Indexing: A Note on Wilson's Note.

    ERIC Educational Resources Information Center

    Cooper, William S.

    1979-01-01

    Answers Patrick Wilson's criticism of the theory of utility-theoretic indexing (Journal of the American Society for Information Science, v30 n3) and defends the theory on the basis of its analytic capability. (FM)

  11. The customer bill as an index of utility performance

    SciTech Connect

    Berg, S.V.

    1995-01-01

    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.

  12. MEDOC: An Index for the Health Sciences.

    ERIC Educational Resources Information Center

    Peay, Wayne J.; And Others

    1985-01-01

    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)

  13. 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.

    ERIC Educational Resources Information Center

    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…

  14. Automated utility assessment of global health.

    PubMed

    Nease, R F; Tsai, R; Hynes, L M; Littenberg, B

    1996-02-01

    The objective of this study was to characterize the performance of an automated utility assessment instrument for measuring preferences for overall health. The study population consisted of 83 subjects recruited from the cafeteria of a large tertiary care hospital. We assessed utilities for current health relative to perfect health and death using the rating scale, time tradeoff and standard gamble metrics. To validate the instrument, we compared utilities with the General Health subscale of the SF-36 Health Survey instrument, satisfaction with current health, and degree of bother due to current health. We evaluated interview failure rate based on irrational orderings of two practice assessments (monocular and binocular blindness) or inability to complete the interview. As expected, utility for overall health was statistically significantly associated with the General Health subscale score and measures of satisfaction with current health and degree of bother. There is substantial variation in utilities among patients with similarly severe overall health, and substantial overlap in utilities among subjects with different levels of overall health. The failure rate in the study was acceptable (9.6%). Automated assessment of utility for overall health provides a feasible means for estimating individual preferences.

  15. Preferences for health outcomes and cost-utility analysis.

    PubMed

    Torrance, G W

    1997-05-01

    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

  16. 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".

    PubMed

    Manios, Yannis; Vlachopapadopoulou, Elpis; Moschonis, George; Karachaliou, Feneli; Psaltopoulou, Theodora; Koutsouki, Dimitra; Bogdanis, Gregory; Carayanni, Vilelmine; Hatzakis, Angelos; Michalacos, Stefanos

    2016-12-01

    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.

  17. [Valuation of health-related quality of life and utilities in health economics].

    PubMed

    Greiner, Wolfgang; Klose, Kristina

    2014-01-01

    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).

  18. Social networks and health service utilization.

    PubMed

    Deri, Catherine

    2005-11-01

    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.

  19. Bispectral Index Monitoring: validity and utility in pediatric dentistry.

    PubMed

    Goyal, Ashima; Mittal, Neeti; Mittal, Parteek; Gauba, K

    2014-01-01

    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.

  20. Technology Readiness of Early Career Nurse Trainees: Utilization of the Technology Readiness Index (TRI).

    PubMed

    Odlum, Michelle

    2016-01-01

    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.

  1. 2009 America's Civic Health Index: Civic Health in Hard Times

    ERIC Educational Resources Information Center

    Center for Information and Research on Civic Learning and Engagement (CIRCLE), 2009

    2009-01-01

    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…

  2. Health utilities for children and adults with type 1 diabetes.

    PubMed

    Lee, Joyce M; Rhee, Kirsten; O'grady, Michael J; Basu, Anirban; Winn, Aaron; John, Priya; Meltzer, David O; Kollman, Craig; Laffel, Lori M; Lawrence, Jean M; Tamborlane, William V; Wysocki, Tim; Xing, Dongyuan; Huang, Elbert S

    2011-10-01

    We studied health utilities in patients with type 1 diabetes to understand potential differences in health utilities as function of age, type of respondent (self report vs. proxy report), and method of assessment (direct vs. indirect). We elicited self-reported health utilities for adults (n=213) and children (n=238) with type 1 diabetes, and by parent proxy report (n=223) for overall quality of life [Health Utilities Index (HUI) Mark 3 and experienced time-trade-off (TTO) questions] and hypothetical complication states (TTO questions). Mean health utilities for overall quality of life (QOL) ranged from 0.81 to 0.91. Children had significantly higher overall QOL compared with adults (0.89 vs. 0.85, P<0.01) by HUI, but had no significant difference in QOL by TTO. There were no significant differences in QOL between child self report and parent proxy report. Utilities were higher for HUI versus TTO for parent proxy report (P<0.01) but not for adult or child self report. Utilities for hypothetical complication states were lower than for current QOL. Values were lower for stroke (0.34 to 0.53), end stage renal disease (0.47 to 0.55), and blindness (0.52 to 0.69) than for amputation (0.73 to 0.82) and angina (0.74 to 0.80). Complication utilities for parent proxy report were higher compared with adult self report for most hypothetical complication states. Individuals with type 1 diabetes with few complications report a relatively high QOL; however, future end stage complications are rated as having a significant impact on QOL. Differences in utilities by age, self report versus proxy report, and method raise important questions about whose utilities should be used in economic analyses.

  3. Health Care Utilization in Patients with Gout

    PubMed Central

    Singh, Jasvinder A; Sarkin, A; Shieh, M; Khanna, D; Terkeltaub, R; Lee, SJ; Kavanaugh, A; Hirsch, JD

    2010-01-01

    Objective To study health care utilization patterns in patients with gout. Methods In a gout population from primary care and rheumatology clinics in three U.S. metropolitan cities, we collected data on gout-related utilization (primary care, rheumatology, urgent care, emergency room and other) in the past year. We evaluated the association of comorbidities, age, gender, gout characteristics (time since last gout attack and tophi) and gout severity ratings (mean of serum uric acid, patient-rated and physician-rated gout severity) and with emergency/urgent care and primary care utilization using regression and correlation analyses. Results Of the 296 patients who reported visiting at least one type of health practitioner for gout in the past year, percent of patients utilizing the service at least once and annual utilization rates among utilizers were: primary care physician, 60%, 3.0±3.4; nurse practitioner/physician assistant, 26%, 2.7±2.5; rheumatologist, 51%, 3.7±5.7; urgent care, 23%, 2.1±2.2; emergency room, 20%, 2.0±1.7; and hospitalization, 7%, 2.1±1.4. Higher overall gout severity was associated with greater use of each resource type and with overall gout-related utilization. Non- emergency/non-urgent care utilization (primary care physician, nurse practitioner, physician’s assistant and rheumatologist for gout) was the strongest predictor of gout-related emergency/urgent care utilization. Patients with more comorbidities had greater gout-related primary care utilization. Conclusions Overall gout severity was associated with all types of gout-related utilization. This may help to screen high utilizers for targeted behavioral and therapeutic interventions. Having a higher number of comorbid conditions was a risk factor for higher gout-related primary care utilization. PMID:20828793

  4. Health Condition Impacts in a Nationally Representative Cross-Sectional Survey Vary Substantially by Preference-Based Health Index

    PubMed Central

    Hanmer, Janel; Cherepanov, Dasha; Palta, Mari; Kaplan, Robert M.; Feeny, David; Fryback, Dennis

    2015-01-01

    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

  5. Evaluation on equality and efficiency of health resources allocation and health services utilization in China.

    PubMed

    Sun, Jian; Luo, Hongye

    2017-07-14

    China is faced with a daunting challenge to equality and efficiency in health resources allocation and health services utilization in the context of rapid economic growth. This study sought to evaluate the equality and efficiency of health resources allocation and health services utilization in China. Demographic, economic, and geographic area data was sourced from China Statistical Yearbook 2012-2016. Data related to health resources and health services was obtained from China Health Statistics Yearbook 2012-2016. Furthermore, we evaluated the equality of health resources allocation based on Gini coefficient. Concentration index was used to measure the equality in utilization of health services. Data envelopment analysis (DEA) was employed to assess the efficiency of health resources allocation. From 2011 to 2015, the Gini coefficients for health resources by population ranged between 0.0644 and 0.1879, while the Gini coefficients for the resources by geographic area ranged from 0.6136 to 0.6568. Meanwhile, the concentration index values for health services utilization ranged from -0.0392 to 0.2110. Moreover, in 2015, 10 provinces (32.26%) were relatively efficient in terms of health resources allocation, while 7 provinces (22.58%) and 14 provinces (45.16%) were weakly efficient and inefficient, respectively. There exist distinct regional disparities in the distribution of health resources in China, which are mainly reflected in the geographic distribution of health resources. Furthermore, the people living in the eastern developed areas are more likely to use outpatient care, while the people living in western underdeveloped areas are more likely to use inpatient care. Moreover, the efficiency of health resources allocation in 21 provinces (67.74%) of China was low and needs to be improved. Thus, the government should pay more attention to the equality based on geographic area, guide patients to choose medical treatment rationally, and optimize the resource

  6. Income-related inequality in health and health care utilization in Chile, 2000-2009.

    PubMed

    Vásquez, Felipe; Paraje, Guillermo; Estay, Manuel

    2013-02-01

    To measure and explain income-related inequalities in health and health care utilization in the period 2000 - 2009 in Chile, while assessing variations within the country and determinants of inequalities. Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, pro-rich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist, general practitioner, specialized, and all physician visits. Income contributes to a pro-rich inequity in specialized and dentist visits, whereas urban residence and economic activity contribute to a pro-poor inequity in emergency room visits. The pattern of health care utilization in Chile is consistent with policies implemented in the country and in the intended direction. The significant income inequality in the

  7. Health Service Utilization and Poor Health Reporting in Asthma Patients.

    PubMed

    Behr, Joshua G; Diaz, Rafael; Akpinar-Elci, Muge

    2016-06-30

    The management and treatment of adult asthma has been associated with utilization of health services. First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. Those with asthma are found more likely (OR 1.50, 95% CI 1.05-2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56-11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32-2.65) and hospitalization (OR 2.21, 95% CI 1.39-3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are increasingly more likely to be characterized as frequent utilizers of

  8. Predictors of differences in health services utilization for children in Nigerian communities.

    PubMed

    Adekanmbi, Victor T; Adedokun, Sulaimon T; Taylor-Phillips, Sian; Uthman, Olalekan A; Clarke, Aileen

    2017-03-01

    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.

  9. Developing a utility index for the Aberrant Behavior Checklist (ABC-C) for fragile X syndrome.

    PubMed

    Kerr, Cicely; Breheny, Katie; Lloyd, Andrew; Brazier, John; Bailey, Donald B; Berry-Kravis, Elizabeth; Cohen, Jonathan; Petrillo, Jennifer

    2015-02-01

    This study aimed to develop a utility index (the ABC-UI) from the Aberrant Behavior Checklist-Community (ABC-C), for use in quantifying the benefit of emerging treatments for fragile X syndrome (FXS). The ABC-C is a proxy-completed assessment of behaviour and is a widely used measure in FXS. A subset of ABC-C items across seven dimensions was identified to include in health state descriptions. This item reduction process was based on item performance, factor analysis and Rasch analysis performed on an observational study dataset, and consultation with five clinical experts and a methodological expert. Dimensions were combined into health states using an orthogonal design and valued using time trade-off (TTO), with lead-time TTO methods used where TTO indicated a state valued as worse than dead. Preference weights were estimated using mean, individual level, ordinary least squares and random-effects maximum likelihood estimation [RE (MLE)] regression models. A representative sample of the UK general public (n = 349; mean age 35.8 years, 58.2% female) each valued 12 health states. Mean observed values ranged from 0.92 to 0.16 for best to worst health states. The RE (MLE) model performed best based on number of significant coefficients and mean absolute error of 0.018. Mean utilities predicted by the model covered a similar range to that observed. The ABC-UI estimates a wide range of utilities from patient-level FXS ABC-C data, allowing estimation of FXS health-related quality of life impact for economic evaluation from an established FXS clinical trial instrument.

  10. Comprehensive Index for Community Health Assessment of Typical District Administrative Units in Maharashtra State, India

    PubMed Central

    Doke, Prakash Prabhakarrao

    2016-01-01

    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

  11. Health care utilization by immigrants in Italy.

    PubMed

    De Luca, Giuliana; Ponzo, Michela; Andrés, Antonio Rodríguez

    2013-03-01

    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.

  12. Evaluating preference weights for the Asthma Symptom Utility Index (ASUI) across countries

    PubMed Central

    Flood, Emuella M; Cock, Erwin De; Mörk, Ann-Christin; Revicki, Dennis A

    2006-01-01

    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

  13. Health Literacy Impact on National Healthcare Utilization and Expenditure.

    PubMed

    Rasu, Rafia S; Bawa, Walter Agbor; Suminski, Richard; Snella, Kathleen; Warady, Bradley

    2015-08-17

    Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05). The extrapolated national estimates show that the annual

  14. Women's health care utilization and expenditures.

    PubMed

    Taylor, Amy K; Larson, Sharon; Correa-de-Araujo, Rosaly

    2006-01-01

    This study examines women's use and expenditures for medical care in the US. In 2000, 91% of women aged 18 years and older used any form of health care services. Overall, 82% of adult women reported an ambulatory care visit, and 11% had an inpatient hospital stay. Mean expense per person with expenses was 3219 dollars for that year. We examined use and expenditures by sociodemographic characteristics. The most notable findings indicate that women with private insurance and those on Medicaid are more likely to use health services than uninsured women. White women, compared to black and Hispanic women, are more likely to have an ambulatory care visit, buy prescription drugs, and use preventive health care services. In addition, white and Hispanic women pay a higher proportion of medical care expenses out-of-pocket than do black women. Finally, nearly 30% of older women in fair or poor health spent 10% or more of their income on medical care. Preventable disparities in access to and receipt of care are unacceptable. To improve the quality of health care for all women, it is important for policymakers to understand the factors that influence their utilization and expenditures for medical care. Data collection, analysis, and reporting by race, ethnicity, and primary language across federally supported health programs are essential to help identify, understand the causes of, monitor, and eventually eliminate disparities.

  15. Health information exchange and healthcare utilization.

    PubMed

    Vest, Joshua R

    2009-06-01

    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.

  16. Health care utilization for musculoskeletal disorders.

    PubMed

    MacKay, Crystal; Canizares, Mayilee; Davis, Aileen M; Badley, Elizabeth M

    2010-02-01

    To examine patterns of ambulatory care and hospital utilization for people with musculoskeletal disorders (MSDs), including arthritis and related conditions, bone and spinal conditions, trauma and related conditions, and unspecified MSDs. Administrative data from the Ontario Health Insurance Plan database for ambulatory care physician visits, the National Ambulatory Care Reporting System database for day (outpatient) surgeries and emergency department visits, and the Discharge Abstract Database for hospital discharges were used to examine health care utilization for MSDs in fiscal year 2006-2007. Person visit rates (number of people with physician visits or hospital encounters per population) were calculated. Overall, 22.3% of Ontario's population (2.8 million persons) saw a physician for an MSD in ambulatory settings. Person visit rates were highest for arthritis and related conditions (107.7 per 1,000 population), followed by trauma and related conditions (89.6 per 1,000 population), unspecified MSDs (71.0 per 1,000 population), and bone and spinal conditions (62.4 per 1,000 population). The majority of visits were to primary care physicians, with 83.2% of those with visits for all MSDs seeing a primary care physician at least once. Overall, 33.0% of people with a physician visit for an MSD saw a specialist, with orthopedic surgeons being the most commonly consulted type of specialist. In hospital settings, person visit rates for MSDs were highest in the emergency department, followed by day surgeries and inpatient hospitalizations. The findings of our study highlight the magnitude of health care utilization for MSDs and the central role of primary care physicians in the management of these conditions.

  17. Time Preferences, Mental Health and Treatment Utilization.

    PubMed

    Eisenberg, Daniel; Druss, Benjamin G

    2015-09-01

    In all countries of the world, fewer than half of people with mental disorders receive treatment. This treatment gap is commonly attributed to factors such as consumers' limited knowledge, negative attitudes, and financial constraints. In the context of other health behaviors, such as diet and exercise, behavioral economists have emphasized time preferences and procrastination as additional barriers. These factors might also be relevant to mental health. We examine conceptually and empirically how lack of help-seeking for mental health conditions might be related to time preferences and procrastination. Our conceptual discussion explores how the interrelationships between time preferences and mental health treatment utilization could fit into basic microeconomic theory. The empirical analysis uses survey data of student populations from 12 colleges and universities in 2011 (the Healthy Minds Study, N=8,806). Using standard brief measures of discounting, procrastination, and mental health (depression and anxiety symptoms), we examine the conditional correlations between indicators of present-orientation (discount rate and procrastination) and mental health symptoms. The conceptual discussion reveals a number of potential relationships that would be useful to examine empirically. In the empirical analysis depression is significantly associated with procrastination and discounting. Treatment utilization is significantly associated with procrastination but not discounting. The empirical results are generally consistent with the idea that depression increases present orientation (reduces future orientation), as measured by discounting and procrastination. These analyses have notable limitations that will require further examination in future research: the measures are simple and brief, and the estimates may be biased from true causal effects because of omitted variables and reverse causality. There are several possibilities for future research, including: (i

  18. COMPARISON OF FIVE HEALTH-RELATED QUALITY-OF-LIFE INDEXES USING ITEM RESPONSE THEORY ANALYSIS

    PubMed Central

    Fryback, Dennis G.; Palta, Mari; Cherepanov, Dasha; Bolt, Daniel; Kim, Jee-Seon

    2009-01-01

    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

  19. Body Mass Index Trajectories and Healthcare Utilization in Young and Middle-aged Adults.

    PubMed

    Elrashidi, Muhamad Y; Jacobson, Debra J; St Sauver, Jennifer; Fan, Chun; Lynch, Brian A; Rutten, Lila J Finney; Ebbert, Jon O

    2016-01-01

    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.

  20. Marital Distress and Mental Health Care Service Utilization

    ERIC Educational Resources Information Center

    Schonbrun, Yael Chatav; Whisman, Mark A.

    2010-01-01

    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…

  1. Marital Distress and Mental Health Care Service Utilization

    ERIC Educational Resources Information Center

    Schonbrun, Yael Chatav; Whisman, Mark A.

    2010-01-01

    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…

  2. EPA's Environmental Quality Index Supports Public Health

    EPA Pesticide Factsheets

    The Environmental Quality Index (EQI) pulls data from five domains: air, water, land, built, and sociodemographic environments to provide a county-by-county snapshot of overall environmental quality across the entire U.S.

  3. 5 CFR 591.220 - How does OPM calculate energy utility cost indexes?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 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) OPM...

  4. 5 CFR 591.220 - How does OPM calculate energy utility cost indexes?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 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)...

  5. Horizontal inequity in public health care service utilization for non-communicable diseases in urban Vietnam

    PubMed Central

    Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Weinehall, Lars; Ng, Nawi

    2014-01-01

    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

  6. The Global Health Impact Index: Promoting Global Health

    PubMed Central

    Hassoun, Nicole

    2015-01-01

    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. PMID:26657064

  7. The Global Health Impact Index: Promoting Global Health.

    PubMed

    Hassoun, Nicole

    2015-01-01

    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.

  8. Omega-3 Index and Cardiovascular Health

    PubMed Central

    von Schacky, Clemens

    2014-01-01

    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

  9. Health utilities for chronic low back pain.

    PubMed

    Seidler, Anna Lene; Rethberg, Constanze; Schmitt, Jochen; Nienhaus, Albert; Seidler, Andreas

    2017-01-01

    Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means "prefer to die immediately", a value of 1 means "not willing to trade any life time". The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23-1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24-1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address

  10. Index of health development: conceptualization and reflections on its need.

    PubMed

    Andrade, Edson de Oliveira; Gouveia, Valdiney V; D'Ávila, Roberto Luiz; Carneiro, Mauro Brandão; Massud, Munir; Gallo, José Hiran

    2012-01-01

    This article aimed to review the concept of social indices by focusing on their practical use and need in the health setting. For this purpose, the initial consideration was how these indices are defined, their possible use, and the importance they have as a means of depicting the real world. Thus, a wide concept of health, consistent with the current view, was adopted. Health was further described within international and national settings, emphasizing indicators that can be employed to estimate health problems in the population were highlighted. Finally, as no specific social index describing health in a Brazilian setting has been developed, the need to rely on the Health Development Index was indicated. This index will serve as a tool for managers, inspection agents, and the general population to follow-up the developments reached and the shortcomings that should be addressed to ensure a better health status for the majority of the population.

  11. Data Sources for an Environmental Quality Index: Availability, Quality, and Utility

    PubMed Central

    Rappazzo, Kristen; Messer, Lynne C.

    2011-01-01

    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

  12. Design of the national health security preparedness index.

    PubMed

    Uzun Jacobson, Evin; Inglesby, Tom; Khan, Ali S; Rajotte, James C; Burhans, Robert L; Slemp, Catherine C; Links, Jonathan M

    2014-01-01

    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.

  13. Relationship between adequacy of prenatal care utilization index and pregnancy outcomes.

    PubMed

    Tayebi, Tahereh; Zahrani, Shahnaz Turk; Mohammadpour, Rezaali

    2013-09-01

    Prenatal care is a comprehensive antepartum care program involving a coordinated approach to medical care and psychosocial support that is optimally offered before conception. Inadequate care during pregnancy can lead to undesirable outcomes, including preterm labor and low birth weight. One of these new, accurate, and comprehensive indicator measurements is adequacy of prenatal care utilization index. This study aimed to assess the adequacy of care and its relationship with preterm labor and low birth weight. This analytic historical cohort study was performed on 420 mothers who referred to health centers in Sari during 2010. Data were collected by interviews and questionnaires. Based on the adequacy of prenatal care utilization, this care was classified into four groups: intensive, adequate, intermediate, and inadequate. Data were analyzed using chi-square test, analysis of variance (ANOVA), Spearman correlation coefficient, and relative risk (RR). Of the 420 mothers who were studied, inadequate care was observed in 151 (36%) cases, which was the highest percentage of care. There was a significant relationship between the adequacy of prenatal care utilization and preterm labor and low birth weight (for both P < 0.05). Performing inadequate care, the rate of preterm labor was RR = 1.36 times and the rate of low birth weight was RR = 1.08 times more than in adequate and intensive care. According to the programs that reduced the number of referrals of pregnant mothers (standardization protocol for mothers in Iran), this study confirms the efficacy of adequacy of prenatal care on reducing preterm labor and low birth weight. This study emphasizes on minimum care performance and the importance of conducting further studies to assess the relationship between quantities of care and other outcomes.

  14. Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh.

    PubMed

    Haider, Mohammad Rifat; Rahman, Mohammad Masudur; Moinuddin, Md; Rahman, Ahmed Ehsanur; Ahmed, Shakil; Khan, M Mahmud

    2017-01-01

    Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups

  15. Aging, social capital, and health care utilization in Canada.

    PubMed

    Laporte, Audrey; Nauenberg, Eric; Shen, Leilei

    2008-10-01

    This paper examines relationships between aging, social capital, and healthcare utilization. Cross-sectional data from the 2001 Canadian Community Health Survey and the Canadian Census are used to estimate a two-part model for both GP physicians (visits) and hospitalization (annual nights) focusing on the impact of community- (CSC) and individual-level social capital (ISC). Quantile regressions were also performed for GP visits. CSC is measured using the Petris Social Capital Index (PSCI) based on employment levels in religious and community-based organizations [NAICS 813XX] and ISC is based on self-reported connectedness to community. A higher CSC/lower ISC is associated with a lower propensity for GP visits/higher propensity for hospital utilization among seniors. The part-two (intensity model) results indicated that a one standard deviation increase (0.13%) in the PSCI index leads to an overall 5% decrease in GP visits and an annual offset in Canada of approximately $225 M. The ISC impact was smaller; however, neither measure was significant in the hospital intensity models. ISC mainly impacted the lower quantiles in which there was a positive association with GP utilization, while the impact of CSC was strongest in the middle quantiles. Each form of social capital likely operates through a different mechanism: ISC perhaps serves an enabling role by improving access (e.g. transportation services), while CSC serves to obviate some physician visits that may involve counseling/caring services most important to seniors. Policy implications of these results are discussed herein.

  16. Cost Sharing, Health Care Expenditures, and Utilization: An International Comparison.

    PubMed

    Perkowski, Patryk; Rodberg, Leonard

    2016-01-01

    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. © The Author(s) 2015.

  17. Does the small fit them all? The utility of Disabkids-10 Index for the assessment of pediatric health-related quality of life across age-groups, genders, and informants.

    PubMed

    Carona, Carlos; Silva, Neuza; Moreira, Helena; Canavarro, Maria Cristina; Bullinger, Monika

    2015-12-01

    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.

  18. Environmental Quality Index and Childhood Mental Health

    EPA Science Inventory

    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...

  19. Environmental Quality Index and Childhood Mental Health

    EPA Science Inventory

    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...

  20. Construction of an environmental quality index for public health research

    PubMed Central

    2014-01-01

    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

  1. Construction of an environmental quality index for public health research.

    PubMed

    Messer, Lynne C; Jagai, Jyotsna S; Rappazzo, Kristen M; Lobdell, Danelle T

    2014-05-22

    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: 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. 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). 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 exposed and domain-specific EQI loadings indicate

  2. [Assessing forest ecosystem health I. Model, method, and index system].

    PubMed

    Chen, Gao; Dai, Limin; Ji, Lanzhu; Deng, Hongbing; Hao, Zhanqing; Wang, Qingli

    2004-10-01

    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.

  3. Depression, social factors, and farmworker health care utilization.

    PubMed

    Georges, A; Alterman, T; Gabbard, S; Grzywacz, J G; Shen, R; Nakamoto, J; Carroll, D J; Muntaner, C

    2013-08-01

    Farmworkers frequently live in rural areas and experience high rates of depressive symptoms. This study examines the association between elevated depressive symptoms and health care utilization among Latino farmworkers. Data were obtained from 2,905 Latino farmworkers interviewed for the National Agricultural Workers Survey. Elevated depressive symptoms were measured using the Center for Epidemiologic Studies Depression short-form. A dichotomous health care utilization variable was constructed from self-reported use of health care services in the United States. A categorical measure of provider type was constructed for those reporting use of health care. Over 50% of farmworkers reported at least 1 health care visit in the United States during the past 2 years; most visits occurred in a private practice. The odds of reporting health care utilization in the United States were 45% higher among farmworkers with elevated depressive symptoms. Type of provider was not associated with depressive symptoms. Women were more likely to seek health care; education and family relationships were associated with health care utilization. Latino farmworkers who live and work in rural areas seek care from private practices or migrant/Community Health Clinics. Farmworkers with elevated depressive symptoms are more likely to access health care. Rural health care providers need to be prepared to recognize, screen, and treat mental health problems among Latino farmworkers. Outreach focused on protecting farmworker mental health may be useful in reducing health care utilization while improving farmworker quality of life. © 2013 National Rural Health Association.

  4. Medline and Index Medicus for the Health Science Librarian.

    ERIC Educational Resources Information Center

    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…

  5. Child Health USA 2013: Prenatal Care Utilization

    MedlinePlus

    ... 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 ...

  6. 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.

    PubMed

    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

    2016-04-01

    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.

  7. Community Priority Index: Utility, Applicability and Validation for Priority Setting in Community-Based Participatory Research

    PubMed Central

    Salihu, Hamisu M.; Salinas-Miranda, Abraham A.; Wang, Wei; Turner, DeAnne; Berry, Estrellita Lo; Zoorob, Roger

    2015-01-01

    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

  8. Community Priority Index: Utility, Applicability and Validation for Priority Setting in Community-Based Participatory Research.

    PubMed

    Salihu, Hamisu M; Salinas-Miranda, Abraham A; Wang, Wei; Turner, DeAnne; Berry, Estrellita Lo; Zoorob, Roger

    2015-07-16

    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. 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. 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). This study demonstrates the applicability of the CPI as a simple and intuitive measure for priority setting in CBPR. Significance for public healthCommunity-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 setting is an essential decision-making step in

  9. Methods for comparing drug policies--the utility of composite drug harm indexes.

    PubMed

    Ritter, Alison

    2009-11-01

    One of the challenges for drug policy research is being able to compare policy options and outcomes. The development of indexes, such as the UK Drug Harm Index or the UNODC Illicit Drug Index is a way to systematically enable such comparisons. An Index is a single common metric that represents the diverse outcomes or consequences of drug use. An Index may be used for performance monitoring within one country/region over time; to establish societal benefit of drug policies as expressed in social costs saved; to compare countries or regions; or for comparative policy analysis. Clarity of purpose is important in how an Index is used. The consequences or outcomes that can be combined into a single Index include health consequences, crime consequences, public amenity, pain and suffering, labour market outcomes, and drug manufacture and trafficking activity. The choice of outcomes for inclusion is driven by the purpose but also often by practical considerations, such as data availability. The weighting of the consequences is an important consideration in translating the outcomes into a common metric. A monetary unit has a number of advantages: it is a unit that can be measured across diverse impacts; it gives implicit "weighting" of harms; and it is intuitive for policy makers and community. On the other hand, it represents an economic perspective. No one Index will be regarded as suitable and appropriate by every stakeholder and ongoing research effort on Indexes is an important foundational research activity to advance illicit drug policy.

  10. Wealth index and maternal health care: Revisiting NFHS-3.

    PubMed

    Goel, Manish Kr; Roy, Pritam; Rasania, Sanjeev Kumar; Roy, Sakhi; Kumar, Yogesh; Kumar, Arun

    2015-01-01

    The third National Family Health Survey (NFHS-3) is a large dataset on indicators of family welfare, maternal and child health, and nutrition in India. This article using NFHS-3 data is an attempt to bring out the impact of economic status, i.e., the wealth index on maternal health. The study was based on an analysis of the NFHS-3 data. Independent variables taken were the wealth index, literacy, and age at first child birth. Effects of these variables on the maternal health care services were investigated. Out of the total 124,385 women aged 15-49 years included in the NFHS-3 dataset, 36,850 (29.6%) had one or more childbirth during the past 5 years. The number of antenatal care (ANC) visits increased as the wealth index increased and there was a pattern for choice of place of delivery (for all deliveries during the last 5 years) according to the wealth index. Logistic regression analysis of the abovementioned variables were sought to find out the independent role of key determinants of the different aspects of maternal health care. It showed that the wealth index is the leading key independent determinant for three or more ANC received: Tetanus toxoid (TT) received before delivery, iron tablet/syrup taken for more than 100 days, and institutional delivery. Mother's literacy was the leading independent key determinant for early antenatal registration. The study suggested that along with the mother's literacy, the wealth index that is an important predictor of maternal health care can be added for categorization of the districts for providing differential approach for maternal health care services.

  11. Horizontal Inequity in Elderly Health Care Utilization: Evidence from India

    PubMed Central

    Rudra, Shalini; Subramanian, S V

    2015-01-01

    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

  12. Assimilation and health service utilization of Korean immigrant women.

    PubMed

    Son, Juyeon

    2013-11-01

    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.

  13. Mental health service utilization among the Arabs in Israel.

    PubMed

    Al-Krenawi, Alean

    2002-01-01

    National hospitalization records (1995, 1986, N = 15,698) reveal that Arab women utilize psychiatric services less than Arab men. The exact reverse occurs among Jewish patients. Moreover, Arab patients significantly underutilize mental health services, compared to Jewish patients. Possible reasons for these utilization patterns include: Arab health care utilization patterns in general; the availability of mental health services in Arab communities; the influence of the "cultural" over the "professional" in Arab mental health utilization; the lack of Arab mental health practitioners; Arab attitudes towards mental health; and gendered role constructions within Arab society. Findings emphasize the need for a policy of developing infrastructure and trained personnel that can provide services adapted to the special cultural characteristics of the Arab population.

  14. Optimal vortex formation as an index of cardiac health.

    PubMed

    Gharib, Morteza; Rambod, Edmond; Kheradvar, Arash; Sahn, David J; Dabiri, John O

    2006-04-18

    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.

  15. [Nanoparticles: structures, utilizations and health impacts].

    PubMed

    Prosie, Florin; Lesage, François-Xavier; Deschamps, Frédéric

    2008-10-01

    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.

  16. Agricultural chemical utilization and human health.

    PubMed Central

    Mushak, E W; Piver, W T

    1992-01-01

    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

  17. Health literacy and health care spending and utilization in a consumer-driven health plan.

    PubMed

    Hardie, Nancy A; Kyanko, Kelly; Busch, Susan; Losasso, Anthony T; Levin, Regina A

    2011-01-01

    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.

  18. Mental Health Utilization Among Diverse Parenting Young Couples

    PubMed Central

    Angley, Meghan; Gibson, Crystal; Sipsma, Heather; Kershaw, Trace

    2016-01-01

    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

  19. Managing water utility financial risks through third-party index insurance contracts

    NASA Astrophysics Data System (ADS)

    Zeff, Harrison B.; Characklis, Gregory W.

    2013-08-01

    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.

  20. Utilizing education infrastructure for primary health care.

    PubMed

    Hope, R; Carter, C A; Rai, I M

    1988-01-01

    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.

  1. Developing a risk-based air quality health index

    NASA Astrophysics Data System (ADS)

    Wong, Tze Wai; Tam, Wilson Wai San; Yu, Ignatius Tak Sun; Lau, Alexis Kai Hon; Pang, Sik Wing; Wong, Andromeda H. S.

    2013-09-01

    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.

  2. High Performance Optical Coatings Utilizing Tailored Refractive Index Nanoporous Thin Films

    NASA Astrophysics Data System (ADS)

    Poxson, David J.

    Refractive index is perhaps the most important quantity in optics. It is particularly relevant in the field of optical coatings, where the refractive index appears in virtually every optics equation as a figure of merit. Recently it has been demonstrated through control of the deposition angle during oblique-angle electron-beam deposition, nanoporous films of virtually any desired porosity may be accurately deposited. As the porosity of a nanoporous film directly relates to its effective refractive index, the refractive index value of a film may be tailored to any value between that of the bulk material and close to that of air. These two characteristics, namely; (i) tailored-refractive index and (ii) very low-refractive index values close to that of air, offer significant advantages in the design and optical performance in all optical coating applications. In this dissertation we explore optical coating applications whose performance can be greatly enhanced by utilization of a tailored- and low-refractive index nanoporous material system. One such important application is in the design and fabrication of broadband, omnidirectional antireflection (AR) coatings on solar cell devices. To harness the full spectrum of solar energy, Fresnel reflections at the surface of a photovoltaic cell must be reduced as much as possible over the relevant solar wavelength range and over a wide range of incident angles. However, the development of AR coatings embodying omni-directionality over a wide range of wavelengths is challenging. By utilizing the tailored- and low-refractive index properties of the nanoporous material system, in conjunction with a computational genetic algorithm and a predictive quantitative model for the porosity of such nanoporous films, truly optimized AR coatings can be designed and fabricated on solar cells. Here we show that these optimized AR structures demonstrate significant improvement to overall device efficiency. Traditionally, nanoporous films

  3. Construction of an environmental quality index for public health research

    EPA Science Inventory

    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...

  4. Development of the Geriatric Oral Health Assessment Index.

    ERIC Educational Resources Information Center

    Atchison, Kathryn A.; Dolan, Teresa A.

    1990-01-01

    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.…

  5. Construction of an environmental quality index for public health research

    EPA Science Inventory

    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...

  6. Development of the Geriatric Oral Health Assessment Index.

    ERIC Educational Resources Information Center

    Atchison, Kathryn A.; Dolan, Teresa A.

    1990-01-01

    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.…

  7. Health utilities in people with chronic pain using a population-level survey and linked health care administrative data.

    PubMed

    Hogan, Mary-Ellen; Taddio, Anna; Katz, Joel; Shah, Vibhuti; Krahn, Murray

    2017-03-01

    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.

  8. Separate and Cumulative Effects of Adverse Childhood Experiences in Predicting Adult Health and Health Care Utilization

    ERIC Educational Resources Information Center

    Chartier, Mariette J.; Walker, John R.; Naimark, Barbara

    2010-01-01

    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:…

  9. Separate and Cumulative Effects of Adverse Childhood Experiences in Predicting Adult Health and Health Care Utilization

    ERIC Educational Resources Information Center

    Chartier, Mariette J.; Walker, John R.; Naimark, Barbara

    2010-01-01

    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:…

  10. A flexible urban health index for small area disparities.

    PubMed

    Rothenberg, Richard; Weaver, Scott R; Dai, Dajun; Stauber, Christine; Prasad, Amit; Kano, Megumi

    2014-10-01

    Available urban health metrics focus primarily on large area rankings. Less has been done to develop an index that provides information about level of health and health disparities for small geographic areas. Adopting a method used by the Human Development Index, we standardized indicators for small area units on a (0, 1) interval and combined them using their geometric mean to form an Urban Health Index (UHI). Disparities were assessed using the ratio of the highest to lowest decile and measurement of the slope of the eight middle deciles (middle; 80 %) of the data. We examined the sensitivity of the measure to weighting, to changes in the method, to correlation among indicators, and to substitution of indicators. Using seven health determinants and applying these methods to the 128 census tracts in the city of Atlanta, USA, we found a disparity ratio of 5.92 and a disparity slope of 0.54, suggesting substantial inequality and heterogeneity of risk. The component indicators were highly correlated; their systematic removal had a small effect on the results. Except in extreme cases, weighting had a little effect on the rankings. A map of Atlanta census tracts exposed a swath of high disparity. UHI rankings, ratio, and slope were resistant to alteration in composition and to non-extreme weighting schemes. This empirical evaluation was limited to a single realization, but suggests that a flexible tool, whose method rather than content is standardized, may be of use for local evaluation, for decision making, and for area comparison.

  11. Determinants of maternal health services utilization in Uganda.

    PubMed

    Rutaremwa, Gideon; Wandera, Stephen Ojiambo; Jhamba, Tapiwa; Akiror, Edith; Kiconco, Angela

    2015-07-17

    Uganda's poor maternal health indicators have resulted from weak maternal health services delivery, including access to quality family planning, skilled birth attendance, emergency obstetric care, and postnatal care for mothers and newborns. This paper investigated the predictors of maternal health services (MHS) utilization characterized as: desirable, moderate and undesirable. We used a sample of 1728 women of reproductive ages (15-49), who delivered a child a year prior to the 2011 UDHS survey. A multinomial logistic regression model was used to analyze the relative contribution of the various predictors of ideal maternal health services package utilization. Andersen's Behavioral Model of Health Services Utilization guided the selection of covariates in the regression model. Women with secondary and higher education were more likely to utilize the desirable maternal health care package (RRR = 4.5; 95% CI = 1.5-14.0), compared to those who had none (reference = undesirable MHS package). Women who lived in regions outside Kampala, Uganda's capital, were less likely to utilize the desirable package of maternal health services (Eastern--RRR = 0.2, CI = 0.1-0.5; Western--RRR = 0.3, CI = 0.1-0.8; Central--RRR = 0.3, CI = 0.1-0.8; Northern--RRR = 0.4, CI = 0.2-1.0). Women from the richest households were more likely to utilize the desirable maternal health services package (RRR = 1.9; 95% CI = 1.0-3.7). Residence in rural areas, being Moslem and being married reduced a woman's chances of utilizing moderate maternal health care services. Utilization of maternal health services varied greatly by demographic and socio-economic characteristics. Women with a secondary and higher education, and those of higher income levels, were more likely to utilize the ideal maternal health services package. Therefore, there is need to formulate policies and design maternal health services programs that target the socially marginalized

  12. Developing Valid and Reliable Health Utilities in Irritable Bowel Syndrome: Results From the IBS PROOF Cohort

    PubMed Central

    Spiegel, Brennan; Harris, Lucinda; Lucak, Susan; Mayer, Emeran; Naliboff, Bruce; Bolus, Roger; Esrailian, Eric; Chey, William D.; Lembo, Anthony; Karsan, Hetal; Tillisch, Kirsten; Dulai, Gareth; Talley, Jennifer; Chang, Lin

    2013-01-01

    OBJECTIVES A “utility” is a measure of health-related quality of life (HRQOL) that ranges between 0 (death) and 1 (perfect health). Disease-targeted utilities are mandatory to conduct cost–utility analyses. Given the economic and healthcare burden of irritable bowel syndrome (IBS), cost–utility analyses will play an important role in guiding health economic decision-making. To inform future cost–utility analyses in IBS, we measured and validated the IBS utilities. METHODS We analyzed data from Rome III IBS patients in the Patient Reported Observed Outcomes and Function (PROOF) Cohort—a longitudinal multi-center IBS registry. At entry, the patients completed a multi-attribute utility instrument (EuroQOL), bowel symptom items, IBS severity measurements (IBS Severity Scale (IBSSS), Functional Bowel Disease Severity Index (FBDSI)), HRQOL indexes (IBS quality-of-life instrument (IBS-QOL), Center for disease control-4 (CDC-4)), and the Worker Productivity Activity Index for IBS (WPAI). We repeated assessments at 3 months. RESULTS There were 257 patients (79% women; age = 43±15 years) at baseline and 85 at 3 months. The mean utilities in patients with severe vs. non-severe IBS were 0.70 and 0.80, respectively (P < 0.001). There were no differences in utilities among IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), and mixed IBS (IBS-M) subgroups. EuroQOL utilities correlated with FBDSI (r = 0.31; P < 0.01), IBSSS (r = 0.36; P < 0.01), IBS-QOL (r = 0.36; P < 0.01), CDC-4 (r = 0.44; P < 0.01), WPAI presenteeism (r = 0.16; P < 0.01), abdominal pain (r = 0.43; P < 0.01), and distension (r = 0.18; P = 0.01). The utilities in patients reporting “considerable relief” of symptoms at 3 months vs. those without considerable relief were 0.78 and 0.73, respectively (P = 0.02). CONCLUSIONS EuroQOL utilities are valid and reliable in IBS. The utility of severe IBS (0.7) is similar to Class III congestive heart failure and rheumatoid arthritis. These validated

  13. Building knowledge about health services utilization by refugees.

    PubMed

    Kiss, Valerie; Pim, Carolyn; Hemmelgarn, Brenda R; Quan, Hude

    2013-02-01

    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.

  14. A Technology of Health Manpower Utilization: Uniform Measurement and Evaluation.

    ERIC Educational Resources Information Center

    National Institutes of Health (DHEW), Bethesda, MD. Bureau of Health Manpower Education.

    This annotated bibliography documenting the range of recent studies of manpower utilization is intended to stimulate qualified investigators to begin a systematic, technologically sound ordering of human manpower and skills in the health field. To correct the existing inefficient distribution of manpower in the health industry, more appropriate…

  15. Valve Health Monitoring System Utilizing Smart Instrumentation

    NASA Technical Reports Server (NTRS)

    Jensen, Scott L.; Drouant, George J.

    2006-01-01

    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

  16. Multilevel analysis of health care service utilization among medical aid beneficiaries in Korea.

    PubMed

    Ahn, Yang Heui; Ham, Ok Kyung; Kim, Soo Hyun; Park, Chang Gi

    2012-12-01

    The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

  17. Predictors of Healthcare Service Utilization for Mental Health Reasons

    PubMed Central

    Fleury, Marie-Josée; Ngamini Ngui, André; Bamvita, Jean-Marie; Grenier, Guy; Caron, Jean

    2014-01-01

    This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care. PMID:25321874

  18. Community perceptions and utilization of a consumer health center*

    PubMed Central

    Ports, Katie A.; Ayers, Antoinette; Crocker, Wayne; Hart, Alton; Mosavel, Maghboeba; Rafie, Carlin

    2015-01-01

    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

  19. Valve health monitoring system utilizing smart instrumentation

    NASA Astrophysics Data System (ADS)

    Jensen, Scott L.; Drouant, George J.

    2006-05-01

    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, outlet 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 Commissions requirements and are limited to a 35 foot transmission radius for preserving data security. The base-station controller correlates related 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.

  20. Impact of a Value-based Formulary on Medication Utilization, Health Services Utilization, and Expenditures.

    PubMed

    Yeung, Kai; Basu, Anirban; Hansen, Ryan N; Watkins, John B; Sullivan, Sean D

    2017-02-01

    Value-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a value-based formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments. The objective of the study was to determine the impact of the VBF. Interrupted time series of employer-sponsored plans from 2006 to 2013. Intervention group: 5235 beneficiaries exposed to the VBF. 11,171 beneficiaries in plans without any changes in pharmacy benefits. The VBF-assigned medications with lower value (estimated by CEA) to higher copayment tiers and assigned medications with higher value to lower copayment tiers. Primary outcome was medication expenditures from member, health plan, and member plus health plan perspectives. Secondary outcomes were medication utilization, emergency department visits, hospitalizations, office visits, and nonmedication expenditures. In the intervention group after VBF implementation, member medication expenditures increased by $2 per member per month (PMPM) [95% confidence interval (CI), $1-$3] or 9%, whereas health plan medication expenditures decreased by $10 PMPM (CI, $18-$2) or 16%, resulting in a net decrease of $8 PMPM (CI, $15-$2) or 10%, which translates to a net savings of $1.1 million. Utilization of medications moved into lower copayment tiers increased by 1.95 days' supply (CI, 1.29-2.62) or 17%. Total medication utilization, health services utilization, and nonmedication expenditures did not change. Cost-sharing informed by CEA reduced overall medication expenditures without negatively impacting medication utilization, health services utilization, or nonmedication expenditures.

  1. Marriage, bereavement and mortality: the role of health care utilization.

    PubMed

    Simeonova, Emilia

    2013-01-01

    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.

  2. Exploring Lab Tests Over Utilization Patterns Using Health Analytics Methods.

    PubMed

    Khalifa, Mohamed; Zabani, Ibrahim; Khalid, Parwaiz

    2016-01-01

    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.

  3. The importance of establishing a national health security preparedness index.

    PubMed

    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

    2013-03-01

    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).

  4. [Investigation of health literacy and enterprise provided health service utilization among migrants in construction site].

    PubMed

    Jiang, Ying; Zeng, Qingqi; Ji, Ying; Wang, Yanling; Zheng, Yunting; Chang, Chun

    2015-01-01

    To investigate health literacy and enterprise provided health service utilization among migrants in construction sites and explore the influencing factors of enterprise provided health service utilization. All 652 migrants in 10 construction sites in Xi'an and Tongchuan were selected using stratified cluster sampling method, and health literacy level, occupational health awareness and enterprise provided health service utilization of migrants were investigated in 2013 April to June.Score and pass rate was used to describe status of health literacy and occupational health awareness of migrants. Chi-square was used to analyze the difference of occupational health awareness and enterprise provided health service utilization between migrants of different levels of health literacy. And logistic regression was used to analyze the influencing factors of enterprise provided health service utilization. Average score of health literacy among migrants in construction site was (3.75 ± 2.17) (9 score totally). Migrants who knew enterprise should provide health training, physical examination, safety training, occupational protection and pay health insurance for workers accounted for 28.2% (174/616), 43.5% (268/616), 52.8% (325/616), 54.9% (338/616) and 37.7% (230/616) respectively, and the percentage of migrants who thought there were noise and dust in their working environment were 46.4% (201/627) and 44.8% (281/627) respectively.61.1% (373/610) received none of health training, occupational training, physical examination and first-aid kit, and only 0.8% (5/610) had utilized all of the above health service in workplace. And logistic regression showed that migrants whose health literacy score was higher than 5 had 1.819 times probability to utilize enterprise provided health service (OR = 1.82, 95%CI:1.13-2.92) , and migrants who were educated for more than 13 years had 3.812 times probability to utilize enterprise provided health service than those who were educated for less

  5. Heart failure in primary care: co-morbidity and utilization of health care resources.

    PubMed

    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

    2013-10-01

    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. To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. 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. 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). 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.

  6. Heart failure in primary care: co-morbidity and utilization of health care resources

    PubMed Central

    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

    2013-01-01

    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

  7. Characteristics utilization of public space in Padang City based on good public space index

    NASA Astrophysics Data System (ADS)

    Eriawan, T.

    2017-06-01

    Padang is a metropolitan city which has 40 units of open space like plansum park, playground, and sports park with 10,88 hectar of total area. These open spaces are publics’, but not all of them are able to use as active public open spaces it caused by some of the parks are dormant parks beacuse they only for planted ground not for public activites.This study conducted to assess the quality of public space that exsist in Padang; Imam Bonjol park (representing of city open space (go-green)), H. Agus Salim sport center ( representing of sports park) and Pantai Muaro Padang area (representing of recreation/tourism).The method of this research conducted in several stages, first was the identification toward space’s function (Carmona,2008) and assess the space utilization index based approach to public space index (Metha,2007). The spaced quality is measured based on variable in Good Public Space Index which is the intensity of use, social activities, duration of activities, variation and pattern of use. The urgency of this research related to the effort to evaluate the policy of space arrangement and space control through the assessment of the use of existed spaces, until it can be references to Padang goverment in improving and increasing the quality of space thorugh development of spaces that have high quality.The assesment of quality of public open spaces in Padang conducted by assessed five space quality variables, result of analysis, utilization of public space was 0.69. based on the result it can be concluded the quality of public space in some parks in Padang has moderate index quality. This is caused by the time differentiation of the society, there is no interaction among society, and short time duration of the society in visiting the public space.

  8. A Regional-Scale Ocean Health Index for Brazil

    PubMed Central

    Elfes, Cristiane T.; Longo, Catherine; Halpern, Benjamin S.; Hardy, Darren; Scarborough, Courtney; Best, Benjamin D.; Pinheiro, Tiago; Dutra, Guilherme F.

    2014-01-01

    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

  9. ADHD and Health Services Utilization in the National Health Interview Survey

    ERIC Educational Resources Information Center

    Cuffe, Steven P.; Moore, Charity G.; McKeown, Robert

    2009-01-01

    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…

  10. ADHD and Health Services Utilization in the National Health Interview Survey

    ERIC Educational Resources Information Center

    Cuffe, Steven P.; Moore, Charity G.; McKeown, Robert

    2009-01-01

    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…

  11. [Health expenditures, income inequality, and the marginalization index in Mexico's health system].

    PubMed

    Pinzón Florez, Carlos Eduardo; Reveiz, Ludovic; Idrovo, Alvaro J; Reyes Morales, Hortensia

    2014-01-01

    Evaluate the effect of the relationship among public health expenditures, income inequality, and the marginalization index on maternal and child mortality in Mexico, to determine the effect of these factors on health system performance from a technical efficiency perspective. An ecological study of 32 Mexican states. Correlations were estimated between maternal and infant mortality and public health expenditures in total per capita, federal per capita, and state per capita for the years 2000, 2005, and 2010 (Gini coefficient and marginalization index). Linear regressions were used to explore the association of these variables with health indicators in the state systems. Negative correlations were observed for the marginalization index and Gini coefficient with regard to life expectancy at birth (-0.62 and -0.28 respectively). Furthermore, there was a positive correlation of 0.59 between the marginalization index and infant mortality (P <0.05). Multiple linear regression models revealed a negative effect of the marginalization index and Gini coefficient on health out-comes. Federal funding had a positive effect on system performance in terms of health indicators. Health system reform in Mexico has had a positive impact on the country's health indicators; federal financial investment seems to be effective in this regard. Social determinants have an important effect on health system performance, and analysis using multisectoral and multidisciplinary approaches are needed in addressing them.

  12. Chronicity of Voice-Related Health Care Utilization in the General Medicine Community.

    PubMed

    Cohen, Seth M; Lee, Hui-Jie; Roy, Nelson; Misono, Stephanie

    2017-04-01

    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.

  13. Determinants of health care utilization by immigrants in Portugal.

    PubMed

    Dias, Sónia F; Severo, Milton; Barros, Henrique

    2008-10-07

    The increasing diversity of population in European Countries poses new challenges to national health systems. There is a lack of data on accessibility and use of health care services by migrants, appropriateness of the care provided, client satisfaction and problems experienced when confronting the health care system. This limits knowledge about the multiple determinants of the utilization of health services. The aim of this study was to describe the access of migrants to health care and its determinants in Portugal. The study sample included 1513 immigrants (53% men), interviewed at the National Immigrant Support Centre, in Lisbon. Data were collected using questionnaires. The magnitude of associations between use of National Health Service and socio-demographic variables was estimated by means of odds ratios (OR) at 95% confidence intervals, calculated using logistic regression. Among participants, 3.6% stated not knowing where to go if facing a health problem. Approximately 20% of the respondents reported that they had never used the National Health Service, men more than women. Among National Health Service users, 35.6% attended Health Centres, 12% used Hospital services, and 54.4% used both. Among the participants that ever used the health services, 22.4% reported to be unsatisfied or very unsatisfied. After adjusting for all variables, utilization of health services, among immigrant men, remained significantly associated with length of stay, legal status, and country of origin. Among immigrant women, the use of health services was significantly associated with length of stay and country of origin. There is a clear need to better understand how to ensure access to health care services and to deliver appropriate care to immigrants, and that special consideration must be given to recent and undocumented migrants. To increase health services use, and the uptake of prevention programs, barriers must be identified and approaches to remove them developed, through

  14. Immigrant-based Disparities in Mental Health Care Utilization

    PubMed Central

    Bauldry, Shawn; Szaflarski, Magdalena

    2017-01-01

    Studies of immigrant-based disparities in mental health care have been limited by small sample sizes and a lack of measures of different dimensions of acculturation. This study draws on the National Epidemiological Survey on Alcohol and Related Conditions to address these limitations. Results indicate first-generation immigrants have lower rates of utilization for both mood and anxiety disorders. Nativity-based disparities in treatment are particularly notable among people from African and Hispanic origins, while there is little evidence of disparities among people from European origins. Of three dimensions of acculturation, only the identity dimension has a positive association with mental health care utilization. PMID:28845455

  15. Evidence for potential bias in the Health and Activity Limitation Index as a health preference measure for persons with disabilities.

    PubMed

    Boslaugh, Sarah E; Andresen, Elena M; Recktenwald, Angela; Gillespie, Kathleen

    2009-01-01

    The American public health plan Healthy People 2010 sets overall goals based on utility-linked information from the Health and Activity Limitation Index (HALex). However, little is known about how utilities measured by the HALex compare with those from established gold standard preference-based utility measures. In addition, distribution of HALex values from the general population underrepresents the experience of persons with disability, leading to uncertain interpretation of their utility values. Therefore, we sought to report the validity and interpretation of HALex scores compared to scores from a preference-based health-related quality of life measure, the Quality of Well-Being (QWB) scale. A telephone survey with component measures was administered in random order. Participants consisted of 401 adults from a large Midwest metropolitan area: 302 were selected by random-digit-dial methodology and 99 were volunteers with mobility impairment extending the disability values of the sample. Multiple regression analysis predicted HALex scores from QWB scores and from demographic and self-reported health characteristics. QWB scores accounted for 41% of the variance in HALex scores. The addition of five demographic and health factors increased the variance explained to 63%. Scores on the QWB and HALex were similar on mid-range values and discrepant at the extremes; that is, persons with extreme HALex scores tended to have more moderate QWB scores. HALex scores were higher for white adults than predicted by their QWB scores and lower for people with chronic diseases and disabilities. Utilities as measured by the HALex and QWB can differ markedly, particularly if the person is classified at either end of the spectrum of function. Of similar concern is that fact that HALex scores show a systematic bias in relationship to QWB scores depending on a person's demographic and health-related characteristics.

  16. Deriving health utilities from the MacNew Heart Disease Quality of Life Questionnaire.

    PubMed

    Chen, Gang; McKie, John; Khan, Munir A; Richardson, Jeff R

    2015-10-01

    Quality of life is included in the economic evaluation of health services by measuring the preference for health states, i.e. health state utilities. However, most intervention studies include a disease-specific, not a utility, instrument. Consequently, there has been increasing use of statistical mapping algorithms which permit utilities to be estimated from a disease-specific instrument. The present paper provides such algorithms between the MacNew Heart Disease Quality of Life Questionnaire (MacNew) instrument and six multi-attribute utility (MAU) instruments, the Euroqol (EQ-5D), the Short Form 6D (SF-6D), the Health Utilities Index (HUI) 3, the Quality of Wellbeing (QWB), the 15D (15 Dimension) and the Assessment of Quality of Life (AQoL-8D). Heart disease patients and members of the healthy public were recruited from six countries. Non-parametric rank tests were used to compare subgroup utilities and MacNew scores. Mapping algorithms were estimated using three separate statistical techniques. Mapping algorithms achieved a high degree of precision. Based on the mean absolute error and the intra class correlation the preferred mapping is MacNew into SF-6D or 15D. Using the R squared statistic the preferred mapping is MacNew into AQoL-8D. The algorithms reported in this paper enable MacNew data to be mapped into utilities predicted from any of six instruments. This permits studies which have included the MacNew to be used in cost utility analyses which, in turn, allows the comparison of services with interventions across the health system. © The European Society of Cardiology 2014.

  17. Effect of laparoscopic surgery on health care utilization and costs in patients who undergo colectomy.

    PubMed

    Crawshaw, Benjamin P; Chien, Hung-Lun; Augestad, Knut M; Delaney, Conor P

    2015-05-01

    Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated. To evaluate the effect of laparoscopic vs open colectomy on short- and long-term health care utilization and costs. Retrospective multivariate regression analysis of national health insurance claims data was used to evaluate health care utilization and costs up to 1 year following elective colectomy. Data were obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Patients aged 18 to 64 years who underwent elective laparoscopic or open colectomy from January 1, 2010, through December 31, 2010, were included. Patients with complex diagnoses that require increased non-surgery-related health care utilization, including malignant neoplasm, inflammatory bowel disease, human immunodeficiency virus, transplantation, and pregnancy, were excluded. Of 25 481 patients who underwent colectomy, 4160 were included in the study. Healthcare utilization, including office, hospital outpatient, and emergency department visits and inpatient services 90 and 365 days after the index procedure; total health care costs; and estimated days off from work owing to health care utilization. Of 25 481 patients who underwent colectomy, 4160 were included in the study (laparoscopic, 45.6%; open, 54.4%). The mean (SD) net and total payments were lower for laparoscopy ($23 064 [$14 558] and $24 196 [$14 507] vs $29 753 [$21 421] and $31 606 [$23 586]). In the first 90 days after surgery, an open approach was significantly associated with a 1.26-fold increase in health care costs (estimated, $1715; 95% CI, $338-$2853), increased use of heath care services, and more estimated days off from work (2.78 days; 95% CI, 1.93-3.59). Similar trends were found in the full postoperative year, with

  18. Prior service utilization in detained youth with mental health needs.

    PubMed

    Kates, Emily; Gerber, Emily B; Casey, Shannon

    2014-01-01

    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.

  19. Monitoring Rangeland Health With MODIS Vegetation Index Data

    NASA Astrophysics Data System (ADS)

    Brown, J. F.

    2004-12-01

    Rangelands cover approximately one third of the land area of the conterminous U.S. These lands supply much of the forage for the U.S. cattle industry. Large area monitoring of these vast expanses of range has proved challenging since most of these lands are in the western U.S., are relatively sparsely populated, and are not well covered by meteorological weather stations. Improvements in the spatial and temporal precision of rangeland health information would be useful both for the cattle industry and for scientific studies of soil erosion, water runoff, ecosystem health, and carbon cycling. Optical multispectral remote sensing data from satellites are an objective source of synoptic, timely information for monitoring rangeland health. The objective of this study is to develop and evaluate a method for measuring and monitoring rangeland health over large areas. In the past, data collected by the Advanced Very High Resolution Radiometer has proved useful for this purpose, however the basic 1 km spatial resolution is not ideal when scaling up from ground observations. This study assesses MODIS 250 meter resolution vegetation index data for this purpose. MODIS data not only have finer spatial resolution and improved geolocation, but they also exhibit enhanced vegetation sensitivity and minimized variations associated with external atmospheric and non-atmospheric effects. Ground data collected over 51 sites in western South Dakota over four years are used as training for regression tree models of range health. Range health maps for the growing season derived from the models are presented and evaluated.

  20. Utilization of kidneys with similar kidney donor risk index values from standard versus expanded criteria donors.

    PubMed

    Woodside, K J; Merion, R M; Leichtman, A B; de los Santos, R; Arrington, C J; Rao, P S; Sung, R S

    2012-08-01

    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.

  1. Estimation of health state utilities in breast cancer

    PubMed Central

    Kim, Seon-Ha; Jo, Min-Woo; Ock, Minsu; Lee, Hyeon-Jeong; Lee, Jong-Won

    2017-01-01

    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

  2. EQ-5D health utilities: exploring ways to improve upon responsiveness in psoriasis.

    PubMed

    Pickard, A Simon; Gooderham, Melinda; Hartz, Susanne; Nicolay, Claudia

    2017-01-01

    To determine if EuroQoL 5-Dimension Health Questionnaire (EQ-5D) health utility scores were able to discriminate among different levels of improvement in psoriasis severity following therapy. Data were from three placebo-controlled phase 3 ixekizumab studies (UNCOVER-1, UNCOVER-2, and UNCOVER-3) with patients who had baseline Dermatology Life Quality Index scores >10 (DLQI >10). Psoriasis severity (Psoriasis Area and Severity Index [PASI]), general health utility (EQ-5D), and psoriasis-specific utility (EQ-PSO, UNCOVER-3 only) were assessed. EQ-5D-5L utility scores were generated using the England EQ-5D-5L value set, a crosswalk applied to the EQ-5D-3L United States (US) and United Kingdom (UK) value sets, and a regression-based exploratory scoring function for the EQ-PSO (UK). Analysis of variance was used to estimate change in EQ-5D-5L from baseline to Week 12 per PASI improvement level: PASI <50, PASI 50 to <75, PASI 75 to <90, PASI 90 to <100, and PASI 100. Missing data were imputed using the last observation carried forward method. Value sets for the UK, England, and the US were applied. In total, 2085 patients across UNCOVER-1, UNCOVER-2, and UNCOVER-3 had baseline DLQI >10 and available utility scores. At Week 12, mean EQ-5D utility scores increased with increasing PASI improvement levels (p < 0.001, all analyses). Mean health utilities for PASI 90 to <100 and PASI 100 were similar when based on the generic classifier, whereas a clear differentiation between PASI 90 to <100 and PASI 100 was observed for EQ-PSO mean scores (UNCOVER-3 only, n = 645; PASI 90 to <100: 0.141, PASI 100: 0.200; adjusted p = 0.043). EQ-5D-5L index-based scores have limited ability to differentiate among psoriasis patients at the highest PASI improvement levels. ConclusionsL Adding psoriasis-specific EQ-PSO dimensions to the EQ-5D may enhance responsiveness to improvement in skin clarity at the highest PASI levels, and, therefore, generate utility scores that better

  3. Condition Assessment for Power Transformer Using Health Index

    NASA Astrophysics Data System (ADS)

    Wang, Jian; Wu, Kuihua; Zhu, Wenbing; Gu, Chao

    2017-05-01

    To improve the forecasting accuracy and ensure reliable and stable operation of transformer, based on health index estimation model is proposed. The transformer data is divided into different levels and parts, so multi-parameter statistical analysis is carried on. The indicator system is scored and weighted by computing history data (inspection and maintenance, family defects, basic information and loading history) and condition data (such as routine test data). The condition parameters, which are classified on the component level, are scored and weighted, using statistical tools calculation. By using the statistical tools SPSS (statistical product and service solutions), multivariate statistical analysis was carried out. On the basis of studying the relationship between various parameters, a health evaluation model, which is based on contribution analysis, is presented. A condition-based evaluation tool, that quantifies power transformer degradation and clarifies the relationship between each health index, is put forward. Results are presented to verify the validity and feasibility of evaluating model and assessment algorithm. This paper provides a scientific method for the transmitting and transforming field.

  4. Health beliefs, attitudes and service utilization among Haitians.

    PubMed

    Allen, Jennifer D; Mars, Dana R; Tom, Laura; Apollon, Guy; Hilaire, Dany; Iralien, Gerald; Cloutier, Lindsay B; Sheets, Margaret M; Zamor, Riché

    2013-02-01

    Understanding the factors that influence health beliefs, attitudes, and service use among Haitians in the United States is increasingly important for this growing population. We undertook a qualitative analysis to explore the factors related to cancer screening and utilization of health services among Haitians in Boston. Key informant interviews (n=42) and nine focus groups (n=78) revealed that Haitians experience unique barriers to health services. These include language barriers, unfamiliarity with preventive care, confidentiality concerns, mistrust and stigma concerning Western medicine, and a preference for natural remedies. Results suggest that many Haitians could benefit from health system navigation assistance, and highlight the need for comprehensive, rather than disease-focused programs, to decrease stigma and increase programmatic reach. Faith-based organizations, social service agencies, and Haitian media were identified as promising channels for disseminating health information. Leveraging positive cultural traditions and existing communication networks could increase the impact of Haitian health initiatives.

  5. A Persian version of Geriatric Oral Health Assessment Index.

    PubMed

    Rezaei, Mohammad; Rashedi, Vahid; Khedmati Morasae, Esmaeil

    2016-09-01

    This study aimed to translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into a Persian version and to assess the preliminary psychometric properties of the translated index among a sample of Persian elders. Twelve items included in GOHAI were first translated into Persian using a back-translation technique and then were compared with the original version. Four hundred and seventeen elderly subjects who were admitted to a day care centre answered GOHAI and an attached socio-demographic questionnaire. Internal consistency of the Persian version was measured by Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation coefficient (ICC) and weighted kappa. Factor structure of GOHAI was evaluated by principal component factor analysis. Mean of GOHAI score was 45.71 (SD: 5.14; range: 27-51). The mean of GOHAI score was higher for the elders who rated their oral and general health as 'good'. The Cronbach's alpha for GOHAI score was 0.748, indicating a high degree of internal consistency and homogeneity between the GOHAI items. The test-retest correlation for the total GOHAI score using ICC was 0.763 (95% CI = 0.713-0.809). Factor analysis revealed a three-factor solution that bolstered the theoretical construction of the index. Significant differences in the GOHAI scores were found for income and current number of teeth. The Persian version of the GOHAI can be used reliably to identify oral health-related concerns of older Persian speakers, but further research is needed to confirm its cultural consonance in this population. © 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  6. Diagnostic Utility of WISC-IV General Abilities Index and Cognitive Proficiency Index Difference Scores among Children with ADHD

    ERIC Educational Resources Information Center

    Devena, Sarah E.; Watkins, Marley W.

    2012-01-01

    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…

  7. Diagnostic Utility of WISC-IV General Abilities Index and Cognitive Proficiency Index Difference Scores among Children with ADHD

    ERIC Educational Resources Information Center

    Devena, Sarah E.; Watkins, Marley W.

    2012-01-01

    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…

  8. The Utilization of Dental Health Services by Chicanos and Anglos.

    ERIC Educational Resources Information Center

    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…

  9. Improving Mental Health Service Utilization for Children and Adolescents

    ERIC Educational Resources Information Center

    Power, Thomas J.; Eiraldi, Ricardo B.; Clarke, Angela T.; Mazzuca, Laurie B.; Krain, Amy L.

    2005-01-01

    Approximately 10% of children and adolescents have mental health problems necessitating intervention, but well below 50% of these children receive needed services, and far fewer receive the quality of care required to effectively reduce their impairments. Although system reform is needed to improve service utilization and quality of care for all…

  10. An equity analysis of utilization of health services in Afghanistan using a national household survey.

    PubMed

    Kim, Christine; Saeed, Khwaja Mir Ahad; Salehi, Ahmad Shah; Zeng, Wu

    2016-12-05

    Afghanistan has made great strides in the coverage of health services across the country but coverage of key indicators remains low nationally and whether the poorest households are accessing these services is not well understood. We analyzed the Afghanistan Mortality Survey 2010 on utilization of inpatient and outpatient care, institutional delivery and antenatal care by wealth quintiles. Concentration indexes (CIs) were generated to measure the inequality of using the four services. Additional analyses were conducted to examine factors that explain the health inequalities (e.g. age, gender, education and residence). Among households reporting utilization of health services, public health facilities were used more often for inpatient care, while they were used less for outpatient care. Overall, the utilization of inpatient and outpatient care, and antenatal care was equally distributed among income groups, with CIs of 0.04, 0.03 and 0.08, respectively. However, the poor used more public facilities while the wealthy used more private facilities. There was a substantial inequality in the use of institutional delivery services, with a CI of 0.31. Poorer women had a lower rate of institutional deliveries overall, in both public and private facilities, compared to the wealthy. Location was an important factor in explaining the inequality in the use of health services. The large gap between the rich and poor in access to and utilization of key maternal services, such as institutional delivery, may be a central factor to the high rates of maternal mortality and morbidity and impedes efforts to make progress toward universal health coverage. While poorer households use public health services more often, the use of public facilities for outpatient visits remains half that of private facilities. Pro-poor targeting as well as a better understanding of the private sector's role in increasing equitable coverage of maternal health services is needed. Equity-oriented approaches

  11. Predictors of 6-month health utility outcomes in survivors of acute respiratory distress syndrome.

    PubMed

    Brown, Samuel M; Wilson, Emily; Presson, Angela P; Zhang, Chong; Dinglas, Victor D; Greene, Tom; Hopkins, Ramona O; Needham, Dale M

    2017-04-01

    With improving short-term mortality in acute respiratory distress syndrome (ARDS), understanding and improving quality of life (QOL) outcomes in ARDS survivors is a clinical and research priority. We sought to identify variables associated with QOL, as measured by the EQ-5D health utility score, after ARDS using contemporary data science methods. Analysis of prospectively acquired baseline variables and 6-month EQ-5D health utility scores for adults with ARDS enrolled in the ARDS Network Long-Term Outcomes Study (ALTOS). Penalised regression identified predictors of health utility, with results validated using 10-fold cross-validation. Among 616 ARDS survivors, several predictors were associated with 6-month EQ-5D utility scores, including two lifestyle factors. Specifically, older age, female sex, Hispanic/Latino ethnicity, current smoking and higher body mass index were associated with lower EQ-5D utilities, while living at home without assistance at baseline and AIDS were associated with higher EQ-5D utilities in ARDS survivors. No acute illness variables were associated with EQ-5D utility. Acute illness variables do not appear to be associated with postdischarge QOL among ARDS survivors. Functional independence and lifestyle factors, such as obesity and tobacco smoking, were associated with worse QOL. Future analyses of postdischarge health utility among ARDS survivors should incorporate measures of demographics and functional independence at baseline. NCT00719446 (ALTOS), NCT00434993 (ALTA), NCT00609180 (EDEN/OMEGA), and NCT00883948 (EDEN); Post-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. Sleep quality and health service utilization in Chinese general population: a cross-sectional study in Dongguan, China.

    PubMed

    Zhang, Hui-Shan; Mai, Yan-Bing; Li, Wei-Da; Xi, Wen-Tao; Wang, Jin-Ming; Lei, Yi-Xiong; Wang, Pei-Xi

    The aims of this study were to explore the Pittsburgh Sleep Quality Index (PSQI) and health service utilization in Chinese general population, to investigate the association between PSQI and health service utilization and to identify the independent contributions of social demographic variables, health related factors and PSQI to health service utilization. In a cross-sectional community-based health survey using a multi-instrument questionnaire, 4067 subjects (≥15 years old) were studied. The Chinese version of the PSQI was used to assess sleep quality. Health service utilization was measured by recent two-week physician visit and annual hospitalization rates. Higher PSQI scores were associated with more frequent health service utilization. Higher scores in subjective sleep quality were associated with higher rate of recent two-week physician visit (adjusted OR = 1.24 per SD increase, P = 0.015). Higher scores in habitual sleep efficiency (adjusted OR = 1.24 per SD increase, P = 0.038) and sleep disturbances (adjusted OR = 2.09 per SD increase, P < 0.001) were associated with more frequent annual hospitalization. The independent influence of PSQI on the risk of recent two-week physician visit was 0.7%, and that of annual hospitalization 31.4%. Poorer sleep quality predicted more frequent health service utilization. The independent contribution of PSQI on health service utilization was smaller than social demographic variables. Copyright © 2016. Published by Elsevier B.V.

  13. Medicare Interim Payment System's Impact on Medicare Home Health Utilization

    PubMed Central

    Liu, Korbin; Long, Sharon K.; Dowling, Krista

    2003-01-01

    The Medicare home health interim payment system (IPS) implemented in fiscal year 1998 provided very strong incentives for home health agencies (HHAs) to reduce the number of visits provided to each Medicare user and to avoid those beneficiaries whose Medicare plan of care was likely to exceed the average beneficiary cost limit. We analyzed multiple years of data from the Medicare Current Beneficiary Survey (MCBS) to examine how the IPS affected subgroups of the Medicare population by health and socioeconomic characteristics. We found that the IPS strongly reduced overall utilization, but that few subgroups were disproportionately affected. PMID:14997695

  14. Quality of life utilities for pelvic inflammatory disease health states.

    PubMed

    Smith, Kenneth J; Tsevat, Joel; Ness, Roberta B; Wiesenfeld, Harold C; Roberts, Mark S

    2008-03-01

    Quality of life utilities for health states associated with pelvic inflammatory disease (PID) have been estimated but not directly measured. Utilities for PID could have important implications on the cost-effectiveness of interventions to prevent and manage this disease. We obtained, in women with versus without a history of PID, visual analogue scale (VAS) and time-tradeoff (TTO) valuations for 5 PID-associated health states: ambulatory PID treatment, hospital PID treatment, ectopic pregnancy, chronic pelvic pain, and infertility. Subjects read brief scenarios describing the medical, functional, and social activity effects typically associated with each state, then gave valuations in the order above. Health state valuations were obtained from 56 women with and 150 women without a PID history. Subjects with a PID history had significantly lower mean valuations (P <0.05) on the VAS for ectopic pregnancy (0.55 vs. 0.63), pelvic pain (0.45 vs. 0.53), and infertility (0.53 vs. 0.66) but not on the TTO; VAS differences remained significant when controlling for demographic and childbearing characteristics. VAS and TTO valuations were similar in women with versus without a history of PID for the ambulatory and hospital PID treatment health states. PID has substantial impact on utility. In addition, some PID-related health states are valued less by women who have experienced PID, which could affect cost-effectiveness analyses of PID treatments when examined from the societal versus patient perspective.

  15. Surrogate analysis and index developer (SAID) tool and real-time data dissemination utilities

    USGS Publications Warehouse

    Domanski, Marian M.; Straub, Timothy D.; Wood, Molly S.; Landers, Mark N.; Wall, Gary R.; Brady, Steven J.

    2015-01-01

    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.

  16. The Impact of Medicare Part D on Out-of-Pocket Costs for Prescription Drugs, Medication Utilization, Health Resource Utilization, and Preference-Based Health Utility

    PubMed Central

    Liu, Frank Xiaoqing; Alexander, G Caleb; Crawford, Stephanie Y; Pickard, A Simon; Hedeker, Donald; Walton, Surrey M

    2011-01-01

    Objectives To quantify the impact of Medicare Part D eligibility on medication utilization, emergency department use, hospitalization, and preference-based health utility among civilian noninstitutionalized Medicare beneficiaries. Study Design Difference-in-differences analyses were used to estimate the effects of Part D eligibility on health outcomes by comparing a 12-month period before and after Part D implementation using the Medical Expenditure Panel Survey. Models adjusted for sociodemographic characteristics and health status and compared Medicare beneficiaries aged 65 and older with near elderly aged 55–63 years old. Principal Findings Five hundred and fifty-six elderly and 549 near elderly were included. After adjustment, Part D was associated with a U.S.$179.86 (p = .034) reduction in out-of-pocket costs and an increase of 2.05 prescriptions (p = .081) per patient year. The associations between Part D and emergency department use, hospitalizations, and preference-based health utility did not suggest cost offsets and were not statistically significant. Conclusions Although there was a substantial reduction in out-of-pocket costs and a moderate increase in medication utilization among Medicare beneficiaries during the first year after Part D, there was no evidence of improvement in emergency department use, hospitalizations, or preference-based health utility for those eligible for Part D during its first year of implementation. PMID:21609328

  17. Relationship between Revised Graduated Index (R-GINDEX) of prenatal care utilization & preterm labor and low birth weight.

    PubMed

    Tayebi, Tahereh; Hamzehgardeshi, Zeinab; Ahmad Shirvani, Marjan; Dayhimi, Marjaneh; Danesh, Mahmonir

    2014-02-28

    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.

  18. Public mental health care utilization by older adults.

    PubMed

    Karlin, Bradley E; Norris, Margaret P

    2006-11-01

    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.

  19. Health service utilization of heroin abusers: a retrospective cohort study.

    PubMed

    Chen, I-Ming; Huang, Charles Lung-Cheng; Yeh, Bao-Juan; Chien, Yi-Ling

    2015-06-01

    This study aimed to determine the patterns of medical service utilization among heroin users and to identify the factors associated with the frequency of utilization. We conducted a retrospective/prospective cohort study of 789 heroin-using adults in a catchment area, collecting data on their usage of medical care, including inpatient care, emergency visits, and outpatient care, in a 2-year observation period. We interviewed and reviewed the medical records of 789 heroin users in a methadone clinic of a general hospital in a rural area of Taiwan. The demographic data, records of service use, diagnoses, and information on viral infection status from Jan. 1, 2007 to Dec. 31, 2008 were collected. Most patients were middle-aged and unemployed, had a basic educational level, and began their first heroin use in their twenties. The health service utilization of heroin users was mostly for infectious diseases, orthopedic conditions, and gastroenterological disorders mainly due to blood-borne or local infections and traumatic injury. Heroin users utilize fewer outpatient or inpatient services, but more emergency care than the general public. The major correlates of inpatient and emergency service utilization were HIV status and education level. Our findings suggest that integrated outpatient services may help to enhance medical service accessibility and adherence, and also imply the necessity of putting more effort into promoting health management and safe behaviors in heroin users, particularly the lower-educated addicts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam

    PubMed Central

    Duc, Nguyen Huu Chau; Nakamura, Keiko; Kizuki, Masashi; Seino, Kaoruko; Rahman, Mosiur

    2015-01-01

    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

  1. [Determinants of health care utilization in Costa Rica].

    PubMed

    Morera Salas, Melvin; Aparicio Llanos, Amada

    2010-01-01

    To analyze the determinants of health care utilization (visits to the doctor) in Costa Rica using an econometric approach. Data were drawn from the National Survey of Health for Costa Rica 2006. We modeled the Grossman approach to the demand for health services by using a standard negative binomial regression, and used a hurdle model for the principal-agent specification. The factors determining healthcare utilization were level of education, self-assessed health, number of declared chronic diseases and geographic region of residence. The number of outpatient visits to the doctor depends on the proxies for medical need, but we found no multivariate association between the use of outpatient visits and income or insurance status. This result suggests that there is no problem with access in the public - almost universal - Costa Rican health system. No conclusive results were obtained on the influence of the physician on the frequency of use of health care services, as postulated by the principal-agent model. Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

  2. [The association between alcohol consumption and health services utilization].

    PubMed

    Peruga, A; Martínez, R M; Martín Sánchez, L; Aracil Rodríguez, E

    1990-01-01

    The association between alcohol consumption patterns and the use of health services was examined in a cross-sectional survey of the general population of the Region of Madrid. Logistic regression analysis was used to determine the odds of moderate drinkers, excessive drinkers and non-drinkers to utilize health care services. Our findings indicate that moderate drinkers have a lower probability of utilizing health care services as compared to non-drinkers. Specifically, moderate drinkers showed a lower probability of utilizing both hospital (OR = 0.65 CI = 0.48-0.89) and ambulatory care (OR = 0.79 CI = 0.66-0.95) services. Furthermore, the frequency of use of ambulatory (OR = 0.79 CI = 0.64-0.95) and emergency care services (OR = 0.38 CI = 0.21-0.69) was also lower for moderate drinkers. Excessive drinkers also showed a tendency to use emergency care services less frequently (OR = 0.43 CI = 0.19-0.93). Both moderate and excessive drinking were also significantly associated with a shorter length of stay as compared to non-drinkers. The odds ratios are 0.41 (CI = 0.21-0.79) and 0.29 (CI = 0.19-0.39) respectively. Possible explanations of this "protective" effect of alcohol consumption, especially of moderate drinking, are discussed in relation to the diagnostic entities motivating the use of health care services.

  3. Alcohol Dependence and Health Care Utilization in African Americans

    PubMed Central

    Marshall, Vanessa J.; Kalu, Nnenna; Kwagyan, John; Scott, Denise M.; Cain, Gloria E.; Hill, Karen; Hesselbrock, Victor; Ferguson, Clifford L.; Taylor, Robert E.

    2013-01-01

    Objective Ethnic and cultural differences in patterns of alcohol use disorders must be understood in order to address improvement in prevention of such disorders and accessibility to health care services. The purpose of this study was to evaluate factors that influence the utilization of medical and mental health services among alcohol-dependent and non alcohol–dependent African Americans. Method A cohort of 454 African Americans was evaluated. Alcohol-dependent participants were recruited from various inpatient treatment facilities in the Washington, DC, metropolitan area and through advertisement and word of mouth. Non–alcohol-dependent participants were recruited by advertisements. Each participant was administered the Semi-Structured Assessment for the Genetics of Alcoholism to assess alcohol dependency and the Family History Assessment module to access family history of alcoholism. χ2 Test and analysis of variance were used to analyze the data. Results Alcohol dependence was more prevalent among men, those with lower income, those with less education, and they utilized mental health counseling as opposed to medical-based therapy. Increased reports of medical conditions such as migraine (p < .001), loss of consciousness (p = .001), and sexually transmitted diseases (p < .001) were also associated with alcohol dependency. Other factors, including visits to inpatient treatment programs, were directly related to incidence of alcohol dependency regardless of gender status (p < .001). Conclusions This study suggests an association exists among alcohol dependence, medical conditions, health care, and mental care utilization among African Americans. Future research may benefit from investigating if an association exists between alcohol use disorders and health care utilization for other ethnic groups. PMID:23862295

  4. Effect of Women's autonomy on maternal health service utilization in Nepal: a cross sectional study.

    PubMed

    Adhikari, Ramesh

    2016-05-13

    Women's role has been a priority area not only for sustainable development, but also in reproductive health since ICPD 1994. However, very little empirical evidence is available about women's role on maternal health service utilization in Nepal. This paper explores dimensions of women's autonomy and their relationship to utilization of maternal health services. The analysis uses data from the Nepal Demographic and Health Survey, 2011. The analysis is confined to women who had given birth in the 5 years preceding the survey (n = 4,148). Women's autonomy related variables are taken from the standard DHS questionnaire and measured based on decision in household about obtaining health care, large household purchases and visit to family or relative. The net effect of women's autonomy on utilization of maternal health services after controlling for the effect of other predictors has been measured through multivariate logistic regression analysis. The findings indicate only about a half of the women who had given birth in the past 5 years preceding the survey had 4 or more ANC check up for their last birth. Similarly, 40 % of the women had delivered their last child in the health facilities. Furthermore, slightly higher than two-fifth women (43 %) had postnatal check up for their last child. Only slightly higher than a fourth woman (27 %) had utilized all the services (adequate ANC visit, delivered at health institution and post natal check up) for their last child. This study found that many socio-demographic variables such as age of women, number of children born, level of education, ethnicity, place of residence and wealth index are predicators of utilizing the maternal health services of recent child. Notably, higher level autonomy was associated with higher use of maternal health services [adjusted odds ratio (aOR) =1.40; CI 1.18-1.65]. Utilization of maternal health services for the recent child among women is very low. The study results suggest that policy

  5. The ART Advantage: Health Care Utilization for Diabetes and Hypertension in Rural South Africa.

    PubMed

    Manne-Goehler, Jennifer; Montana, Livia; Gómez-Olivé, Francesc Xavier; Rohr, Julia; Harling, Guy; Wagner, Ryan G; Wade, Alisha; Kabudula, Chodziwadziwa W; Geldsetzer, Pascal; Kahn, Kathleen; Tollman, Stephen; Berkman, Lisa F; Bärnighausen, Till W; Gaziano, Thomas A

    2017-08-15

    The prevalence of diabetes and hypertension has increased in HIV-positive populations, but there is limited understanding of the role that antiretroviral therapy (ART) programs play in the delivery of services for these conditions. The aim of this study is to assess the relationship between ART use and utilization of health care services for diabetes and hypertension. Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa is a cohort of 5059 adults. The baseline study collects biomarker-based data on HIV, ART, diabetes, and hypertension and self-reported data on health care utilization. We calculated differences in care utilization for diabetes and hypertension by HIV and ART status and used multivariable logistic regressions to estimate the relationship between ART use and utilization of services for these conditions, controlling for age, sex, body mass index, education, and household wealth quintile. Mean age, body mass index, hypertension, and diabetes prevalence were lower in the HIV-positive population (all P < 0.001). Multivariable logistic regression showed that ART use was significantly associated with greater odds of blood pressure measurement [adjusted odds ratio (aOR) 1.27, 95% confidence interval (CI): 1.04 to 1.55] and blood sugar measurement (aOR 1.26, 95% CI: 1.05 to 1.51), counseling regarding exercise (aOR 1.57, 95% CI: 1.11 to 2.22), awareness of hypertension diagnosis (aOR 1.52, 95% CI: 1.12 to 2.05), and treatment for hypertension (aOR 1.63, 95% CI: 1.21 to 2.19). HIV-positive patients who use ART are more likely to have received health care services for diabetes and hypertension. This apparent ART advantage suggests that ART programs may be a vehicle for strengthening health systems for chronic care.

  6. Education-related Inequity in Access and Utilization of Oral Health Care in Iran.

    PubMed

    Mohammadbeigi, Abolfazl; Arsangjang, Shahram; Mohammadsalehi, Narges; Anbari, Zohreh; Ghaderi, Ebrahim

    2015-01-01

    Oral health affects peoples' lives physically and psychologically and is related to general health, quality of life, and feelings of social well-being. As the educational level is an important predictor of healthy life and can affect healthcare utilization, this study aims to estimate the inequity related to the educational level of parents on the access and utilization of oral health care (OHC) in Qom, Iran. An analytical, cross-sectional study. Overall 281 children, six to seven years of age, were given a self-administrated questionnaire to fill. The sex, access to utilization of OHC, and educational level of the children's parents were questioned. The concentration (C) index was used as the inequity measure and statistical inference was conducted by chi square and the confidence interval of C. The mean age of the children was 6.48 ± 0.5 years. There was not statistically significant difference in the access and utilization rate of OHC between the two sexes (P > 0.05). There was an increasing trend in the utilization rate of OHC, because of the increased educational level of the parents. The C for access and utilization rate, for different levels of fathers' education was 0.055(-0.095 to 0.205) and 0.097(-0.068 to 0.261) and for mothers' educational level was 0.086(-0.068 to 0.241) and 0.091(-0.81 to 0.263), respectively. Our results did not show evidence of sex disparity in the access and utilization of OHC in Iranian children. Also the inequity related to the educational level in access and utilization of OHC was low and not considerable.

  7. Correlates of maternal health care utilization in rohilkhand region, India.

    PubMed

    Srivastava, A; Mahmood, Se; Mishra, P; Shrotriya, Vp

    2014-05-01

    Until date, the importance of maternal health care services in reducing maternal mortality and morbidity has received a significant recognition. Most of the maternal deaths can be prevented if women have access to basic antenatal, natal and postnatal care. However, uptake of maternal health care services is far from universal even in settings where they are extensively available. The aim of this study is to assess the pattern and identify underlying factors on maternal health care utilization in rural areas of Bareilly. This was a cross-sectional study was conducted during June-December 2011. Six villages were selected by convenience out of 99 villages in Bhojipura Block of Bareilly district, Uttar Pradesh to cover maximum number of women. All currently married women aged between 15 and 49 years who had delivered a child within last 1 year were interviewed by house-to-house survey and comprised the study unit. Their socioeconomic and demographic characteristics, reproductive history and knowledge of specific obstetric complications were taken. The information was gathered on various aspects of maternal-care utilization. In analyzing data, both bivariate and multivariate analyses were employed, using the Microsoft Excel and SPSS for Windows, Version 15.0 (SPSS Inc., Chicago, Illinois,USA). Most (88.6%; 343/387) of pregnancies had registration for antenatal care (ANC). Majority (69.7%; 239/343) of them were registered between 16 and 24 weeks. Only 28.5% (110/343) of women received ANC from a private doctor. Maternal health care service utilization from health personnel was significantly associated with age at marriage ≥18 years, family size ≤3, birth order ≤2, nuclear family and higher socio-economic status. Most of the pregnancy related complications were found among women aged >30 years, with birth order ≥3, having birth interval <24 months, among Muslims, working mothers and among those belonging to joint family. Mother's education and husband's occupation

  8. Health literacy and 30-day postdischarge hospital utilization.

    PubMed

    Mitchell, Suzanne E; Sadikova, Ekaterina; Jack, Brian W; Paasche-Orlow, Michael K

    2012-01-01

    Low health literacy is associated with higher mortality, higher rates of hospitalization, and poor self-management skills for chronic disease. Early, unplanned hospital reutilization after discharge is a common and costly occurrence in U.S. hospitals. Still, few studies have examined the relation between health literacy and 30-day hospital reutilization rates. The authors examined the association between health literacy and 30-day reutilization of hospital services (readmission or return to the emergency department) in an urban safety net hospital, and conducted a secondary analysis of data from the control arm subjects of the Project RED and the RED-LIT trials. Health literacy was measured using the REALM tool. The primary outcome was rate of 30-day reutilization. The authors used multivariate Poisson regression analysis to control for potential confounding. Of the 703 subjects, 20% had low health literacy, 29% had marginal health literacy, and 51% had adequate health literacy. Sixty-two percent of subjects had a 12th-grade education or less. Subjects with low health literacy were more likely to be insured by Medicaid (p < .001); Black non-Hispanic (p < .001); unemployed, disabled, or retired (p < .001); low income (p < .001); and less educated (high school education or less, p < .001). The fully adjusted incidence rate ratio for low health literacy compared with adequate health literacy was 1.46 (CI [1.04, 2.05]). Low health literacy is a significant, independent, and modifiable risk factor for 30-day hospital reutilization after discharge. Interventions designed to reduce early, unplanned, hospital utilization after discharge should include activities to mitigate the effect of patients' low health literacy.

  9. Utilization of virtual learning environments in the allied health professions.

    PubMed

    Butina, Michelle; Brooks, Donna; Dominguez, Paul J; Mahon, Gwendolyn M

    2013-01-01

    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.

  10. Mental health service utilization by victims of crime.

    PubMed

    New, M; Berliner, L

    2000-10-01

    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.

  11. Health services utilization and cost of retinitis pigmentosa.

    PubMed

    Frick, Kevin D; Roebuck, M Christopher; Feldstein, Joshua I; McCarty, Catherine A; Grover, Lori L

    2012-05-01

    To estimate annual per-patient health services utilization and costs of retinitis pigmentosa (RP) in the United States. A retrospective claims analysis of patients with RP (N = 2990) and a 1:1 exactly matched cohort of non-RP patients was conducted using the MarketScan Commercial and Medicare Supplemental Databases. Individuals were continuously enrolled in a commercial health plan or employer-sponsored health insurance for at least 1 year. The following annual outcomes were analyzed using nonlinear multivariate models: inpatient hospital admissions, inpatient hospital days, emergency department visits, outpatient physician visits, and prescription drug refills and inpatient and outpatient medical, pharmacy, and total health care costs. Patients with RP had 0.04 more hospital admissions (P < .001), 0.19 more inpatient hospital days (P < .02), 0.05 more emergency department visits (P < .01), 2.74 more outpatient visits (P < .001), and 2.18 additional prescription drug fills (P < .001) annually compared with their non-RP counterparts. Health care expenditures were significantly higher for patients with RP, who cost $894, $4855, and $452 more for inpatient, outpatient, and pharmacy services, respectively (P < .001). Overall health care costs were $7317 more per patient per year in the RP cohort, with expenditures varying considerably by age. Patients with RP consume substantially greater amounts of health services with significantly higher health care costs. Treatments that slow, halt, or possibly restore RP-related vision loss may prove cost-effective for payers and society.

  12. A recycling index for food and health security: urban Taipei.

    PubMed

    Huang, Susana Tzy-Ying

    2010-01-01

    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.

  13. Quality of life, health status, and health service utilization related to a new measure of health literacy: FLIGHT/VIDAS.

    PubMed

    Ownby, Raymond L; Acevedo, Amarilis; Jacobs, Robin J; Caballero, Joshua; Waldrop-Valverde, Drenna

    2014-09-01

    Researchers have identified significant limitations in some currently used measures of health literacy. The purpose of this paper is to present data on the relation of health-related quality of life, health status, and health service utilization to performance on a new measure of health literacy in a nonpatient population. The new measure was administered to 475 English- and Spanish-speaking community-dwelling volunteers along with existing measures of health literacy and assessments of health-related quality of life, health status, and healthcare service utilization. Relations among measures were assessed via correlations and health status and utilization was tested across levels of health literacy using ANCOVA models. The new health literacy measure is significantly related to existing measures of health literacy as well as to participants' health-related quality of life. Persons with lower levels of health literacy reported more health conditions, more frequent physical symptoms, and greater healthcare service utilization. The new measure of health literacy is valid and shows relations to measures of conceptually related constructs such as quality of life and health behaviors. FLIGHT/VIDAS may be useful to researchers and clinicians interested in a computer administered and scored measure of health literacy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Report on health and environmental effects of increased coal utilization*

    PubMed Central

    1980-01-01

    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

  15. Occupational safety and health implications of increased coal utilization.

    PubMed Central

    Bridbord, K; Costello, J; Gamble, J; Groce, D; Hutchison, M; Jones, W; Merchant, J; Ortmeyer, C; Reger, R; Wagner, W L

    1979-01-01

    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

  16. Utilization of maternal health services in Ejisu District, Ghana.

    PubMed

    Martey, J O; Djan, J O; Twum, S; Browne, E N; Opoku, S A

    1995-01-01

    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.

  17. Urban poverty and utilization of maternal and child health care services in India.

    PubMed

    Prakash, Ravi; Kumar, Abhishek

    2013-07-01

    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.

  18. Is Dental Utilization Associated with Oral Health Literacy?

    PubMed

    Burgette, J M; Lee, J Y; Baker, A D; Vann, W F

    2016-02-01

    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. © International & American Associations for Dental Research 2015.

  19. Is Dental Utilization Associated with Oral Health Literacy?

    PubMed Central

    Burgette, J.M.; Lee, J.Y.; Baker, A.D.; Vann, W.F.

    2016-01-01

    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

  20. Coal utilization in China: environmental impacts and human health.

    PubMed

    Chen, Jian; Liu, Guijian; Kang, Yu; Wu, Bin; Sun, Ruoyu; Zhou, Chuncai; Wu, Dun

    2014-08-01

    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.

  1. Developing a Forest Health Index for public engagement and decision support using local climatic, ecological, and socioeconomic data

    NASA Astrophysics Data System (ADS)

    Arnott, J. C.; Katzenberger, J.; Cundiff, J.

    2013-12-01

    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

  2. Health Care Access and Utilization after the 2010 Pakistan Floods.

    PubMed

    Jacquet, Gabrielle A; Kirsch, Thomas; Durrani, Aqsa; Sauer, Lauren; Doocy, Shannon

    2016-10-01

    Introduction The 2010 floods submerged more than one-fifth of Pakistan's land area and affected more than 20 million people. Over 1.6 million homes were damaged or destroyed and 2,946 direct injuries and 1,985 deaths were reported. Infrastructure damage was widespread, including critical disruptions to the power and transportation networks. Hypothesis Damage and loss of critical infrastructure will affect the population's ability to seek and access adequate health care for years to come. This study sought to evaluate factors associated with access to health care in the aftermath of the 2010 Pakistan floods. A population-proportional, randomized cluster-sampling survey method with 80 clusters of 20 (1,600) households of the flood-affected population was used. Heads of households were surveyed approximately six months after flood onset. Multivariate analysis was used to determine significance. A total of 77.8% of households reported needing health services within the first month after the floods. Household characteristics, including rural residence location, large household size, and lower pre- and post-flood income, were significantly associated (P<.05) with inadequate access to health care after the disaster. Households with inadequate access to health care were more likely to have a death or injury in the household. Significantly higher odds of inadequate access to health care were observed in rural populations (adjusted OR 4.26; 95% CI, 1.89-9.61). Adequate health care access after the 2010 Pakistani floods was associated with urban residence location, suggesting that locating health care providers in rural areas may be difficult. Access to health services also was associated with post-flood income level, suggesting health resources are not readily available to households suffering great income losses. Jacquet GA , Kirsch T , Durrani A , Sauer L , Doocy S . Health care access and utilization after the 2010 Pakistan floods. Prehosp Disaster Med. 2016;31(5):485-491.

  3. Mapping the functional assessment of cancer therapy-breast (FACT-B) to the 5-level EuroQoL Group's 5-dimension questionnaire (EQ-5D-5L) utility index in a multi-ethnic Asian population.

    PubMed

    Cheung, Yin Bun; Luo, Nan; Ng, Raymond; Lee, Chun Fan

    2014-12-12

    To develop an algorithm for mapping the Functional Assessment of Cancer Therapy-Breast (FACT-B) to the 5-level EuroQoL Group's 5-dimension questionnaire (EQ-5D-5L) utility index. A survey of 238 breast cancer patients in Singapore was conducted. Models using various regression methods with or without recognizing the upper boundary of utility values at 1 were fitted to predict the EQ-5D-5L utility index based on the five subscale scores of the FACT-B. Data from a follow-up survey of these patients were used to validate the results. A model that maps the physical, emotional, functional well-being and the breast cancer concerns subscales of the FACT-B to the EQ-5D-5L utility index was derived. The social well-being subscale was not associated to the utility index. Although theoretical assumptions may not be valid, ordinary least square outperformed other regression methods. The mean predicted utility index within each performance status level at follow-up deviated from the observed mean less than the minimally important difference of EQ-5D for cancer patients. The mapping algorithm converts the FACT-B to the EQ-5D utility index. This enables oncologists, clinical researchers and policy makers to obtain a quantitative utility summary of a patient's health status when only the FACT-B is assessed.

  4. Fuzzy Logic Based Rotor Health Index of Induction Motor

    NASA Astrophysics Data System (ADS)

    Misra, Rajul; Pahuja, G. L.

    2015-10-01

    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.

  5. New Insights Into the Alleged Kidney Donor Profile Index Labeling Effect on Kidney Utilization.

    PubMed

    Stewart, D E; Garcia, V C; Aeder, M I; Klassen, D K

    2017-10-01

    The Kidney Donor Profile Index (KDPI) became a driving factor in deceased donor kidney allocation on December 4, 2014, with the implementation of the kidney allocation system (KAS). On April 20, 2016, the annual recalibration of the Kidney Donor Risk Index into KDPI was incorrectly programmed in DonorNet, resulting in erroneously high KDPI values, by between 1 and 21 percentage points (e.g. actual KDPI of 70% was displayed as 86%). The error was corrected on May 19, 2016, <24 h after being recognized. During this 30-day period, the distribution of recipients largely resembled pre-KAS patterns. The observed discard rate of 22.9% was higher than the post-KAS average of 19.6% (odds ratio [OR]: 1.22) but far lower than the projected rate of 31.4% (OR: 1.96) based on the usual discard rate by KDPI relationship, suggesting clinicians and patients did not rely heavily on this single number (KDPI) in kidney-utilization decisions. Still, risk-adjusted analyses suggest the elevated discard rate was most likely attributable to the erroneously high KDPIs, not a shift in donor characteristics or random chance. The rise in discard rate was sharply higher for kidneys with inflated KDPI that crossed the 85% policy threshold (OR: 1.46; p = 0.049) versus those that did not (OR: 1.06; p = 0.631). © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  6. Health service access and utilization among Syrian refugees in Jordan.

    PubMed

    Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Burton, Ann; Burnham, Gilbert

    2016-07-14

    The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system. Changing lifestyles and aging populations are shifting the global disease burden towards increased non-infectious diseases including chronic conditions, co-morbidities, and injuries which are more complicated and costly to manage. The strain placed on health systems threatens the ability to ensure the health needs of both refugees and host country populations are adequately addressed. In light of the increasing challenges facing host governments and humanitarian actors to meet health needs of Syrian refugees and affected host communities, this study was undertaken to assess utilization of health services among Syrian refugees in non-camp settings. A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Differences in household characteristics by geographic region, facility type, and sector utilized were examined using chi-square and t-test methods. Care-seeking was high with 86.1 % of households reporting an adult sought medical care the last time it was needed. Approximately half (51.5 %) of services were sought from public sector facilities, 38.7 % in private facilities, and 9.8 % in charity/NGO facilities. Among adult care seekers, 87.4 % were prescribed medication during the most recent visit, 89.8 % of which obtained the medication. Overall, 51.8 % of households reported out-of-pocket expenditures for the consultation or medications at the most recent visit (mean US$39.9, median US$4.2). Despite high levels of care-seeking, cost was an important barrier to health service access for Syrian refugees in Jordan. The cessation of free access to health care since the time of the survey is likely to have worsened

  7. Continuous versus intermittent data collection of health care utilization.

    PubMed

    Hendriks, Marike R C; Al, Maiwenn J; Bleijlevens, Michel H C; van Haastregt, Jolanda C M; Crebolder, Harry F J M; van Eijk, Jacques Th M; Evers, Silvia M A A

    2013-11-01

    In economic evaluations, participants have to report their health care utilization continuously during follow-up. To unburden participants, researchers often collect data intermittently (i.e., in at least 3 months a year). However, comparability of intermittent v. continuous data collection is unknown. Therefore, this study aimed to compare costs estimated with intermittent data collection of health care utilization with those based on continuous data collection. We used continuous health care utilization data from a trial with 12 months of follow-up and simulated several intermittent data collection patterns. Then 3 imputation techniques--individual mean (IM), last observation carried forward (LOCF) and next observation carried backward (NOCB)--were used to estimate total annual costs. Estimated annual costs were compared with observed annual costs from continuous data collection both in the original sample and in 1000 bootstrap samples. Analyses showed that intermittent data collection using cost diaries may offer good estimates of the actual total annual health expenditures. However, estimations of groups of costs differ between data collection patterns and imputation methods. The best estimations of annual total costs and groups of costs were obtained by random cohort data collection, using 3 random cohorts, ensuring that at least a third of the participants were measuring costs each month, combined with IM imputation. Intermittent data collection of health expenditures carries a small risk of missing infrequent expensive events. Continuous cost data collection remains the first choice. However, if intermittent measurement is chosen, we recommend calculating annual costs from intermittent data collection in random cohorts, combined with IM imputation.

  8. School Health Index: A Self-Assessment and Planning Guide. [Brochure

    ERIC Educational Resources Information Center

    US Department of Health and Human Services, 2004

    2004-01-01

    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…

  9. The Stigma of Reproductive Health Services Utilization by Unmarried Women

    PubMed Central

    Mohammadi, Fatemeh; Kohan, Shahnaz; Mostafavi, Firoozeh; Gholami, Ali

    2016-01-01

    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

  10. Organizational attributes that assure optimal utilization of public health nurses.

    PubMed

    Meagher-Stewart, Donna; Underwood, Jane; MacDonald, Mary; Schoenfeld, Bonnie; Blythe, Jennifer; Knibbs, Kristin; Munroe, Val; Lavoie-Tremblay, Mélanie; Ehrlich, Anne; Ganann, Rebecca; Crea, Mary

    2010-01-01

    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.

  11. EXAMINING SOCIOECONOMIC HEALTH DISPARITIES USING A RANK-DEPENDENT RÉNYI INDEX

    PubMed Central

    Talih, Makram

    2015-01-01

    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

  12. Health Impact Index. Development and Validation of a Method for Classifying Comorbid Disease Measured against Self-Reported Health

    PubMed Central

    2016-01-01

    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

  13. Development of Welding Fumes Health Index (WFHI) for Welding Workplace’s Safety and Health Assessment

    PubMed Central

    HARIRI, Azian; PAIMAN, Nuur Azreen; LEMAN, Abdul Mutalib; MD. YUSOF, Mohammad Zainal

    2014-01-01

    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

  14. Multi-attribute utility function or statistical inference models: a comparison of health state valuation models using the HUI2 health state classification system.

    PubMed

    Stevens, Katherine; McCabe, Christopher; Brazier, John; Roberts, Jennifer

    2007-09-01

    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.

  15. The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda

    PubMed Central

    Temsah, Gheda; Mallick, Lindsay

    2017-01-01

    Abstract 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. PMID:28365754

  16. The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda.

    PubMed

    Wang, Wenjuan; Temsah, Gheda; Mallick, Lindsay

    2017-04-01

    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.

  17. Effect of glycemic index and fructose content in lunch on substrate utilization during subsequent brisk walking.

    PubMed

    Sun, Feng-Hua; Wong, Stephen Heung-Sang; Chen, Ya-Jun; Huang, Ya-Jun; Hsieh, Sandy Shen-Yu

    2011-12-01

    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.

  18. Rates of minor adverse events and health resource utilization postcolonoscopy.

    PubMed

    Marquez Azalgara, Vladimir; Sewitch, Maida J; Joseph, Lawrence; Barkun, Alan N

    2014-12-01

    Little is known about minor adverse events (MAEs) following outpatient colonoscopies and associated health care resource utilization. To estimate the rates of incident MAE at two, 14 and 30 days postcolonoscopy, and associated health care resource utilization. A secondary aim was to identify factors associated with cumulative 30-day MAE incidence. A longitudinal cohort study was conducted among individuals undergoing an outpatient colonoscopy at the Montreal General Hospital (Montreal, Quebec). Before colonoscopy, consecutive individuals were enrolled and interviewed to obtain data regarding age, sex, comorbidities, use of antiplatelets/anticoagulants and previous symptoms. Endoscopy reports were reviewed for intracolonoscopy procedures (biopsy, polypectomy). Telephone or Internet follow-up was used to obtain data regarding MAEs (abdominal pain, bloating, diarrhea, constipation, nausea, vomiting, blood in the stools, rectal or anal pain, headaches, other) and health resource use (visits to emergency department, primary care doctor, gastroenterologist; consults with nurse, pharmacist or telephone hotline). Rates of incident MAEs and health resources utilization were estimated using Bayesian hierarchical modelling to account for patient clustering within physician practices. Of the 705 individuals approached, 420 (59.6%) were enrolled. Incident MAE rates at the two-, 14- and 30-day follow-ups were 17.3% (95% credible interval [CrI] 8.1% to 30%), 10.5% (95% CrI 2.9% to 23.7%) and 3.2% (95% CrI 0.01% to 19.8%), respectively. The 30-day rate of health resources utilization was 1.7%, with 0.95% of participants seeking the services of a physician. No predictors of the cumulative 30-day incidence of MAEs were identified. The incidence of MAEs was highest in the 48 h following colonoscopy and uncommon after two weeks, supporting the Canadian Association of Gastroenterology's recommendation for assessment of late complications at 14 days. Predictors of new onset of MAEs were

  19. Rates of minor adverse events and health resource utilization postcolonoscopy

    PubMed Central

    Azalgara, Vladimir Marquez; Sewitch, Maida J; Joseph, Lawrence; Barkun, Alan N

    2014-01-01

    BACKGROUND: Little is known about minor adverse events (MAEs) following outpatient colonoscopies and associated health care resource utilization. OBJECTIVE: To estimate the rates of incident MAE at two, 14 and 30 days postcolonoscopy, and associated health care resource utilization. A secondary aim was to identify factors associated with cumulative 30-day MAE incidence. METHODS: A longitudinal cohort study was conducted among individuals undergoing an outpatient colonoscopy at the Montreal General Hospital (Montreal, Quebec). Before colonoscopy, consecutive individuals were enrolled and interviewed to obtain data regarding age, sex, comorbidities, use of antiplatelets/anticoagulants and previous symptoms. Endoscopy reports were reviewed for intracolonoscopy procedures (biopsy, polypectomy). Telephone or Internet follow-up was used to obtain data regarding MAEs (abdominal pain, bloating, diarrhea, constipation, nausea, vomiting, blood in the stools, rectal or anal pain, headaches, other) and health resource use (visits to emergency department, primary care doctor, gastroenterologist; consults with nurse, pharmacist or telephone hotline). Rates of incident MAEs and health resources utilization were estimated using Bayesian hierarchical modelling to account for patient clustering within physician practices. RESULTS: Of the 705 individuals approached, 420 (59.6%) were enrolled. Incident MAE rates at the two-, 14- and 30-day follow-ups were 17.3% (95% credible interval [CrI] 8.1% to 30%), 10.5% (95% CrI 2.9% to 23.7%) and 3.2% (95% CrI 0.01% to 19.8%), respectively. The 30-day rate of health resources utilization was 1.7%, with 0.95% of participants seeking the services of a physician. No predictors of the cumulative 30-day incidence of MAEs were identified. DISCUSSION: The incidence of MAEs was highest in the 48 h following colonoscopy and uncommon after two weeks, supporting the Canadian Association of Gastroenterology’s recommendation for assessment of late

  20. Utility of the National Death Index in Ascertaining Mortality in Acquired Immunodeficiency Syndrome Surveillance

    PubMed Central

    Trepka, Mary Jo; Maddox, Lorene M.; Lieb, Spencer; Niyonsenga, Theophile

    2011-01-01

    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. PMID:21540319

  1. Utility of the National Death Index in ascertaining mortality in acquired immunodeficiency syndrome surveillance.

    PubMed

    Trepka, Mary Jo; Maddox, Lorene M; Lieb, Spencer; Niyonsenga, Theophile

    2011-07-01

    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.

  2. Clinical and research utility of Spanish Teen-Addiction Severity Index (T-ASI).

    PubMed

    Díaz, Rosa; Castro-Fornieles, Josefina; Serrano, Lourdes; González, Laura; Calvo, Rosa; Goti, Javier; Kaminer, Yifrah; Gual, Antoni

    2008-01-01

    This paper aims to test the clinical and research utility of a Spanish version of the Teen-Addiction Severity Index (T-ASI) in adolescents with psychiatric disorders attending a treatment programme. Eighty adolescents, 12 to 17 years old (Mean=14.5; SD=1.48) were evaluated with a research battery including the T-ASI to obtain data on socio-demographics, psychopathology, drug use, family environment and school achievement. The Substance Use scale of the T-ASI correlated significantly (Rho=0.90, p

  3. Health care utilization of refugee children after resettlement.

    PubMed

    Watts, Delma-Jean; Friedman, Jennifer F; Vivier, Patrick M; Tompkins, Christine E A; Alario, Anthony J

    2012-08-01

    Refugee children can have significant health problems. Our objective was to describe health status and health care utilization of refugee children after resettlement. A retrospective chart review of refugee children was performed. Initial laboratory data was extracted. Primary care visits, emergency room visits, and subspecialty referrals in the first 15 months from arrival were recorded. The sample included 198 refugees, many with positive initial screening tests. After arrival, 21% had an emergency department visit, 40% had a primary care sick visit, and 71% had a primary care follow-up. Mean number of visits ranged from 0.3 for emergency department to 1.9 for follow-up. Fifty-seven percent were referred to at least one subspecialist. Refugee children had substantial disease burden at arrival. Most had primary care follow-up visits and subspecialty referral after resettlement. These visits were largely for problems identified on initial screening and for general pediatric illnesses.

  4. A carotenoid health index based on plasma carotenoids and health outcomes.

    PubMed

    Donaldson, Michael S

    2011-12-01

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

  5. Health Vulnerability Index and newborn hearing screening: urban inequality.

    PubMed

    Januário, Gabriela Cintra; Alves, Claudia Regina Lindgren; Lemos, Stela Maris Aguiar; Almeida, Maria Cristina de Mattos; Cruz, Ramon Costa; Friche, Amélia Augusta de Lima

    To analyze the intra-urban differentials related to the outcome of the Newborn Hearing Screening (NHS) of children living in Belo Horizonte tested in a reference service using the Health Vulnerability Index (HVI). cross-sectional study with children living in Belo Horizonte evaluated by a Newborn Hearing Screening Reference Service (NHSRS) between 2010 and 2011. The HVI of the census tract of each child was obtained by the georeferencing of their respective addresses. Multivariate analysis was conducted using the decision tree technique, considering a statistical model for each response. A thematic map of points representing the geographic distribution of the children evaluated by the NHS program was also developed. The NHS failure rate for children living in areas with very high HVI, or without HVI data, was 1.5 times higher than that for children living in other census tracts. For children living in areas of low, medium, and high HVI, who underwent NHS after 30 days of life, the NHS failure rate was 2.1 times higher in children that presented Risk Indicator for Hearing Loss (RIHL) (17.2%) than in those who did not (8.1%). Uneven distribution was observed between areas for children that underwent the NHS and those who failed it. Significant intra-urban differentials were found in Belo Horizonte, indicating correlation between health vulnerability and NHS outcomes.

  6. Caregiver burden, health utilities and institutional service costs among community-dwelling paients with Alzheimer's disease

    PubMed Central

    Miller, Edward Alan; Rosenheck, Robert A.; Schneider, Lon S.

    2014-01-01

    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

  7. Body Mass Index, Perceived Health, and Happiness: Their Determinants and Structural Relationships

    ERIC Educational Resources Information Center

    Cornelisse-Vermaat, Judith R.; Antonides, Gerrit; Van Ophem, Johan A. C.; Van Den Brink, Henriette Maassen

    2006-01-01

    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…

  8. Social determinants of mental health service utilization in Switzerland.

    PubMed

    Dey, Michelle; Jorm, Anthony Francis

    2017-01-01

    To investigate whether mental health services utilization in Switzerland is equitably distributed (i.e., predicted only by the need of a person). Data on 17,789 participants of the Swiss Health Survey 2012 (≥15 years) was analysed. Logistic regression analyses were conducted to predict: having been in treatment for a psychological problem; having used psychotropic medication; having had medical treatment for depression; and having visited a psychologist or psychotherapist. Need (depression severity and risky alcohol consumption) and socio-demographic variables were used as independent variables. Depression severity was the strongest predictor for using mental health services. In contrast, risky alcohol consumption was not associated with an increased likelihood of using mental health services. After adjusting for need, the following groups were less likely to use (some of) the mental health services: males, young people, participants who (almost) work full-time, single/unmarried, non-Swiss people and those living in rural areas. Education and income were not significantly associated with the outcomes in the adjusted analyses. Some socio-demographic subgroups are less likely to use mental health services despite having the same need.

  9. Supply-side barriers to maternal health care utilization at health sub-centers in India

    PubMed Central

    2016-01-01

    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

  10. Quality of life and health care utilization in patients with chronic respiratory diseases.

    PubMed

    Kurpas, D; Mroczek, B; Sitko, Z; Helicka, D; Kuchar, E

    2015-01-01

    High quality of life (QoL) may reduce the costs of medical care of chronically ill patients due to lower health care utilization. The purpose of this study was to establish the influence of the QoL of primary care patients with chronic respiratory diseases on the level of health care utilization and the predictors of hospitalization. The study group consisted of 594 adult patients with chronic respiratory diseases of the mean age 59.8±14.9 years. The highest QoL was observed in the social relationship domain and the lowest in the physical domain. Low QoL was associated with a low level of health care utilization among patients with chronic respiratory diseases. Most patients were hospitalized during the past 3 years. In a group of patients with chronic respiratory diseases, chances for hospitalization were: higher among patients with low QoL and health satisfaction, low QoL levels in the physical and social relationship domains, high QoL levels in the psychological domain, those with higher education, residents of rural areas, patients using frequent consultations over the phone, and those with at least an average index of services.

  11. Eliciting health state utilities for Dupuytren’s contracture using a discrete choice experiment

    PubMed Central

    2013-01-01

    Background and purpose An internet-based discrete choice experiment (DCE) was conducted to elicit preferences for a wide range of Dupuytren’s contracture (DC)-related health states. An algorithm was subsequently developed to convert these preferences into health state utilities that can be used to assess DC’s impact on quality of life and the value of its treatments. Methods Health state preferences for varying levels of DC hand severity were elicited via an internet survey from a sample of the UK adult population. Severity levels were defined using a combination of contractures (0, 45, or 90 degrees) in 8 proximal interphalangeal and metacarpophalangeal joints of the index, middle, ring, and little fingers. Right-handed, left-handed, and ambidextrous respondents indicated which hand was preferable in each of the 10 randomly-selected hand-pairings comparing different DC severity levels. For consistency across comparisons, anatomically precise digital hand drawings were used. To anchor preferences onto the traditional 0–1 utility scale used in health economic evaluations, unaffected hands were assigned a utility of 1.0 whereas the utility for a maximally affected hand (i.e., all 8 joints set at 90 degrees of contracture) was derived by asking respondents to indicate what combination of attributes and levels of the EQ-5D-5L profile most accurately reflects the impact of living with such hand. Conditional logistic models were used to estimate indirect utilities, then rescaled to the anchor points on the EQ-5D-5L. Results Estimated utilities based on the responses of 1,745 qualified respondents were 0.49, 0.57, and 0.63 for completely affected dominant hands, non-dominant hands, or ambidextrous hands, respectively. Utility for a dominant hand with 90-degree contracture in t h e metacarpophalangeal joints of the ring and little fingers was estimated to be 0.89. Separately, reducing the contracture of metacarpophalangeal joint for a little finger from 50 to 12

  12. Access to health: women's status and utilization of maternal health services in Nepal.

    PubMed

    Sharma, Sharad Kumar; Sawangdee, Yothin; Sirirassamee, Buppha

    2007-09-01

    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.

  13. Health-related quality of life in pediatric Chiari Type I malformation: the Chiari Health Index for Pediatrics.

    PubMed

    Ladner, Travis R; Westrick, Ashly C; Wellons, John C; Shannon, Chevis N

    2016-01-01

    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

  14. A systematic literature review of health state utility values in head and neck cancer.

    PubMed

    Meregaglia, Michela; Cairns, John

    2017-09-02

    Health state utility values (HSUVs) are essential parameters in model-based economic evaluations. This study systematically identifies HSUVs in head and neck cancer and provides guidance for selecting them from a growing body of health-related quality of life studies. We systematically reviewed the published literature by searching PubMed, EMBASE and The Cochrane Library using a pre-defined combination of keywords. The Tufts Cost-Effectiveness Analysis Registry and the School of Health and Related Research Health Utilities Database (ScHARRHUD) specifically containing health utilities were also queried, in addition to the Health Economics Research Centre database of mapping studies. Studies were considered for inclusion if reporting original HSUVs assessed using established techniques. The characteristics of each study including country, design, sample size, cancer subsite addressed and demographics of responders were summarized narratively using a data extraction form. Quality scoring and critical appraisal of the included studies were performed based on published recommendations. Of a total 1048 records identified by the search, 28 studies qualified for data extraction and 346 unique HSUVs were retrieved from them. HSUVs were estimated using direct methods (e.g. standard gamble; n = 10 studies), multi-attribute utility instruments (MAUIs; n = 13) and mapping techniques (n = 3); two studies adopted both direct and indirect approaches. Within the MAUIs, the EuroQol 5-dimension questionnaire (EQ-5D) was the most frequently used (n = 11), followed by the Health Utility Index Mark 3 (HUI3; n = 2), the 15D (n = 2) and the Short Form-Six Dimension (SF-6D; n = 1). Different methods and types of responders (i.e. patients, healthy subjects, clinical experts) influenced the magnitude of HSUVs for comparable health states. Only one mapping study developed an original algorithm using head and neck cancer data. The identified studies were considered

  15. [Health services utilization by the immigrant population in Spain].

    PubMed

    Regidor, Enrique; Sanz, Belén; Pascual, Cruz; Lostao, Lourdes; Sánchez, Elisabeth; Díaz Olalla, José Manuel

    2009-12-01

    To compare health services utilization between the immigrant and indigenous populations in Spain. We used information provided by the following four health surveys carried out around 2005: Catalonia 2005; city of Madrid 2005, Canary Islands 2004 and the Autonomous Community of Valencia 2005. The health services studied were general practice, specialist services, emergency services, hospitalization, and two preventive services: pap smear test and mammography. In general, most health services were less frequently used by the immigrant population than by the Spanish population. The health services showing the least differences between the two populations were general practice and hospitalization, while the greatest differences were found in the use of specialist and preventive services. The most heterogeneous results were found in general practice and hospitalization, since some immigrant groups showed a relatively high frequency of use in some geographical areas and a relatively low frequency in other areas. The results of the present study reproduce those found in other studies carried out in countries with similar social and economic characteristics to Spain. Like previous results, the present results are difficult to explain. Future research should aim to use other study designs and to test hypotheses not put forward by the scientific community to date.

  16. Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

    ERIC Educational Resources Information Center

    Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.

    2008-01-01

    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…

  17. The Prostate Health Index Selectively Identifies Clinically Significant Prostate Cancer

    PubMed Central

    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.

    2015-01-01

    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

  18. Predicting Health Utilities for Children with Autism Spectrum Disorders

    PubMed Central

    Payakachat, Nalin; Tilford, J. Mick; Kuhlthau, Karen A.; van Exel, N. Job; Kovacs, Erica; Bellando, Jayne; Pyne, Jeffrey M.; Brouwer, Werner BF

    2014-01-01

    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

  19. Sarcopenia and Health Care Utilization in Older Women.

    PubMed

    Cawthon, Peggy M; Lui, Li-Yung; McCulloch, Charles E; Cauley, Jane A; Paudel, Misti L; Taylor, Brent; Schousboe, John T; Ensrud, Kristine E

    2017-01-01

    Although there are several consensus definitions of sarcopenia, their association with health care utilization has not been studied. We included women from the prospective Study of Osteoporotic Fractures with complete assessment of sarcopenia by several definitions at the Study of Osteoporotic Fractures Year 10 (Y10) exam (1997-1998) who also had available data from Medicare Fee- For-Service Claims (N = 566) or Kaiser Encounter data (N = 194). Sarcopenia definitions evaluated were: International Working Group, European Working Group for Sarcopenia in Older Persons, Foundation for the NIH Sarcopenia Project, Baumgartner, and Newman. Hurdle models and logistic regression were used to assess the relation between sarcopenia status (the summary definition and the components of slowness, weakness and/or lean mass) and outcomes that included hospitalizations, cumulative inpatient days/year, short-term (part A paid) skilled nursing facility stay in the 3 years following the Y10 visit. None of the consensus definitions, nor the definition components of weakness or low lean mass, was associated with increased risk of hospitalization or greater likelihood of short-term skilled nursing facility stay. Women with slowness by any criterion definition were about 50% more likely to be hospitalized; had a greater rate of hospitalization days amongst those hospitalized; and had 1.8 to 2.1 times greater likelihood of a short-term skilled nursing facility stay than women without slowness. There was the suggestion of a protective association of low lean mass by the various criterion definitions on short-term skilled nursing facility stay. Estimated effects of sarcopenia on health care utilization were negligible. However, slowness was associated with greater health care utilization. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. [Systematic review of health-related utilities in Spain: the case of mental health].

    PubMed

    García-Pérez, Lidia; Aguiar-Ibáñez, Raquel; Pinilla-Domínguez, Pilar; Arvelo-Martín, Alejandro; Linertová, Renata; Rivero-Santana, Amado

    2014-01-01

    Currently, there is no registry of utility values for the Spanish population that could potentially be used in economic evaluations. Consequently, a systematic review of utilities or preferences for health states in the Spanish population was conducted. The results related to mental health are reported. A systematic review of the literature was conducted. The main databases searched were MEDLINE, CRD, Embase, PsycINFO, CINAHL, and Cochrane. The search strategy combined terms related to utilities and Spain. The inclusion criteria comprised the resident population in Spain, whether affected by any disease or not; the reported utilities had to be evaluated through a tool validated in Spain (i.e., EQ-5D, HUI, SF-6D) and/or following accepted techniques (e.g., time trade-off, standard gamble, or the visual analog scale). A narrative synthesis of articles was undertaken and the results related to mental health summarized. A total of 103 articles were finally included, from which 742 utility values were extracted. Sixty-nine utility values related to mental health and behavioral disorders were extracted from 12 studies. The most widely used tool was the E5-QD questionnaire. Most of the excluded articles evaluated quality of life but did not provide an estimation of utilities. This review adds value to research on utilities in Spain by gathering values to be included in economic evaluations, as well as by identifying research gaps in this field. The utility values related to mental health identified in this study are similar to those reported in international publications. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  1. Developing a measure of engagement with telehealth systems: The mHealth Technology Engagement Index.

    PubMed

    Dewar, Alexis R; Bull, Tyler P; Malvey, Donna M; Szalma, James L

    2017-02-01

    Introduction Telehealth systems and mobile health (mHealth) devices allow for the exchange of both physical and mental healthcare data, as well as information from a patient to a practitioner, or care recipient to caregiver; but there has been little research on why users are motivated to engage with telehealth systems. Given this, we sought to create a measure that satisfactorily assesses human motivation to use telehealth devices. Methods 532 survey responses were used in an exploratory factor analysis and confirmatory factor analysis, which tested and retested the feasibility of this new measure. Convergent and divergent validity analyses indicated that the mHealth Technology Engagement Index (mTEI) is a unique measure of motivation. Results The results indicated that autonomy, competence, relatedness, goal attainment, and goal setting underpin motivation to use telehealth systems. Discussion The mTEI shows promise in indexing human motivation to use telehealth technologies. We also discuss the importance of developing measurement tools based on theory and how practitioners can best utilize the mTEI.

  2. Estimating a preference-based index for a menopause specific health quality of life questionnaire

    PubMed Central

    Brazier, John E; Roberts, Jennifer; Platts, Maria; Zoellner, York F

    2005-01-01

    Background The aim of the study was to develop a menopause-specific, preference-based health-related quality-of-life (HRQoL) index reflecting both menopausal symptoms and potential side-effects of Hormone Replacement Therapy (HRT). Methods The study had three phases: the development of a health state classification, a prospective valuation survey and the estimation of a model to interpolate HRQoL indices for all remaining health states as defined by the classification. A menopausal health state classification was developed with seven dimensions: hot flushes, aching joints/muscles, anxious/frightened feelings, breast tenderness, bleeding, vaginal dryness and undesirable androgenic signs. Each dimension contains between three and five levels and defines a total of 6,075 health states. A sample of 96 health states was selected for the valuation survey. These states were valued by a sample of 229 women aged 45 to 60, randomly selected from 6 general practice lists in Sheffield, UK. Respondents were asked to complete a time trade-off (TTO) task for nine health states, resulting in an average of 16.5 values for each health state. Results Mean health states valued range from 0.48 to 0.98 (where 1.0 is full health and zero is for states regarded as equivalent to death). Symptoms, as described by the classification system, can be rank-ordered in terms of their impact (from high to low) on menopausal HRQoL as follows: aching joints and muscles, bleeding, breast tenderness, anxious or frightened feelings, vaginal dryness, androgenic signs. Hot flushes did not significantly contribute to model fit. The preferred model produced a mean absolute error of 0.053, but suffered from bias at both ends of the scale. Conclusion This article presents an attempt to directly value a condition specific health state classification. The overall fit was disappointing, but the results demonstrate that menopausal symptoms are perceived by patients to have a significant impact on utility. The

  3. Gendered utilization differences of mental health services in Jordan.

    PubMed

    Al-Krenawi, A; Graham, J R; Kandah, J

    2000-10-01

    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.

  4. Health care resource utilization before and after natalizumab initiation among patients with multiple sclerosis in Germany

    PubMed Central

    Watson, Crystal; Prosser, Christine; Braun, Sebastian; Landsman-Blumberg, Pamela B; Gleissner, Erika; Naoshy, Sarah

    2017-01-01

    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

  5. Asthma Symptom Utility Index: Reliability, validity, responsiveness and the minimal important difference in adult asthma patients

    PubMed Central

    Bime, Christian; Wei, Christine Y.; Holbrook, Janet T.; Sockrider, Marianna M.; Revicki, Dennis A.; Wise, Robert A.

    2012-01-01

    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

  6. The Utility of the MMPI-2 Malingering Discriminant Function Index in the Detection of Malingering: A Study of Criminal Defendants

    ERIC Educational Resources Information Center

    Toomey, Joseph A.; Kucharski, L. Thomas; Duncan, Scott

    2009-01-01

    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…

  7. The Utility of the MMPI-2 Malingering Discriminant Function Index in the Detection of Malingering: A Study of Criminal Defendants

    ERIC Educational Resources Information Center

    Toomey, Joseph A.; Kucharski, L. Thomas; Duncan, Scott

    2009-01-01

    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…

  8. [Mental health service utilization among borderline personality disorder patients inpatient].

    PubMed

    Cailhol, L; Thalamas, C; Garrido, C; Birmes, P; Lapeyre-Mestre, M

    2015-04-01

    Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability and impulsivity. Several North American prospective studies support the high level of mental health care utilization in this population. There is little data in other systems of health organization, such as France. Furthermore, little is known on the variables associated with the mental health service utilization among BPD patients. The main objective was to compare the utilization of mental health care among BPD patients, to the general population and patients with another personality disorder (PD) and to describe the demographic and clinical factors associated with the group of patients who use the most health care. A multi-center (5 public and private centers), epidemiological study. Data were collected prospectively (database of an insurance fund covering 80% of the population) and viewed, retrospectively. We used the data collected during the five years previously to the inclusion. Inclusion criteria were age (18-60 years) and membership in the health insurance fund targeted. Patients on legal protection, forced hospitalization, with a chronic psychotic disorder, manic, mental retardation, or not reading French were excluded. First, four groups were composed: BPD, other PD, control groups for PD and other PD. The first two groups were recruited from a screening of inpatients including a self-administered questionnaire (Personality Disorder Questionnaire 4+). Assessment by a psychologist including the Structured Interview for DSM-IV Personality Disorders (SIDP-IV) was given straight to those who had a score above 28. This questionnaire allowed us to distinguish one group of subjects with BPD and a group with other PD (without BPD). Clinical evaluation included Axis I (MINI), Axis II (SIDP-IV), psychopathological features (YSQ-I, DSQ-40), demographic variables and therapeutic alliance (Haq-II). Matched controls (age, sex) composed the 3rd and 4th group (BPD control and

  9. [Variability in Spanish National Health System hospital emergency services utilization].

    PubMed

    Peiró, Salvador; Librero, Julián; Ridao, Manuel; Bernal-Delgado, Enrique

    2010-01-01

    The aims of this study were to estimate the rate of hospital emergency services (HES) visits per health area, the associated percentage of admissions and the standardized HES utilization ratio, and to analyze their relationship with hospital resources. We performed an ecological study that combined information from distinct sources (Survey of Health Care Hospitalization Establishments 2006 and Minimum Data Set 2006) to estimate the rate of HES visits and the percentage of associated emergency admissions in 164 health areas in 14 autonomous communities (AC). Among 35.3 million inhabitants in the 164 areas examined, there were 16.2 million visits to the HES (45.75 per 100 inhabitants); more than 2 million (12.6%) were hospitalized. Excluding 5% of extreme areas, rates oscillated between 31.60 and 78.69 HES visits/100 inhabitants, and the percentage of admissions was between 7.6% and 27.9%. These differences were not attenuated after standardization. The AC factor explained 29% of variance in HES visits and 82% of variance in admissions. The rate of visits was not associated with the number of beds or staff physicians but did correlate with the number HES doctors, and smaller and non-teaching hospitals. There is wide variability in the rates of HES visits and emergency admissions in the different areas of the Spanish National Health System. This variability seems to be associated with a differential use for minor problems. Copyright 2009 SESPAS. Published by Elsevier Espana. All rights reserved.

  10. [Campylobacter and Salmonella acute gastroenteritis: epidemiology and health care utilization].

    PubMed

    Sala Farré, Maria Rosa; Osorio Sánchez, Dimelza; Arias Varela, Cesar; Simó Sanahuja, Maria; Recasens Recasens, Assumpta; Pérez Jové, Josefa

    2015-10-05

    In Catalonia the current surveillance systems do not allow to know the true incidence or the health care utilization of acute gastroenteritis (AGE) caused by Campylobacter and Salmonella infections. The aim of this study is to analyze these characteristics. Descriptive study of Campylobacter and Salmonella infections reported in 2002 and 2012 in Catalonia, Spain. We included cases isolated and reported by the laboratory to a regional Surveillance Unit. The estimated incidence of Salmonella and Campylobacter AGE decreased by almost 50% and 20% respectively in 2012. Children between one and 4 years old were the most affected in both years. Significant differences in the clinical characteristics and disease duration were observed between Campylobacter and Salmonella. Visits to the Emergency Department and hospitalization rates were 63.7% and 15%, being more frequent among salmonellosis cases. The estimated incidence of Campylobacter and Salmonella infections has decreased, however rates are still important, as well as it is the health care utilization in both diseases. Current surveillance systems need appropriateness improvements to reach a better control of these infections. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  11. Gender of physician as the usual source of care and patient health care utilization and mortality.

    PubMed

    Jerant, Anthony; Bertakis, Klea D; Fenton, Joshua J; Franks, Peter

    2013-01-01

    Practice styles differ by provider gender, but whether provider gender influences health care utilization and mortality is unknown. The objective of this study was to examine associations of the gender of a patient's usual source of health care (USOC) with health care utilization and mortality. This was a prospective observational study employing data from respondents aged ≥18 years entering the 2002 to 2008 United States Medical Expenditure Panel Surveys, reporting a USOC at entry, and participating for 2 years (N = 21,365). Analyses examined the association of gender of the USOC in survey participation year 1 with the following health care utilization outcomes in participation year 2: total health care expenditures, prescription drug expenditures, and number of office visits (Poisson regressions) and having more than one emergency visit and more than one hospitalization (logistic regressions). A Cox regression examined survival (ascertained via linkage with the National Death Index) through 2006 for the subset of respondents enrolled from 2002 to 2006 (n = 11,328). All analyses were adjusted for respondent sociodemographic and health characteristics and USOC specialty and race/ethnicity. Reporting a female USOC was associated with being younger, female, and urban. There were no significant adjusted associations of female USOC status with total expenditures (parameter estimate of increase [PE], 4.56%; 95% confidence interval [CI], -3.04 to 12.76), prescription expenditures (PE, 3.33% ; 95% CI, -4.32 to 11.59), number of office visits (PE, 1.28%; 95% CI, -3.30 to 6.08), having more than one emergency visit (odds ratio, 0.98; 95% CI, 0.87-1.11), having more than one hospitalization (odds ratio, 0.98; 95% CI, 0.87-1.11), or mortality (hazard ratio, 0.94; 95% CI, 0.64-1.38). Gender of the USOC was not associated with health care utilization or mortality. These findings suggest reported gender of the USOC may not have nationally important effects on health care

  12. Periodontal health, perceived oral health, and dental care utilization of breast cancer survivors.

    PubMed

    Taichman, L Susan; Griggs, Jennifer J; Inglehart, Marita R

    2015-01-01

    This population-based analysis examined the prevalence of periodontal diseases along with the self-perceived oral health and patterns of dental care utilization of breast cancer survivors in the United States. Data from the 1999-2004 National Health and Nutrition Surveys were utilized, examining information from 3,354 women between 50 and 85 years of age. Primary outcomes were gingivitis and periodontitis, self-perceived oral health, and dental care utilization. Logistic regression analyses were used to estimate relationships of breast cancer diagnosis and primary outcomes while controlling for confounding factors. Breast cancer survivors were more likely to be older than 55 years, white, nonsmokers, have higher levels of education and income, and a higher prevalence of osteoporosis. Breast cancer survivors were significantly less likely to have dental insurance (P = 0.04). Utilization of dental services and reason for last dental visit did not significantly differ between groups. A history of a breast cancer diagnosis did not increase the odds of gingivitis [odds ratio (OR):  1.32; 95 percent confidence interval (CI): 0.53-3.63], periodontitis (OR: 1.82; 95 percent CI:  0.89-4.01), or poor self-perceived oral health (OR: 0.89; 95 percent CI: 0.61-1.33) after adjusting for age, race, education, dental care utilization, and smoking status. In this sample, a history of breast cancer does not significantly impact periodontal health, self-perceived oral health, and dental care utilization. However, efforts should be made to assure that breast cancer survivors have dental insurance. © 2015 American Association of Public Health Dentistry.

  13. Maternal autonomy and child health care utilization in India: results from the National Family Health Survey.

    PubMed

    Malhotra, Chetna; Malhotra, Rahul; Østbye, Truls; Subramanian, S V

    2014-07-01

    The objective of this study was to examine the association of maternal autonomy with preventive and curative child health care utilization in India. Data from the National Family Health Survey 2005-2006 were used to ascertain association of maternal autonomy (in 3 dimensions: decision making, access to financial resources, freedom of movement) with child's primary immunization status (indicative of preventive health care use) and treatment seeking for child's acute respiratory infection (indicative of curative health care use). Low maternal freedom of movement was associated with higher odds of incomplete primary immunization of the child and for not seeking treatment for the child's acute respiratory infection. Low maternal financial access was associated with increased odds for incomplete primary immunization of the child. The findings show that improvement in autonomy of Indian mothers, especially their freedom of movement, may help improve utilization of health care for their children. © 2012 APJPH.

  14. A Carotenoid Health Index Based on Plasma Carotenoids and Health Outcomes

    PubMed Central

    Donaldson, Michael S.

    2011-01-01

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

  15. How to enhance public health service utilization in community pharmacy?: general public and health providers' perspectives.

    PubMed

    Saramunee, Kritsanee; Krska, Janet; Mackridge, Adam; Richards, Jacqueline; Suttajit, Siritree; Phillips-Howard, Penelope

    2014-01-01

    Community pharmacists (PHs) in England are increasingly providing a range of public health services. However, the general public view pharmacists as drug experts and not experts in health, and therefore, services may be underutilized. To explore experiences and views of 4 groups of participants, the general public, PHs, general practitioners (GPs), and other stakeholders (STs) on pharmacy-based public health services, and identify potential factors affecting service use. The study was undertaken in a locality of North West England. Three focus groups were conducted with the general public (n=16), grouped by socioeconomic status. Fourteen semistructured interviews were undertaken with PHs (n=9), GPs (n=2), and STs (n=3). Discussions/interviews were audio recorded, transcribed verbatim, and analyzed thematically. All 4 groups of participants agreed that community pharmacies are a good source of advice on medicines and minor ailments but were less supportive of public health services. Six factors were identified affecting utilization of pharmacy services: community pharmacy environment, pharmacist and support staff, service publicity, general public, GP services, and health care system and policies. Crucial obstacles that could inhibit service utilization are perceptions of both the general public and other health providers toward pharmacists' competencies, privacy and confidentiality in pharmacies, high dispensing workload, and inadequate financial support. Networking between local health professionals could enhance confidence in service delivery, general awareness, and thus utilization. Community pharmacy has the potential to deliver public health services, although the impact on public health may be limited. Addressing the factors identified could help to increase utilization and impact of pharmacy public health services. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Index of cardiometabolic health: a new method of measuring allostatic load using electronic health records.

    PubMed

    Nobel, Lisa; Roblin, Douglas W; Becker, Edmund R; Druss, Benjamin G; Joski, Peter I; Allison, Jeroan J

    2017-07-01

    We developed a measure of allostatic load from electronic medical records (EMRs), which we named "Index of Cardiometabolic Health" (ICMH). Data were collected from participants' EMRs and a written survey in 2005. We computed allostatic load scores using the ICMH score and two previously described approaches. We included 1865 employed adults who were 25-59 years old. Although the magnitude of the association was small, all methods of were predictive of SF-12 physical component subscales (all p < 0.001). We found that the ICMH had similar relationships with health-related quality of life as previously reported in the literature.

  17. Health state utilities and quality of life in patients with hepatitis B

    PubMed Central

    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

    2012-01-01

    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

  18. Utility of bispectral index in the management of multiple trauma patients

    PubMed Central

    Mahmood, Saeed; Parchani, Ashok; El-Menyar, Ayman; Zarour, Ahmad; Al-Thani, Hassan; Latifi, Rifat

    2014-01-01

    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

  19. Determination of the refractive index of microparticles by utilizing light dispersion properties of the particle and an immersion liquid.

    PubMed

    Niskanen, I; Räty, J; Peiponen, K E

    2013-10-15

    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.

  20. Knowledge and utilization of computer among health workers in Addis Ababa hospitals, Ethiopia: computer literacy in the health sector

    PubMed Central

    2013-01-01

    Background Incorporation of information technology advancements in healthcare has gained wide acceptance in the last two decades. Developed countries have successfully incorporated information technology advancements in their healthcare system thus, improving healthcare. However, only a limited application of information technology advancements is seen in developing countries in their healthcare system. Hence, this study was aimed at assessing knowledge and utilization of computer among health workers in Addis Ababa hospitals. Methods A quantitative cross-sectional study was conducted among 304 health workers who were selected using stratified sampling technique from all governmental hospitals in Addis Ababa. Data was collected from April 15 to April 30, 2010 using a structured, self-administered, and pre-tested questionnaire from five government hospitals in Addis Ababa. The data was entered into Epi Info version 3.5.1 and exported to SPSS version 16. Analysis was done using multinomial logistic regression technique. Results A total of 270 participants, age ranging from 21 to 60 years responded to the survey (88.8% response rate). A total of 91 (33.7%) respondents had an adequate knowledge of computers while 108 (40.0%) had fair knowledge and 71(26.3%) of the respondents showed inadequate knowledge. A total of 38(14.1%) were adequately utilizing computers, 14(5.2%) demonstrated average or fair utilization and majority of the respondents 218(80.7%) inadequately utilized computers. Significant predictor variables were average monthly income, job satisfaction index and own computer possession. Conclusions Computer knowledge and utilization habit of health workers were found to be very low. Increasing accessibility to computers and delivering training on the use of computers for workers will increases the knowledge and utilization of computers. This will facilitate the rate of diffusion of the technology to the health sector. Hence, programs targeted at enhancing

  1. Mental Health Services Utilization and Expenditures Among Children Enrolled in Employer-Sponsored Health Plans.

    PubMed

    Walter, Angela Wangari; Yuan, Yiyang; Cabral, Howard J

    2017-05-01

    Mental illness in children increases the risk of developing mental health disorders in adulthood, and reduces physical and emotional well-being across the life course. The Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) aimed to improve access to mental health treatment by requiring employer-sponsored health plans to include insurance coverage for behavioral health services. Investigators used IBM Watson/Truven Analytics MarketScan claims data (2007-2013) to examine: (1) the distribution of mental illness; (2) trends in utilization and out-of-pocket expenditures; and (3) the overall effect of the MHPAEA on mental health services utilization and out-of-pocket expenditures among privately-insured children aged 3 to 17 with mental health disorders. Multivariate Poisson regression and linear regression modeling techniques were used. Mental health services use for outpatient behavioral health therapy (BHT) was higher in the years after the implementation of the MHPAEA (2010-2013). Specifically, before the MHPAEA implementation, the annual total visits for BHT provided by mental health physicians were 17.1% lower and 2.5% lower for BHT by mental health professionals, compared to years when MHPAEA was in effect. Children covered by consumer-driven and high-deductible plans had significantly higher out-of-pocket expenditures for BHT compared to those enrolled PPOs. Our findings demonstrate increased mental health services use and higher out-of-pocket costs per outpatient visit after implementation of the MHPAEA. As consumer-driven and high-deductible health plans continue to grow, enrollees need to be cognizant of the impact of health insurance benefit designs on health services offered in these plans. Copyright © 2017 by the American Academy of Pediatrics.

  2. Patterns of Mental Health Care Utilization Among Sexual Orientation Minority Groups.

    PubMed

    Platt, Lisa F; Wolf, Julia Kay; Scheitle, Christopher P

    2017-03-27

    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.

  3. A case-control study of home foreclosure, health conditions, and health care utilization.

    PubMed

    Pollack, Craig Evan; Kurd, Shanu K; Livshits, Alice; Weiner, Mark; Lynch, Julia

    2011-06-01

    Though rates of foreclosure are at a historic high, relatively little is known about the link between foreclosure and health. We performed a case-control study to examine health conditions and health care utilization in the time period prior to foreclosure. Homeowners who received a home foreclosure notice from 2005 to 2008 were matched (by name and address) to a university hospital system in Philadelphia and compared with controls who received care from the hospital system and who lived in the same zip code as cases. Outcome measures included prevalent health conditions and visit history in the 2 years prior to foreclosure. We found that people undergoing foreclosure were similar to controls with regard to age, gender, and insurance status but significantly more likely to be African American. Rates of hypertension and renal disease were significantly higher among cases after adjustment for sociodemographic characteristics. In the 2 years prior to foreclosure, cases were more likely to visit the emergency department, have an outpatient visit, and have a no-show appointment. Cases were less likely to have a primary care physicians (PCP) visit in the 6 months immediately prior to the receipt of a foreclosure notice. The results suggest changes in health care utilization in the time period prior to foreclosure. Policies designed to decrease the incidence of home foreclosure and support people during the process should consider its association with poor health and changes in health care utilization.

  4. Psychological Distress Among Older Prisoners: Associations With Health, Health Care Utilization, and the Prison Environment.

    PubMed

    Baidawi, Susan; Trotter, Christopher

    2016-10-01

    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.

  5. Estimating the effect of changes in body mass index on health state preferences.

    PubMed

    Hakim, Zafar; Wolf, Anne; Garrison, Louis P

    2002-01-01

    To investigate the effect of changes in body mass index (BMI) on health state preferences (HSP). Multiple regression analysis on pooled data from a clinical study, predicting final HSP as a function of changes in BMI and initial HSP, controlling for age and gender. Subgroup analyses according to clinically relevant subgroups were performed. Primary care practice sites. 402 obese patients of varying disease severity. BMI was operationalised as (weight in kilograms)/ (height in metres)(2). HSP were measured directly as visual analogue scale (VAS) scores, and converted to time trade-off (TTO) scores. A one unit decrease in BMI over a 1-year period was associated with a 0.017 gain in utility units (utils). This estimate is comparable to utility gains observed for other widely used treatments (e.g. revascularisation for intermittent claudication, renal transplantation). It varies little over the observed range of VAS to TTO conversion values, and is a conservative estimate compared with using the unconverted VAS scores. If attempts to use weight reduction treatment in only the patients who successfully meet strict weight reduction targets are successful, the gain in HSP experienced by such patients may exceed this estimate. Patients with BMI values >or=28 with hyperglycaemia appear to have the greatest gain in HSP for a given change in BMI over 1 year. The effect of weight reduction on HSP can be significant, at least in the short term. Estimates of HSP changes presented herein may be useful in economic evaluations of weight reduction treatments.

  6. Methods to Calculate the Heat Index as an Exposure Metric in Environmental Health Research

    PubMed Central

    Bell, Michelle L.; Peng, Roger D.

    2013-01-01

    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

  7. Mental Health and High-Cost Health Care Utilization: New Evidence from Axis II Disorders

    PubMed Central

    Maclean, Johanna Catherine; Xu, Haiyong; French, Michael T; Ettner, Susan L

    2014-01-01

    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

  8. Utilizing Health Analytics in Improving Emergency Room Performance.

    PubMed

    Khalifa, Mohamed

    2016-01-01

    Emergency room performance improvement has been a major concern for healthcare professionals and researchers. ER patients' length of stay and percentage of patients leaving without treatment are two of the most important indicators for performance monitoring and improvement. The main objective of this study is to utilize health analytics methods in identifying areas of deficiency, potential improvements and recommending effective solutions to enhance ER performance. ER data of 2014 were retrospectively retrieved in January 2015 and analyzed for significant variables affecting inpatient admission rates. Patient Acuity Level was the significant variable on which the recommendations were based. A Fast-Track area was redesigned and dedicated for managing lower acuity level patients; CTAS levels 4 and 5. The performance of the ER has been monitored for the first six months of 2015 and compared to 2014. 29% improvement was achieved on shortening the total ER LOS and 30% improvement was achieved on the percentage of patients leaving ER without treatment.

  9. Index of Graduate Theses and Projects in Allied Health.

    ERIC Educational Resources Information Center

    Journal of Allied Health, 1991

    1991-01-01

    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…

  10. Index of Graduate Theses and Projects in Allied Health.

    ERIC Educational Resources Information Center

    Journal of Allied Health, 1991

    1991-01-01

    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…

  11. Soil vital signs: A new Soil Quality Index (SQI) for assessing forest soil health

    Treesearch

    Michael C. Amacher; Katherine P. O' Neil; Charles H. Perry

    2007-01-01

    The Forest Inventory and Analysis (FIA) program measures a number of chemical and physical properties of soils to address specific questions about forest soil quality or health. We developed a new index of forest soil health, the soil quality index (SQI), that integrates 19 measured physical and chemical properties of forest soils into a single number that serves as...

  12. Excess Stress Fractures, Musculoskeletal Injuries, and Health Care Utilization Among Unfit and Overweight Female Army Trainees.

    PubMed

    Krauss, Margot R; Garvin, Nadia U; Boivin, Michael R; Cowan, David N

    2017-02-01

    Musculoskeletal injuries are prevalent among military trainees and certain occupations. Fitness and body mass index (BMI) have been associated with musculoskeletal conditions, including stress fractures. The incidence of, and excess health care utilization for, stress fracture and non-stress fracture overuse musculoskeletal injuries during the first 6 months of service is higher among unfit female recruits. Those who exceeded body fat limits are at a greater risk of incident stress fractures, injuries, or health care utilization compared with weight-qualified recruits. Cohort study; Level of evidence, 3. All applicants to the United States Army were required to take a preaccession fitness test during the study period (February 2005-September 2006). The test included a 5-minute step test scored as pass or fail. BMI was recorded at application. There were 2 distinct comparisons made in this study: (1) between weight-qualified physically fit and unfit women and (2) between weight-qualified physically fit women and those who exceeded body fat limits. We compared the incidence of, and excess health care utilization for, musculoskeletal injuries, including stress fractures and physical therapy visits, during the first 183 days of military service. Among the weight-qualified women, unfit participants had a higher non-stress fracture injury incidence and related excess health care utilization rate compared with fit women, with rate ratios of 1.32 (95% CI, 1.14-1.53) and 1.18 (95% CI, 1.10-1.27), respectively. Among fit women, compared with the weight-qualified participants, those exceeding body fat limits had higher rate ratios for non-stress fracture injury incidence and related excess health care utilization of 1.27 (95% CI, 1.07-1.50) and 1.20 (95% CI, 1.11-1.31), respectively. Weight-qualified women who were unfit had a higher incidence of stress fractures and related excess health care utilization compared with fit women, with rate ratios of 1.62 (95% CI, 1

  13. Personal health record use for children and health care utilization: propensity score-matched cohort analysis.

    PubMed

    Zhou, Yi Yvonne; Leith, Wendy M; Li, Hui; Tom, Jeffrey O

    2015-07-01

    To examine the association between caregiver personal health record (PHR) use and health care utilization by pediatric patients. We conducted a retrospective observational cohort study of 2286 pediatric members aged six months to 2.5 years of Kaiser Permanente Hawaii and Northwest Regions in 2007-2011, using propensity score matching methods and t and chi-square tests to examine associations between PHR use and health care utilization. We used ANOVA to examine utilization across quartiles of PHR use. Outpatient clinic visits, telephone encounters, and emergency department visits. PHR-registered children, compared with propensity score-matched nonregistered children, had 21% (95% CI, 14-28; P < .0001) more outpatient clinic visits and 26% (95% CI, 16-37; P < .0001) more telephone encounters. Utilization differences were more pronounced with nonprimary care providers than with primary care providers. Outpatient clinic visits and telephone encounters increased among the quartile with the highest PHR use; no utilization differences occurred in the 3 lowest-use quartiles. PHR use by caregivers was associated with statistically significant increases in outpatient clinic visits and telephone encounters among pediatric patients. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening.

    PubMed

    Davies, Jane H; Kenkre, Joyce; Williams, E Mark

    2014-04-17

    Peripheral arterial disease (PAD) is a marker of systemic atherosclerosis and associated with a three to six fold increased risk of death from cardiovascular causes. Furthermore, it is typically asymptomatic and under-diagnosed; this has resulted in escalating calls for the instigation of Primary Care PAD screening via Ankle Brachial Index (ABI) measurement. However, there is limited evidence regarding the feasibility of this and if the requisite core skills and knowledge for such a task already exist within primary care. This study aimed to determine the current utility of ABI measurement in general practices across Wales, with consideration of the implications for its use as a cardiovascular risk screening tool. A self-reporting questionnaire was distributed to all 478 General Practices within Wales, sent via their responsible Health Boards. The survey response rate was 20%. ABI measurement is primarily performed by nurses (93%) for the purpose of wound management (90%). It is infrequently (73% < 4 times per month) and often incorrectly used (42% out of compliance with current ABI guidance). Only 52% of general practitioners and 16% of nurses reported that patients with an ABI of ≤ 0.9 require aggressive cardiovascular disease risk factor modification (as recommended by current national and international guidelines). ABI measurement is an under-utilised and often incorrectly performed procedure in the surveyed general practices. Prior to its potential adoption as a formalised screening tool for cardiovascular disease, there is a need for a robust training programme with standardised methodology in order to optimise accuracy and consistency of results. The significance of a diagnosis of PAD, in terms of associated increased cardiovascular risk and the necessary risk factor modification, needs to be highlighted.

  15. Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

    ERIC Educational Resources Information Center

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

    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…

  16. Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

    ERIC Educational Resources Information Center

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

    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…

  17. Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

    PubMed Central

    Lin, Junji; Li, Yunfeng; Tian, Haijun; Goodman, Michael J; Gabriel, Susan; Nazareth, Tara; Turner, Stuart J; Arcona, Stephen; Kahler, Kristijan H

    2014-01-01

    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

  18. Impact of high-deductible health plans on health care utilization and costs.

    PubMed

    Waters, Teresa M; Chang, Cyril F; Cecil, William T; Kasteridis, Panagiotis; Mirvis, David

    2011-02-01

    High-deductible health plans (HDHPs) are of high interest to employers, policy makers, and insurers because of potential benefits and risks of this fundamentally new coverage model. To investigate the impact of HDHPs on health care utilization and costs in a heterogeneous group of enrollees from a variety of individual and employer-based health plans. Claims and member data from a major insurer and zip code-level census data. Retrospective difference-in-differences analyses were used to examine the impact of HDHP plans. This analytical approach compared changes in utilization and expenditures over time (2007 versus 2005) across the two comparison groups (HDHP switchers versus matched PPO controls). In two-part models, HDHP enrollment was associated with reduced emergency room use, increases in prescription medication use, and no change in overall outpatient expenditures. The impact of HDHPs on utilization differed by subgroup. Chronically ill enrollees and those who clearly had a choice of plans were more likely to increase utilization in specific categories after switching to an HDHP plan. Whether HDHPs are associated with lower costs is far from settled. Various subgroups of enrollees may choose HDHPs for different reasons and react differently to plan incentives. © Health Research and Educational Trust.

  19. Energy Utilization and Environmental Health: Methods for Prediction and Evaluation of Impact on Human Health.

    ERIC Educational Resources Information Center

    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…

  20. Energy Utilization and Environmental Health: Methods for Prediction and Evaluation of Impact on Human Health.

    ERIC Educational Resources Information Center

    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…

  1. Health Seeking Behaviour and Utilization of Health Facilities for Schistosomiasis-Related Symptoms in Ghana

    PubMed Central

    Danso-Appiah, Anthony; Stolk, Wilma A.; Bosompem, Kwabena M.; Otchere, Joseph; Looman, Caspar W. N.; Habbema, J. Dik F.; de Vlas, Sake J.

    2010-01-01

    Background Schistosomiasis causes long-term illness and significant economic burden. Morbidity control through integration within existing health care delivery systems is considered a potentially sustainable and cost-effective approach, but there is paucity of information about health-seeking behaviour. Methods A questionnaire-based study involving 2,002 subjects was conducted in three regions of Ghana to investigate health-seeking behaviour and utilization of health facilities for symptoms related to urinary (blood in urine and painful urination) and intestinal schistosomiasis (diarrhea, blood in stool, swollen abdomen and abdominal pain). Fever (for malaria) was included for comparison. Results Only 40% of patients with urinary symptoms sought care compared to >70% with intestinal symptoms and >90% with fever. Overall, about 20% of schistosomiasis-related symptoms were reported to a health facility (hospital or clinic), compared to about 30% for fever. Allopathic self-medication was commonly practiced as alternative action. Health-care seeking was relatively lower for patients with chronic symptoms, but if they took action, they were more likely to visit a health facility. In a multivariate logistic regression analysis, perceived severity was the main predictor for seeking health care or visiting a health facility. Age, socio-economic status, somebody else paying for health care, and time for hospital visit occasionally showed a significant impact, but no clear trend. The effect of geographic location was less marked, although people in the central region, and to a lesser extent the north, were usually less inclined to seek health care than people in the south. Perceived quality of health facility did not demonstrate impact. Conclusion Perceived severity of the disease is the most important determinant of seeking health care or visiting a health facility in Ghana. Schistosomiasis control by passive case-finding within the regular health care delivery looks

  2. "Back to Basics" Approach for Improving Maternal Health Care Services Utilization in Lao PDR.

    PubMed

    Ngan, Do Kim; Kang, Minah; Lee, Chaeun; Vanphanom, Sychareun

    2016-04-01

    Earlier studies claim inadequate knowledge and understanding of maternal health care service among women and families account for low demand and utilization of these services. This study explores maternal service utilization in Lao PDR by interviewing women, families, health service providers, and community members in Xiengkhuang province. In general, women's attitude and acceptance of maternal health care were positive, with many expressing appreciation and need for maternal health services. Nevertheless, utilization of maternal health services remained poor largely due to dissatisfaction with services: inaccessibility, irregular services, fund shortage, poor facilities, and problems dealing with male health service providers. It appears that utilization of maternal health care services in Lao PDR is as much a health system concern as it is a user preference issue. This article advocates a "back to basics" approach for reviewing maternal health care infrastructure systems in developing countries to improve community health services and utilization. © 2016 APJPH.

  3. Childhood abuse, adult health, and health care utilization: results from a representative community sample.

    PubMed

    Chartier, M J; Walker, J R; Naimark, B

    2007-05-01

    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.

  4. Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey

    PubMed Central

    Dunai, Andrea; Keszei, Andras P.; Kopp, Maria S.; Shapiro, Colin M.; Mucsi, Istvan; Novak, Marta

    2008-01-01

    Study Objectives: We assessed the prevalence of self-reported snoring in the Hungarian population and established whether different types of snoring are associated with cardiovascular disorders and increased health-care utilization. Design: Cross-sectional study. Door-to-door survey. Setting: Nationally representative population in Hungary. Participants: Interviews were carried out in the homes of 12,643 persons. We used the Hungarian National Population Register as the sampling frame and implemented a clustered, stratified sampling procedure. The study population represented 0.16% of the population over the age of 18 years according to age, sex, and 150 subregions of the country. Interventions: Not applicable. Measurements and Results: Thirty-seven percent of men and 21% of women reported loud snoring with breathing pauses. Hypertension, myocardial infarction, and stroke were reported by 26%, 3%, and 4% of the respondents, respectively. There was a significant increase in the prevalence of hypertension, myocardial infarction, and stroke in quiet and loud snorers, as compared with nonsnorers. Multivariate analysis showed an association between loud snoring and hypertension (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.24 – 1.58), myocardial infarction (OR: 1.34, CI: 1.04 – 1.73), and stroke (OR: 1.67, CI: 1.32 – 2.11) after statistical adjustment for age, sex, body mass index, diabetes, level of education, smoking, and alcohol consumption. Loud snoring was also associated with measures of health-care use in both sexes. Conclusions: Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization. Citation: Dunai A; Keszei AP; Kopp MS; Shapiro CM; Mucsi I; Novak M. Cardiovascular disease and health-care utilization in snorers: a population survey. SLEEP 2008;31(3):411-416. PMID:18363318

  5. Changes in Health State Utilities With Changes in Body Mass in the Diabetes Prevention Program

    PubMed Central

    Ackermann, Ronald T.; Edelstein, Sharon L.; Narayan, K.M. Venkat; Zhang, Ping; Engelgau, Michael M.; Herman, William H.; Marrero, David G.

    2011-01-01

    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

  6. Mental Health Utilization in a Pediatric Emergency Department.

    PubMed

    Sheridan, David C; Spiro, David M; Fu, Rongwei; Johnson, Kyle P; Sheridan, John S; Oue, Alyssa A; Wang, Wensi; Van Nes, Rachel; Hansen, Matthew L

    2015-08-01

    Mental health complaints are frequent in the pediatric emergency department (PED). The objective of this study was to describe trends over time in PED utilization for mental health care at in a single pediatric tertiary care hospital. It is our hypothesis that the resources used by this patient population are high and that mental health-related visits have increased over the most recent decade. This was a retrospective study of all pediatric mental health presentations to the PED from January 2009 to July 2013 at a single pediatric hospital. All patients aged 1 to 19 years with an International Classification of Diseases, Ninth Revision code of 291, 292, 295 to 309, and 311 to 314 were included. Data collected included demographic data, medications received, restraint use, suicidality, length of stay (LOS), charges incurred, final disposition, and daily PED operation variables. Trends over time in presentation, charges, and LOS were analyzed using multiple mixed effects regression models after adjusting for potential patient and PED level confounding variables and clustering of multiple visits within patients. A total of 732 PED visits from 2009 to 2013 were identified representing 646 unique patients. The average age was 13.8 years, and 53% were male. Approximately 25% of the patients expressed suicidal ideation, and 44% of those had attempted suicide before arrival. Behavioral or chemical restraints were used in 33% of patients during their PED visit. There were statistically significant increases in annual visits, LOS, and charges over this period (P < 0.05). Increased charges were significantly associated with longer LOS (P = 0.0062). Charges (P = 0.46) and LOS (P = 0.62) were not significantly different between suicidal and nonsuicidal patients. Approximately 21% of patients were admitted or transferred to another facility. In this single-center study, we found evidence that the resources required to care for pediatric patients with mental health complaints

  7. Monitoring Resource Utilization in a Health Care Coordination Program.

    PubMed

    Popejoy, Lori L; Jaddoo, Julie; Sherman, Jan; Howk, Christopher; Nguyen, Raymond; Parker, Jerry C

    2015-01-01

    This initial article describes the development of a health care coordination intervention and documentation system designed using the Agency for Healthcare Research and Quality (AHRQ) Care Coordination Atlas framework for Centers for Medicare & Medicaid-funded innovation project, Leveraging Information Technology to Guide High-Tech, High-Touch Care (LIGHT). The study occurred at an academic medical center that serves 114 counties. Twenty-five registered nurse care managers (NCMs) were hired to work with 137 providers in 10 family community and internal medicine clinics. Patients were allocated into one of the four tiers on the basis of their chronic medical conditions and health care utilization. Using a documentation system on the basis of the AHRQ domains developed for this study, time and touch data were calculated for 8,593 Medicare, Medicaid, or dual-eligible patients. We discovered through the touch and time analysis that the majority of health care coordination activity occurred in the AHRQ domains of communication, assess needs and goals, and facilitate transitions, accounting for 79% of the NCM time and 61% of the touches. As expected, increasing tier levels resulted in increased use of NCM resources. Tier 3 accounted for roughly 16% of the patients and received 159 minutes/member (33% of total minutes), and Tier 4 accounted for 4% of patients and received 316 minutes/member (17% of all minutes). In contrast Tier 2, which did not require routine touches per protocol, had 5,507 patients (64%), and those patients received 5,246 hours of health care coordination, or 57 minutes/member, and took 48% of NCM time. 1. The AHRQ Care Coordination Atlas offered a systematic way to build a documentation system that allowed for the extraction of data that was used to calculate the amount of time and the number of touches that NCMs delivered per member. 2. Using a framework to systematically guide the work of health care coordination helped NCMs to think strategically

  8. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey

    PubMed Central

    2014-01-01

    Background Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Methods Data were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis. Results Thirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women’s autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by

  9. Exploration of health status, healthcare utilization, and health service expectations among Taiwanese adolescents.

    PubMed

    Tsai, Meng-Che; Lin, Sheng-Hsiang; Chou, Yen-Yin; Lin, Shio-Jean

    2014-02-01

    There have been few reports about adolescent experiences with and expectations of health service utilization in an Asian societal setting. The aim of this study is to analyze the use of healthcare services in relation to health status and explore adolescents' preferences for youth-friendly service among Taiwanese high school students. A cross-sectional questionnaire-based survey was conducted on Taiwanese adolescents aged 12–18 years in 2010.We invited participants to rate their health status, report their previous healthcare service use, and rank their health service preferences.We used logistic regression analysis to investigate the association between self-rated health status and healthcare utilization and used nonparametric analysis to compare health service preferences among sociodemographic subgroups. A total of 4,907 students (97.2 % response rate) returned valid questionnaires for analysis. Poor health status and chronic illness were most salient factors independently associated with frequent healthcare service use. Only 40 % of respondents reported having a regular doctor, and pediatrics (57.7 %) was the most commonly identified professional source of medical care. A great majority (86.2 %) of respondents made clinical visits with parents. For characteristics of youth-friendly clinician, the top-ranked items included competency and patience, while having helpful and friendly personnel was highlighted for clinical setting. Family participation is critical in healthcare for adolescents in Asian cultures. Health service use is significantly influenced by health status and chronic illness in the general health insurance system. Understanding these background influences on expectations for healthcare may help to create youth-friendly health services that are more culturally appropriate.

  10. Utility of the MMPI Pain Assessment Index in Predicting Outcome After Lumbar Surgery.

    ERIC Educational Resources Information Center

    Turner, Judith; And Others

    1986-01-01

    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…

  11. Impact of High-Deductible Health Plans on Health Care Utilization and Costs

    PubMed Central

    Waters, Teresa M; Chang, Cyril F; Cecil, William T; Kasteridis, Panagiotis; Mirvis, David

    2011-01-01

    Background High-deductible health plans (HDHPs) are of high interest to employers, policy makers, and insurers because of potential benefits and risks of this fundamentally new coverage model. Objective To investigate the impact of HDHPs on health care utilization and costs in a heterogeneous group of enrollees from a variety of individual and employer-based health plans. Data Claims and member data from a major insurer and zip code-level census data. Study Design Retrospective difference-in-differences analyses were used to examine the impact of HDHP plans. This analytical approach compared changes in utilization and expenditures over time (2007 versus 2005) across the two comparison groups (HDHP switchers versus matched PPO controls). Results In two-part models, HDHP enrollment was associated with reduced emergency room use, increases in prescription medication use, and no change in overall outpatient expenditures. The impact of HDHPs on utilization differed by subgroup. Chronically ill enrollees and those who clearly had a choice of plans were more likely to increase utilization in specific categories after switching to an HDHP plan. Conclusions Whether HDHPs are associated with lower costs is far from settled. Various subgroups of enrollees may choose HDHPs for different reasons and react differently to plan incentives. PMID:21029087

  12. Patients utilizing a free clinic: physical and mental health, health literacy, and social support.

    PubMed

    Kamimura, Akiko; Christensen, Nancy; Tabler, Jennifer; Ashby, Jeanie; Olson, Lenora M

    2013-08-01

    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.

  13. Using WOMAC Index scores and personal characteristics to estimate Assessment of Quality of Life utility scores in people with hip and knee joint disease.

    PubMed

    Ackerman, Ilana N; Tacey, Mark A; Ademi, Zanfina; Bohensky, Megan A; Liew, Danny; Brand, Caroline A

    2014-10-01

    To determine whether Assessment of Quality of Life (AQoL) utility scores can be reliably estimated from Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in people with hip and knee joint disease (arthritis or osteoarthritis). WOMAC and AQoL data were analysed from 219 people recruited for a national population-based study. Generalised linear models were used to estimate AQoL utility scores based on WOMAC total and subscale scores and personal characteristics. Goodness of fit was assessed for each model, and plots of prediction errors versus actual AQoL utility scores were used to gauge bias. Each model closely predicted the average AQoL utility score for the overall sample (actual mean AQoL 0.64, range of predicted means 0.63-0.64; actual median AQoL 0.71, range of predicted medians 0.68-0.69). No clear preferred model was identified, and overall, the models predicted 40-46% of the variance in AQoL utility scores. The WOMAC function subscale model performed similarly to the total score model. The models functioned best at the mid-range of AQoL scores, with greater bias observed for extreme scores. Inaccuracies in individual-level estimates and low/high health-related quality of life (HRQoL) subgroup estimates were evident. Reliable overall group-level estimates were produced, supporting the application of these techniques at a population level. Using WOMAC scores to predict individual AQoL utility scores is not recommended, and the models may produce inaccurate estimates in studies targeting patients with low/high HRQoL. Where pain and stiffness data are unavailable, the WOMAC function subscale can be used to generate a reasonable utility estimate.

  14. Establishment of Health Utility Indices for Post-Infectious Functional Gastrointestinal Disorders in Active Duty US Military.

    PubMed

    Porter, Chad K; Thura, Nadia; Schlett, Carey D; Sanders, John W; Tribble, David R; Monteville, Marshall R; Riddle, Mark S

    2015-01-01

    Knowledge of disease burden attributable to functional gastrointestinal disorders (FGD) in travelers is lacking, despite the high incidence of travelers' diarrhea (TD) associated with increased FGD risk. One tool for assessing the impact of disease on health-related quality of life is the health utility index (HUI), which values health states based on preferential health outcomes. Health utilities can be used as preference weights in the estimation of quality-adjusted life-years (QALYs). Six months following travel to Egypt or Turkey, 120 US military personnel completed a survey on TD during deployment, health-related quality of life (SF-36), and the onset of functional bowel disorders (Rome II). Elements from the SF-36 were used to develop SF-6D values, which were combined with health state valuations to enable calculation of HUI scores for each subject. Mean index scores were compared across functional outcomes, specific symptoms, and demographic profiles. The presence of FGD significantly reduced index scores, with irritable bowel syndrome (IBS) and dyspepsia showing the greatest impact (-0.17 and -0.19, respectively) compared with those with no FGD (p < 0.05). Importantly, however, several individuals met multiple FGD outcome definitions. Additionally, a number of symptoms associated with abnormal bowel habits and abdominal pain were associated with reduced index scores regardless of outcome. FGD are associated with significant morbidity as assessed by HUIs. Given the strong link between TD and FGD as well as the large number of travelers from the developed to the developing world, additional study is needed to further understand this association and efforts aimed at primary disease prevention are warranted. Published 2015. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

  15. Predicting health care utilization in marginalized populations: Black, female, street-based sex workers.

    PubMed

    Varga, Leah M; Surratt, Hilary L

    2014-01-01

    Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. The outcome variable was utilization of health care services in the previous 12 months. Using Andersen's Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based, female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Any type of resource, link, or connection to or with an institution, or any consistent point of care, contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  16. Caregiver burden, health utilities, and institutional service use in Alzheimer’s Disease

    PubMed Central

    Miller, Edward Alan; Rosenheck, Robert A.; Schneider, Lon S.

    2011-01-01

    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

  17. Changes in Hospital Inpatient Utilization Following Health Care Reform.

    PubMed

    Pickens, Gary; Karaca, Zeynal; Cutler, Eli; Dworsky, Michael; Eibner, Christine; Moore, Brian; Gibson, Teresa; Iyer, Sharat; Wong, Herbert S

    2017-06-30

    To estimate the effects of 2014 Medicaid expansions on inpatient outcomes. Health Care Cost and Utilization Project State Inpatient Databases, 2011-2014; population and unemployment estimates. Retrospective study estimating effects of Medicaid expansions using difference-in-differences regression. Outcomes included total admissions, referral-sensitive surgical and preventable admissions, length of stay, cost, and patient illness severity. In 2014 quarter four, compared with nonexpansion states, Medicaid admissions increased (28.5 percent, p = .006), and uninsured and private admissions decreased (-55.1 percent, p = .001, and -6.6 percent, p = .052), whereas all-payer admissions showed little change. Uninsured expansion effects were negative for preventable admissions (-24.4 percent, p = .068), length of stay (-9.3 percent, p = .039), total cost (-9.2 percent, p = .128), and illness severity (-4.5 percent, p = .397). Significant positive expansion effects were found for Medicaid referral-sensitive surgeries (11.8 percent, p = .021) and patient illness severity (2.3 percent, p = .015). Private and all-payer expansion effects for outcomes other than admission volume were small and mainly nonsignificant (p > .05). Medicaid expansions did not change all-payer admission volumes, but they were associated with increased Medicaid and decreased uninsured volumes. Results suggest those previously uninsured with greater needs for inpatient services were most likely to gain coverage. Compositional changes in uninsured and Medicaid admissions may be due to selection. © Health Research and Educational Trust.

  18. Hurricane exposure and county fetal death rates, utilization of a county environmental quality index for confounding control.

    EPA Science Inventory

    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 ...

  19. Hurricane exposure and county fetal death rates, utilization of a county environmental quality index for confounding control.

    EPA Science Inventory

    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 ...

  20. Urban sprawl, physical activity, and body mass index: Nurses' Health Study and Nurses' Health Study II.

    PubMed

    James, Peter; Troped, Philip J; Hart, Jaime E; Joshu, Corinne E; Colditz, Graham A; Brownson, Ross C; Ewing, Reid; Laden, Francine

    2013-02-01

    We evaluated the association between the county sprawl index, a measure of residential density and street accessibility, and physical activity and body mass index (BMI). We conducted a multilevel cross-sectional analysis in a sample of Nurses' Health Study participants living throughout the United States in 2000 to 2001 (n = 136 592). In analyses adjusted for age, smoking status, race, and husband's education, a 1-SD (25.7) increase in the county sprawl index (indicating a denser, more compact county) was associated with a 0.13 kilograms per meters squared (95% confidence interval [CI] = -0.18, -0.07) lower BMI and 0.41 (95% CI = 0.17, 0.65) more metabolic equivalent (MET) hours per week of total physical activity, 0.26 (95% CI = 0.19, 0.33) more MET hours per week of walking, and 0.47 (95% CI = 0.34, 0.59) more MET hours per week of walking, bicycling, jogging, and running. We detected potential effect modification for age, previous disease status, husband's education level (a proxy for socioeconomic status), and race. Our results suggest that living in a dense, compact county may be conducive to higher levels of physical activity and lower BMI in women.

  1. Urban Sprawl, Physical Activity, and Body Mass Index: Nurses’ Health Study and Nurses’ Health Study II

    PubMed Central

    Troped, Philip J.; Hart, Jaime E.; Joshu, Corinne E.; Colditz, Graham A.; Brownson, Ross C.; Ewing, Reid; Laden, Francine

    2013-01-01

    Objectives. We evaluated the association between the county sprawl index, a measure of residential density and street accessibility, and physical activity and body mass index (BMI). Methods. We conducted a multilevel cross-sectional analysis in a sample of Nurses’ Health Study participants living throughout the United States in 2000 to 2001 (n = 136 592). Results. In analyses adjusted for age, smoking status, race, and husband’s education, a 1-SD (25.7) increase in the county sprawl index (indicating a denser, more compact county) was associated with a 0.13 kilograms per meters squared (95% confidence interval [CI] = −0.18, −0.07) lower BMI and 0.41 (95% CI = 0.17, 0.65) more metabolic equivalent (MET) hours per week of total physical activity, 0.26 (95% CI = 0.19, 0.33) more MET hours per week of walking, and 0.47 (95% CI = 0.34, 0.59) more MET hours per week of walking, bicycling, jogging, and running. We detected potential effect modification for age, previous disease status, husband’s education level (a proxy for socioeconomic status), and race. Conclusions. Our results suggest that living in a dense, compact county may be conducive to higher levels of physical activity and lower BMI in women. PMID:22698015

  2. Health in All Policies utilization by municipal governments: scoping review.

    PubMed

    Van Vliet-Brown, Cheryl E; Shahram, Sana; Oelke, Nelly D

    2017-03-14

    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.

  3. Utilizing codes of ethics in health professions education.

    PubMed

    Dahnke, Michael D

    2014-10-01

    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, however, regarding the value and use of these codes both in professional practice and in the education of healthcare professionals. I intend to review and analyze the various aims and purposes of ethics codes particularly within the study and practice of healthcare in light of various criticisms of codes of ethics. After weighing the strength and import of these criticisms, I plan to explore effective means for utilizing such codes as part of the ethics education of healthcare professionals. While noting significant limitations of this tool, both in practice and in education, I plan to demonstrate its potential usefulness as well, in both generating critical thinking within the study of ethics and as a guide for practice for the professional.

  4. Associations of health literacy with dialysis adherence and health resource utilization in patients receiving maintenance hemodialysis.

    PubMed

    Green, Jamie A; Mor, Maria K; Shields, Anne Marie; Sevick, Mary Ann; Arnold, Robert M; Palevsky, Paul M; Fine, Michael J; Weisbord, Steven D

    2013-07-01

    Although limited health literacy is common in hemodialysis patients, its effects on clinical outcomes are not well understood. Observational study. 260 maintenance hemodialysis patients enrolled in a randomized clinical trial of symptom management strategies from January 2009 through April 2011. Limited health literacy. Dialysis adherence (missed and abbreviated treatments) and health resource utilization (emergency department visits and end-stage renal disease [ESRD]-related hospitalizations). We assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) and used negative binomial regression to analyze the independent associations of limited health literacy with dialysis adherence and health resource utilization over 12-24 months. 41 of 260 (16%) patients showed limited health literacy (REALM score, ≤60). There were 1,152 missed treatments, 5,127 abbreviated treatments, 552 emergency department visits, and 463 ESRD-related hospitalizations. Limited health literacy was associated independently with an increased incidence of missed dialysis treatments (missed, 0.6% vs 0.3%; adjusted incidence rate ratio [IRR], 2.14; 95% CI, 1.10-4.17), emergency department visits (annual visits, 1.7 vs 1.0; adjusted IRR, 1.37; 95% CI, 1.01-1.86), and hospitalizations related to ESRD (annual hospitalizations, 0.9 vs 0.5; adjusted IRR, 1.55; 95% CI, 1.03-2.34). Generalizability and potential for residual confounding. Patients receiving maintenance hemodialysis who have limited health literacy are more likely to miss dialysis treatments, use emergency care, and be hospitalized related to their kidney disease. These findings have important clinical practice and cost implications. Copyright © 2013 National Kidney Foundation, Inc. All rights reserved.

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

    PubMed

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

    2013-02-01

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

  6. Inequity in level of healthcare utilization before and after universal health coverage reforms in China: evidence from household surveys in Sichuan Province.

    PubMed

    Flatø, Hedda; Zhang, Huafeng

    2016-06-22

    China has since the beginning of this millennium engaged in substantial Universal Health Coverage (UHC) reforms. This paper adds evidence on how equity in level of health service utilization changed after UHC reforms. Our study was based on household survey data from 30 counties in Sichuan province in 2004 and 2011. We introduce an unusual outcome variable, namely level of healthcare utilization. Concentration index (CI) was used to measure income based inequality in level of healthcare utilization. Horizontal index (HI) was used to assess whether inequalities are inequitable. We decomposed the concentration index to measure the factors contributing to inequality in level of utilization. Oaxaca type decomposition was applied to control whether identified changes were attributable to changed inequality or to other factors. Pro-rich inequity in level of healthcare utilization increased after UHC reforms. Overall, a higher proportion of users sought services at county hospitals or higher in 2011 compared with 2004. Richer users were considerably more likely than the poor to seek care at hospitals rather than at clinics or health centers, and the pro-rich inequality in level of healthcare utilization was highly inequitable. Insurance enrollment became the main driver of pro-rich inequity in level of healthcare utilization after reforms, while health needs became less important for determining level of care, all disfavoring low income groups. Assessments of equity should pay attention to inequalities in level of healthcare utilization. Our results indicate that in China, wide insurance coverage is insufficient to ensure equity in level of healthcare utilization. On the contrary, type of insurance enrollment has become a main driver of inequity in level of utilization. Hence, equalizing health insurance schemes would be of crucial importance in order to improve health equity in China. Moreover, UHC reforms should strengthen the primary sector and limit non-needs based

  7. Access to Transportation and Health Care Utilization in a Rural Region

    ERIC Educational Resources Information Center

    Arcury, Thomas A.; Preisser, John S.; Gesler, Wilbert M.; Powers, James M.

    2005-01-01

    Access to transportation to transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access to transportation in analyses of rural health care utilization. This analysis addresses the association of transportation and health care utilization in a rural…

  8. Outpatient Health Care Utilization of Suicide Decedents in Their Last Year of Life

    ERIC Educational Resources Information Center

    Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming

    2012-01-01

    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…

  9. Correlates of Suicide among Home Health Care Utilizers Who Died by Suicide and Community Controls

    ERIC Educational Resources Information Center

    Rowe, Jennifer L.; Bruce, Martha L.; Conwell, Yeates

    2006-01-01

    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…

  10. Outpatient Health Care Utilization of Suicide Decedents in Their Last Year of Life

    ERIC Educational Resources Information Center

    Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming

    2012-01-01

    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…

  11. Health utilities for controlled and uncontrolled chronic hand eczema in healthcare employees.

    PubMed

    Küster, Denise; Haufe, Eva; Rethberg, Constanze; Bauer, Andrea; Seidler, Andreas; Schmitt, Jochen

    2017-08-22

    Health utilities provide a universally applicable method for measuring the relative preferences or values of specific health states. Health economic studies use health utilities to estimate disease burden and the cost-effectiveness of interventions. Chronic hand eczema (CHE) affects many individuals and adversely affects work productivity. Health utilities for CHE from the perspective of healthcare professionals are lacking. To assess health utilities for CHE from the perspectives of employees in the healthcare sector and affected patients. A cross-sectional study with volunteers from the healthcare sector (n = 126) and patients (n = 32) was conducted to establish health utilities (ranging from 1 = perfect health to 0 = death) for mild and severe CHE. The median health utilities of the healthy volunteers derived with the time trade-off method were 0.97 (mean: 0.92) for mild CHE and 0.77 (mean: 0.75) for severe CHE. The median health utilities for mild and severe CHE from the perspective of affected patients were 0.98 (mean: 0.91) and 0.82 (mean: 0.77), respectively. Differences in health utilities between the two study groups were not significant. CHE constitutes a considerable burden from the perspective of healthcare employees. Effective control of CHE constitutes an important public health goal. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. [Health-care utilization in elderly (Spain 2006-2012): Influence of health status and social class].

    PubMed

    Aguilar-Palacio, Isabel; Carrera-Lasfuentes, Patricia; Solsona, Sofía; Sartolo, M Teresa; Rabanaque, M José

    2016-04-01

    to explore health-care utilization (primary and specialized health-care, hospitalizations, day hospital and emergency services) and overuse in elderly in Spain, considering the influence of health status, sex, social class and its temporal trend. cross sectional study in two phases. Spain. people surveyed in the National Health Surveys 2006 and 2011-12. Health status was measured using self-rated and diagnosed health (number and diagnoses). Social class was obtained from the last occupation of the main supporter (manual and non-manual workers). Logistic regression analyses were conducted adjusting by sex, age, health status, social class and year, obtaining its predictive capacity. the percentage of elderly population with health-care utilization decreased during the period analyzed. Women who belonged to the manual workers category presented the highest prevalence of low health (low self-rated health in 2006: 70.6%). Low health status was associated with a higher utilization of health-care services. Self-rated health was a better predictor of health-care utilization and overuse than diagnosed health, getting the highest predictive capacity for specialized health-care (C = 0.676). Old people from low social class used with higher frequency primary health-care and emergency services. On the other hand, specialized health-care and day hospital were more used by high social classes. inequalities in health and health-care utilization have been observed in elderly according social class. It is necessary to consider self-rated health as a health-care utilization predictor and to review our health-care services accessibility and equity. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  13. School Health Index: A Self-Assessment and Planning Guide. Middle School/High School.

    ERIC Educational Resources Information Center

    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

    2004-01-01

    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…

  14. Applying the School Health Index to a Nationally Representative Sample of Schools

    ERIC Educational Resources Information Center

    Brener, Nancy D.; Pejavara, Anu; Barrios, Lisa C.; Crossett, Linda; Lee, Sarah M.; McKenna, Mary; Michael, Shannon; Wechsler, Howell

    2006-01-01

    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)…

  15. School Health Index: A Self-Assessment and Planning Guide. Middle School/High School.

    ERIC Educational Resources Information Center

    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

    2004-01-01

    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…

  16. Applying the School Health Index to a Nationally Representative Sample of Schools

    ERIC Educational Resources Information Center

    Brener, Nancy D.; Pejavara, Anu; Barrios, Lisa C.; Crossett, Linda; Lee, Sarah M.; McKenna, Mary; Michael, Shannon; Wechsler, Howell

    2006-01-01

    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)…

  17. Forecasting drug utilization and expenditure in a metropolitan health region

    PubMed Central

    2010-01-01

    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

  18. Undernutrition at baseline and health services utilization and mortality over a 1-year period in older adults receiving Medicare home health services.

    PubMed

    Yang, Yongbin; Brown, Cynthia J; Burgio, Kathryn L; Kilgore, Meredith L; Ritchie, Christine S; Roth, David L; West, Delia Smith; Locher, Julie L

    2011-05-01

    Older adults receiving Medicare home health services who experience undernutrition may be at increased risk of experiencing adverse outcomes. We sought to identify the association between baseline nutritional status and subsequent health service utilization and mortality over a 1-year period in older adults receiving Medicare home health services. This was a longitudinal study using questionnaires and anthropometric measures designed to assess nutritional status (Mini-Nutritional Assessment) at baseline and health services utilization and mortality status at 6-month and 1-year follow-ups. Participants were evaluated in their homes. A total of 198 older adults who were receiving Medicare home health services. Based on Mini-Nutritional Assessment, 12.0% of patients were malnourished, 51.0% were at risk for malnourishment, and 36.9% had normal nutritional status. Based on body mass index, 8.1% of participants were underweight, 37.9% were normal weight, 25.3% were overweight, and 28.8% were obese. Using multivariate binary logistic regression analyses, participants who were malnourished or at risk for malnourishment were more likely to experience subsequent hospitalization, emergency room visit, home health aide use, and mortality for the entire sample and hospitalization and nursing home stay for overweight and obese participants. Experiencing undernutrition at the time of receipt of Medicare home health services was associated with increased health services utilization and mortality for the entire sample, and with increased health services utilization only for the overweight and obese subsample. Opportunities exist to address risk of undernutrition in patients receiving home health services, including those who are overweight or obese, to prevent subsequent adverse health outcomes. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

  19. Under-nutrition at baseline and health services utilization and mortality over a one-year period in older adults receiving Medicare home health services

    PubMed Central

    Yang, Yongbin; Brown, Cynthia J.; Burgio, Kathryn L.; Kilgore, Meredith L.; Ritchie, Christine S.; Roth, David L.; West, Delia Smith; Locher, Julie L.

    2010-01-01

    Objective Older adults receiving Medicare home health services who experience under-nutrition may be at increased risk of experiencing adverse outcomes. We sought to identify the association between baseline nutritional status and subsequent health service utilization and mortality over a one-year period in older adults receiving Medicare home health services. Design This was a longitudinal study using questionnaires and anthropometric measures designed to assess nutritional status (Mini-Nutritional Assessment [MNA]) at baseline and health services utilization and mortality status at six-month and one-year follow-ups. Setting Participants were evaluated in their homes. Participants 198 older adults who were receiving Medicare home health services. Results Based upon MNA, 12.0% of patients were Malnourished, 51.0% were At Risk for Malnourishment, and 36.9% had Normal Nutrition Status. Based upon body mass index (BMI), 8.1% of participants were underweight, 37.9% were normal weight, 25.3% were overweight, and 28.8% were obese. Using multivariate binary logistic regression analyses, participants who were Malnourished or At Risk for Malnourishment were more likely to experience subsequent hospitalization, emergency room visit, home health aide use, and mortality for the entire sample and hospitalization and nursing home stay for overweight and obese participants. Conclusions Experiencing under-nutrition at the time of receipt of Medicare home health services was associated with increased health services utilization and mortality for the entire sample, and with increased health services utilization only for the overweight and obese subsample. Opportunities exist to address risk of under-nutrition in patients receiving home health services, including those who are overweight or obese, to prevent subsequent adverse health outcomes. PMID:21527170

  20. Creating an Overall Environmental Quality Index to Examine Health Outcomes

    EPA Science Inventory

    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...

  1. Creating an Overall Environmental Quality Index to Examine Health Outcomes

    EPA Science Inventory

    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...

  2. Health Canada's evaluation of the use of glycemic index claims on food labels.

    PubMed

    Aziz, Alfred; Dumais, Lydia; Barber, Jennifer

    2013-08-01

    The glycemic index (GI) is a system that ranks foods according to the blood glucose-increasing potential of servings of foods that provide the same amount of available carbohydrate. The GI was originally developed as a tool for carbohydrate exchange in the dietary management of glycemia in persons with diabetes, and studies have generally supported modest benefits of low-GI diets in this population. Despite inconsistent results for the utility of the GI in the nondiabetic population, there is some interest in its universal application on food labels to assist consumers in making food choices that would help them meet their dietary goals. The objective of this review was to evaluate the usefulness of including the GI values of foods as part of the information on food labels in Canada. Health Canada's assessment identified 3 areas of concern with respect to GI labeling: 1) the GI measure has poor accuracy and precision for labeling purposes; 2) as a ratio, the GI does not vary in response to the amount of food consumed and the partial replacement of available carbohydrates with unavailable carbohydrates, whereas the glycemic response does; and 3) an unintended focus on the GI for food selection could lead to food choices that are inconsistent with national dietary guidelines. Hence, Health Canada's current opinion is that the inclusion of the GI value on the label of eligible food products would be misleading and would not add value to nutrition labeling and dietary guidelines in assisting consumers to make healthier food choices.

  3. Toward Development of a Naval Oral Health Status Index,

    DTIC Science & Technology

    1985-12-01

    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

  4. CHI: A contemporaneous health index for degenerative disease monitoring using longitudinal measurements.

    PubMed

    Huang, Yijun; Meng, Qiang; Evans, Heather; Lober, William; Cheng, Yu; Qian, Xiaoning; Liu, Ji; Huang, Shuai

    2017-09-01

    In this paper, we develop a novel formulation for contemporaneous patient risk monitoring by exploiting the emerging data-rich environment in many healthcare applications, where an abundance of longitudinal data that reflect the degeneration of the health condition can be continuously collected. Our objective, and the developed formulation, is fundamentally different from many existing risk score models for different healthcare applications, which mostly focus on predicting the likelihood of a certain outcome at a pre-specified time. Rather, our formulation translates multivariate longitudinal measurements into a contemporaneous health index (CHI) that captures patient condition changes over the course of progression. Another significant feature of our formulation is that, CHI can be estimated with or without label information, different from other risk score models strictly based on supervised learning. To develop this formulation, we focus on the degenerative disease conditions, for which we could utilize the monotonic progression characteristic (either towards disease or recovery) to learn CHI. Such a domain knowledge leads us to a novel learning formulation, and on top of that, we further generalize this formulation with a capacity to incorporate label information if available. We further develop algorithms to mitigate the challenges associated with the nonsmooth convex optimization problem by first identifying its dual reformulation as a constrained smooth optimization problem, and then, using the block coordinate descent algorithm to iteratively solve the optimization with a derived efficient projection at each iteration. Extensive numerical studies are performed on both synthetic datasets and real-world applications on Alzheimer's disease and Surgical Site Infection, which demonstrate the utility and efficacy of the proposed method on degenerative conditions that include a wide range of applications. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. [Barriers in access and utilization of health services among immigrants: the perspective of health professionals].

    PubMed

    Dias, Sónia; Gama, Ana; Silva, António Carlos; Cargaleiro, Helena; Martins, Maria O

    2011-01-01

    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

  6. Determinants related to gender differences in general practice utilization: Danish Diet, Cancer and Health Cohort

    PubMed Central

    Jørgensen, Jeanette Therming; Andersen, John Sahl; Tjønneland, Anne; Andersen, Zorana Jovanovic

    2016-01-01

    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

  7. [Evaluating the utility of MODIS vegetation index for monitoring agricultural drought].

    PubMed

    Li, Hua-Peng; Zhang, Shu-Qing; Gao, Zi-Qiang; Sun, Yan

    2013-03-01

    The exclusive shortwave bands provided by MODIS sensors offer new opportunities for agricultural drought monitoring, since they are very sensitive to vegetation moisture. In the present work, we selected Songnen Plain in Northeast China as study area aiming at monitoring agricultural drought of dry farmland here. Four types of vegetation water indices and vegetation greenness indices were calculated from the 8-day composite MODIS product (MODO9A1) in vegetation growing season between 2001 and 2010, respectively. Multi-scale standardized precipitation index (SPI) derived from precipitation data of weather stations was used as reference data to estimate drought sensitivity of various vegetation indices, and a pixel-to-weather station paired correlation approach was used to calculate the Pearson correlation coefficient between vegetation index and SPIs. The result indicated that vegetation water indices established by near infrared and shortwave infrared bands outperformed vegetation greenness indices based on visible and near infrared bands. Of these indices, NDII7 performs the best with highest correlation coefficients across all SPIs. The authors' results demonstrated the potential of MODIS shortwave spectral bands in monitoring agricultural drought, and this provides new insights to future research.

  8. Relationship between asthma control status, the Asthma Control Test™ and urgent health-care utilization in Asia.

    PubMed

    Lai, Christopher K W; Ko, Fanny W S; Bhome, Arvind; DE Guia, Teresita S; Wong, Gary W K; Zainudin, Bin M Z; Nang, An N; Boonsawat, Watchara; Cho, Sang H; Gunasekera, Kirthi D; Hong, Jian G; Hsu, Jeng-Yuan; Viet, Nhung N; Yunus, Faisal; Mukhopadhyay, Amartya

    2011-05-01

    Accurate assessment of control is an integral part of asthma management. We investigated the relationship between control status derived from the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT) and urgent health-care utilization. Asthma Insights and Reality in Asia-Pacific Phase 2 (AIRIAP 2) was a cross-sectional, community-based survey of 4805 subjects with asthma from urban centres across Asia. A symptom control index was derived from the AIRIAP 2 questionnaire using the GINA control criteria for day- and night-time symptoms, need for rescue medication, activity limitation and exacerbations; lung function was excluded. The main outcomes were asthma control, based on these GINA criteria and the ACT, and the relationship between control and self-reported urgent health-care utilization (hospitalization, emergency room visits or other unscheduled urgent visits) related to asthma over the previous 12months. Each of the symptom criteria was significantly associated with urgent health-care utilization, with odds ratios (ORs) ranging from 2.25 (95% confidence interval (CI): 1.94-2.61) for daytime symptoms to 2.57 (95% CI: 2.29-2.90) for nocturnal awakening. Similarly, control status was significantly associated with urgent health-care utilization, with ORs of 0.19 (95% CI: 0.13-0.28), 0.70 (95% CI: 0.65-0.76) and 1.00 for controlled, partly controlled and uncontrolled, respectively. The optimal ACT cut-off score for identifying uncontrolled asthma was ≤19 for subjects aged ≥12years. Urgent health-care utilization was reported by 57.2% versus 28.7% of patients scoring ≤19 versus >19 (P<0.001). The GINA control classification and the ACT are valid symptom-based measures that are significantly associated with urgent health-care utilization. © 2011 The Authors; Respirology © 2011 Asian Pacific Society of Respirology.

  9. The impacts of health insurance on health care utilization among the older people in China.

    PubMed

    Li, Xin; Zhang, Wei

    2013-05-01

    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.

  10. An Index of Child Health in the Least Developed Countries (LDCs) of Africa

    ERIC Educational Resources Information Center

    Martin, Jose Antonio Rodriguez

    2012-01-01

    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…

  11. An Index of Child Health in the Least Developed Countries (LDCs) of Africa

    ERIC Educational Resources Information Center

    Martin, Jose Antonio Rodriguez

    2012-01-01

    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…

  12. Measuring Access to Continuing Professional Education among the Health Workers in Ghana: Constructing an Index

    ERIC Educational Resources Information Center

    Aiga, Hirotsugu

    2006-01-01

    To measure the levels of access to continuing professional education (CPE) among the health workers, an index (continuing professional education access index: CEAI) was constructed. The CEAI is composed of six indicators: (I) availability of CPE; (II) distribution of CPE; (III) informational access; (IV) geographical access; (V) economic access;…

  13. Establishing Community Health Centers in Rural Appalachia Utilizing Lay Volunteers

    ERIC Educational Resources Information Center

    Morris, Frances

    1978-01-01

    Appalachian Leadership Outreach Health Program established community health centers in the homes of volunteers in 10 Kentucky communities. The cost has been nominal, and the advantages in transportion time and improved health awareness and care promise to help meet basic health needs of the rurally isolated. (JC)

  14. Veterans Affairs Health System Enrollment and Health Care Utilization After the Affordable Care Act: Initial Insights.

    PubMed

    Silva, Abigail; Tarlov, Elizabeth; French, Dustin D; Huo, Zhiping; Martinez, Rachael N; Stroupe, Kevin T

    2016-05-01

    The Affordable Care Act (ACA) was signed into law in 2010 and its individual mandate and expanded health care coverage options were implemented in 2014. These provisions may affect Veterans Affairs (VA) enrollment and health care utilization. Using data from two VA regional networks, we examined recent patterns in the number of new VA enrollees and their primary care use. Trends were assessed by enrollment priority group (based on the veteran's severity of service-connected disabilities, exposures, and income level) and a state's Medicaid expansion status. Compared to the same time period in the previous year, the number of new enrollees from low-income priority groups was higher during the open enrollment period and the increase was sharper in Medicaid non-expansion states (25-42%) than in expansion states (20-32%). In addition, low-income patients with a copay requirement who enrolled in the VA during the ACA open enrollment had a lower average number of primary care visits than counterparts who had enrolled in prior time periods (1.73 versus 1.87, p < 0.0001). Although this study is an initial step, more research is required to better understand veterans' decision making and behavior in regard to health care coverage through the ACA and related impacts on VA and non-VA health care utilization and care coordination. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  15. Race and colorectal cancer disparities: health-care utilization vs different cancer susceptibilities.

    PubMed

    Laiyemo, Adeyinka O; Doubeni, Chyke; Pinsky, Paul F; Doria-Rose, V Paul; Bresalier, Robert; Lamerato, Lois E; Crawford, E David; Kvale, Paul; Fouad, Mona; Hickey, Thomas; Riley, Thomas; Weissfeld, Joel; Schoen, Robert E; Marcus, Pamela M; Prorok, Philip C; Berg, Christine D

    2010-04-21

    It is unclear whether the disproportionately higher incidence and mortality from colorectal cancer among blacks compared with whites reflect differences in health-care utilization or colorectal cancer susceptibility. A total of 60, 572 non-Hispanic white and black participants in the ongoing Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial underwent trial-sponsored screening flexible sigmoidoscopy (FSG) without biopsy at baseline in 10 geographically dispersed centers from November 1993 to July 2001. Subjects with polyps or mass lesions detected by FSG were referred to their physicians for diagnostic workup, the cost of which was not covered by PLCO. The records of follow-up evaluations were collected and reviewed. We used log binomial modeling with adjustment for age, education, sex, body mass index, smoking, family history of colorectal cancer, colon examination within previous 3 years, personal history of polyps, and screening center to examine whether utilization of diagnostic colonoscopy and yield of neoplasia differed by race. Among 57 561 whites and 3011 blacks who underwent FSG, 13,743 (23.9%) and 767 (25.5%) had abnormal examinations, respectively. A total of 9944 (72.4%) whites and 480 (62.6%) blacks had diagnostic colonoscopy within 1 year following the abnormal FSG screening. When compared with whites, blacks were less likely to undergo diagnostic evaluation (adjusted risk ratio = 0.88, 95% confidence interval = 0.83 to 0.93). Overall, among subjects with diagnostic colonoscopy (n = 10 424), there was no statistically significant difference by race in the prevalence of adenoma, advanced adenoma, advanced pathology in small adenomas (high-grade dysplasia or villous histology in adenomas <10 mm), or colorectal cancer. We observed a lower follow-up for screen-detected abnormalities among blacks when compared with whites but little difference in the yield of colorectal neoplasia. Health-care utilization may be playing more of a role in

  16. Utility of the bispectral index for assessing natural physiological sleep stages in children and young adults.

    PubMed

    Benissa, Mohamed-Rida; Khirani, Sonia; Hartley, Sarah; Adala, Annie; Ramirez, Adriana; Fernandez-Bolanos, Marta; Quera-Salva, Maria-Antonia; Fauroux, Brigitte

    2016-12-01

    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.

  17. Index of Opportunity in Nursing and Allied Health Professions, 1972.

    ERIC Educational Resources Information Center

    Resource Publications, Inc., Princeton, NJ.

    This publication contains descriptions of 59 hospitals and other medical agencies which offer job opportunities to nurses and those trained in the allied health professions. Included in the descriptions are a brief introduction, salaries and/or benefits, employment opportunities, location, and source of further information. A geographical index…

  18. Anonymous indexing of health conditions for a similarity measure.

    PubMed

    Song, Insu; Marsh, Nigel V

    2012-07-01

    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.

  19. Watershed health: An evaluation index for New Mexico

    Treesearch

    Bill Fleming

    1999-01-01

    Although watersheds are not equally healthy, there are no generally accepted criteria for evaluating and comparing them. This paper suggests several criteria which numerically evaluate watersheds in four ways: (1) riparian health, (2) aquatic macroinvertebrate biodiversity, (3) hillslope soil loss and (4) upland land use/flood peak potential. Each criterion is...

  20. On the application of structural equation modeling for the construction of a health index

    PubMed Central

    Ibrahim, Kamarulzaman; Jemain, Abdul Aziz

    2010-01-01

    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

  1. Psychometric properties of the incontinence utility index among patients with idiopathic overactive bladder: data from two multicenter, double-blind, randomized, Phase 3, placebo-controlled clinical trials.

    PubMed

    Castejón, Nacho; Khalaf, Kristin; Ni, Quanhong; Cuervo, Jesús; Patrick, Donald L

    2015-08-01

    Overactive bladder is a prevalent and burdensome condition. Generic utility measures may fail to reflect its full impact on patients' health status. The Incontinence Utility Index (IUI) is a community-based preference index derived from the Incontinence Quality of Life Questionnaire (I-QOL) developed to value health states related to urinary symptoms in patients with neurogenic detrusor overactivity. This study assessed the measurement properties of the IUI in patients with idiopathic overactive bladder (OAB). Data were used from two clinical trials which recruited patients with OAB whose symptoms were inadequately managed with ≥ 1 anticholinergic medication. Psychometric evaluation included: Differential Item Functioning (DIF) analysis, concordance between I-QOL and IUI (Intraclass correlation coefficient [ICC], criterion and convergent validity according to relevant patient reported outcomes and clinical variables (Spearman's correlation coefficient, rho), responsiveness, and agreement between utility measures (ICC and Bland-Altman method). A total of 1,105 idiopathic OAB patients were included. Mean age (range) was 60.4 years (18-90), 87.8% (n = 970) were female. DIF was identified in 3 items, none of which are contained in the IUI. ICC (CI95%) was 0.944 (0.936-0.950). Statistically significant differences (p < 0.001) were found in IUI scores for patients improving according to the Treatment Benefit Scale (TBS). Moderate to strong correlations (rho > |0.6|) were found in the expected direction with daily incontinence, urgency episodes and disease-specific domains of King's Health Questionnaire (KHQ). Low to moderate correlations (rho:<|0.6|) were found with Short Form version 2 (SF-12v2) summary components. A large effect size was found for patients reporting improvement (0.98-1.21) or great improvement (1.87-2.56) in the TBS, as well as in patients responding to treatment (1.19-2.40). Across utility measures, directional trends were consistent with OAB

  2. Health State Utility Values for Age-Related Macular Degeneration: Review and Advice.

    PubMed

    Butt, Thomas; Tufail, Adnan; Rubin, Gary

    2017-02-01

    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.

  3. Effect of primary health care reforms in Turkey on health service utilization and user satisfaction.

    PubMed

    Hone, Thomas; Gurol-Urganci, Ipek; Millett, Christopher; Başara, Berrak; Akdağ, Recep; Atun, Rifat

    2017-02-01

    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.

  4. Obesity utilization and health-related quality of life in Medicare enrollees.

    PubMed

    Malinoff, Rochelle L; Elliott, Marc N; Giordano, Laura A; Grace, Susan C; Burroughs, James N

    2013-01-01

    The obese, with disproportionate chronic disease incidence, consume a large share of health care resources and drive up per capita Medicare spending. This study examined the prevalence of obesity and its association with health status, health-related quality of life (HRQOL), function, and outpatient utilization among Medicare Advantage seniors. Results indicate that obese beneficiaries, much more than overweight beneficiaries, have poorer health, functions, and HRQOL than normal weight beneficiaries and have substantially higher outpatient utilization. While weight loss is beneficial to both the overweight and obese, the markedly worse health status and high utilization of obese beneficiaries may merit particular attention.

  5. Utilization and Limitations of the American College Health Association's National College Health Assessment Instrument: A Systematic Review

    ERIC Educational Resources Information Center

    Rahn, Rhonda N.; Pruitt, Buster; Goodson, Patricia

    2016-01-01

    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…

  6. Utilization and Limitations of the American College Health Association's National College Health Assessment Instrument: A Systematic Review

    ERIC Educational Resources Information Center

    Rahn, Rhonda N.; Pruitt, Buster; Goodson, Patricia

    2016-01-01

    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…

  7. The associations between diet quality, body mass index (BMI) and health and activity limitation index (HALEX) in the Geisinger Rural Aging Study (GRAS)

    USDA-ARS?s Scientific Manuscript database

    Objectives To determine the associations between diet quality, body mass index (BMI), and health-related quality of life (HRQOL) as assessed by the health and activity limitation index (HALex) in older adults. Design Multivariate linear regression models were used to analyze associations between Di...

  8. The utility of bispectral index monitoring for prevention of rocuronium-induced withdrawal movement in children

    PubMed Central

    Lim, Byung Gun; Lee, Il Ok; Kim, Young Sung; Won, Young Ju; Kim, Heezoo; Kong, Myoung Hoon

    2017-01-01

    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

  9. [Utilization of technology and communication technologies (TIC) in public health].

    PubMed

    Benigeri, M; Brodeur, J M

    2001-01-01

    The development of information and communications technologies (ICT) and Internet offers public health practitioners new tools to fulfill their missions of monitoring public health, health promotion and disease prevention, and public health protection. In recent years, new applications and practices in public health using these technologies have emerged, particularly in the area of communication among practitioners and transmission of information to the population. This article aims to give an overall view of the use of ICT in public health and to discuss the impact of these technologies on public health practices. The discussion is centred around the implications of using these new technologies: implications with regard to the new possibilities provided by these technologies, but also with regard to the difficulties involved in their use as well as issues related to unequal access and ethics. Finally, the question of the evaluation of these technologies and of their impact on public health is discussed.

  10. Utilizing the AAVSO's Variable Star Index (VSX) in Undergraduate Research Projects (Poster abstract)

    NASA Astrophysics Data System (ADS)

    Larsen, K.

    2016-12-01

    (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.

  11. Utilizing the AAVSO's Variable Star Index (VSX) In Undergraduate Research Projects

    NASA Astrophysics Data System (ADS)

    Larsen, Kristine

    2016-01-01

    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.

  12. Utility of sun-reactive skin typing and melanin index for discerning vitamin D deficiency.

    PubMed

    Khalid, Arshad T; Moore, Charity G; Hall, Christopher; Olabopo, Flora; Rozario, Nigel L; Holick, Michael F; Greenspan, Susan L; Rajakumar, Kumaravel

    2017-09-01

    BackgroundSkin color, a vitamin D status determinant, can be assessed subjectively by Fitzpatrick sun-reactive skin typing (FST) and objectively by melanin index (MI). FST was validated against MI for discerning vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) <20 ng/ml) in children.MethodsWe measured FST, MI, and serum 25(OH)D in healthy, 8- to 18-year-old children from one of two vitamin D trials. MI from forehead, hand, and upper arm split at the median of the more racially balanced study cohort and FST (I-III vs. IV-V) were used for discriminating vitamin D deficiency.ResultsA total of 296 participants (mean age, 12.3±2.3 years; black, 208; FST IV-V, 209; 25(OH)D <20 ng/ml, 159) were studied. MI and FST had a strong positive association. Serum 25(OH)D was negatively associated with MI and FST. Sensitivity, specificity, and predictive values were similar for discriminating vitamin D deficiency between higher vs. lower MI and between FST I-III vs. IV-V. ROC area under the curves for FST (0.59) and MI (forehead (0.63); hand (0.62); and arm (0.64)) were similar.ConclusionsFST is comparable to MI for discerning vitamin D deficiency and can be deemed as an inexpensive, useful surrogate measure of skin color in the context of vitamin D research.

  13. Utilization of the water quality index method as a classification tool.

    PubMed

    Boyacioglu, Hülya

    2010-08-01

    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).

  14. A cross-sectional analytic study of postpartum health care service utilization in the Philippines.

    PubMed

    Yamashita, Tadashi; Suplido, Sherri Ann; Ladines-Llave, Cecilia; Tanaka, Yuko; Senba, Naomi; Matsuo, Hiroya

    2014-01-01

    The maternal mortality ratio in the Philippines remains high; thus, it will be difficult to achieve the Millennium Development Goals 5 by 2015. Approximately two-thirds of all maternal deaths occur during the postpartum period. Therefore, we conducted the present study to examine the current state of postpartum health care service utilization in the Philippines, and identify challenges to accessing postpartum care. A questionnaire and knowledge test were distributed to postpartum women in the Philippines. The questionnaire collected demographical characteristics and information about their utilization of health care services during pregnancy and the postpartum period. The knowledge test consisted of 11 questions regarding 6 topics related to possible physical and mental symptoms after delivery. Sixty-four questionnaires and knowledge tests were analyzed. The mean time of first postpartum health care visit was 5.1 ± 5.2 days after delivery. Postpartum utilization of health care services was significantly correlated with delivery location (P<0.01). Women who delivered at home had a lower rate of postpartum health care service utilization than women who delivered at medical facilities. The majority of participants scored low on the knowledge test. We found inadequate postpartum health care service utilization, especially for women who delivered at home. Our results also suggest that postpartum women lack knowledge about postpartum health concerns. In the Philippines, Barangay health workers may play a role in educating postpartum women regarding health care service utilization to improve their knowledge of possible concerns and their overall utilization of health care services.

  15. Improving the quality of urban public space through the identification of space utilization index at Imam Bonjol Park, Padang city

    NASA Astrophysics Data System (ADS)

    Eriawan, Tomi; Setiawati, Lestari

    2017-06-01

    Padang City as a big city with a population approaching one million people has to address the issue of increased activities of the population and increased need for land and space for those activities. One of the effects of population growth and the development of activities in Padang is the decreasing number of open spaces for the outdoor public activities, both the natural and artificial public. However, Padang City has several open spaces that are built and managed by the government including 40 units of open spaces in the form of plansum parks, playgrounds, and sports parks, with a total area of 10.88 hectares. Despite their status as public open spaces, not all of them can be used and enjoyed by the public since most of them are passive parks, in which they are made only as a garden without any indulgences. This study was performed to assess the quality of public spaces in the central business of Padang City, namely Imam Bonjol Park (Taman Imam Bonjol). The methods of this study were done through several stages, which were to identify the typology of function space based on [1] Carmona (2008) and to assess the space utilization index based on the approach of Public Space Index according to Mehta [2] (2007). The purpose of this study was to assess the quality of space which is a public space in Padang City. The space quality was measured based on the variables in Good Public Space Index, the intensity of use, the intensity of social activity, the duration of activity, the variations in usage, and the diversity of use. The rate of the index of public space quality at Taman Imam Bonjol was determined by assessing 5 (five) variables of space quality. Based on the results of the analysis, public space utilization index was equal to 0.696. This result could be used to determine the quality of public space, in this case was Imam Bonjol Park was in Medium category. The parameters indicated several results including the lack of diversity in users' activity time, less

  16. The Impact of Single Mothers' Health Insurance Coverage on Behavioral Health Services Utilization by Their Adolescent Children.

    PubMed

    Ali, Mir M; Teich, Judith L; Mutter, Ryan

    2017-03-02

    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.

  17. How Multidimensional Health Locus of Control predicts utilization of emergency and inpatient hospital services.

    PubMed

    Mautner, Dawn; Peterson, Bridget; Cunningham, Amy; Ku, Bon; Scott, Kevin; LaNoue, Marianna

    2017-03-01

    Health locus of control may be an important predictor of health care utilization. We analyzed associations between health locus of control and frequency of emergency department visits and hospital admissions, and investigated self-rated health as a potential mediator. Overall, 863 patients in an urban emergency department completed the Multidimensional Health Locus of Control instrument, and self-reported emergency department use and hospital admissions in the last year. We found small but significant associations between Multidimensional Health Locus of Control and utilization, all of which were mediated by self-rated health. We conclude that interventions to shift health locus of control may change patients' perceptions of their own health, thereby impacting utilization.

  18. Utilizing a Health Impact Assessment (HIA) to Connect Natural ...

    EPA Pesticide Factsheets

    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

  19. Health Service Utilization among Older Adults in British Columbia: Making Sense of Geography

    ERIC Educational Resources Information Center

    Allan, Diane; Cloutier-Fisher, Denise

    2006-01-01

    The utilization of health services by older adults has received increased attention over the past decade, but little is known about how service utilization varies between rural and urban areas. In an era of restructuring and downsizing within the Canadian health care system, there are concerns that rural older adults may be increasingly…

  20. Health Services Utilization between Older and Younger Homeless Adults.(author Abstract)

    ERIC Educational Resources Information Center

    Nakonezny, Paul A.; Ojeda, Michael

    2005-01-01

    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…

  1. Health Services Utilization between Older and Younger Homeless Adults.(author Abstract)

    ERIC Educational Resources Information Center

    Nakonezny, Paul A.; Ojeda, Michael

    2005-01-01

    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…

  2. Utilization of Traditional and Non-traditional Sources of Health Care Among Hispanics.

    ERIC Educational Resources Information Center

    Van Oss Marin, Barbara; And Others

    1983-01-01

    One hundred low-income Hispanics were interviewed regarding patterns of health-care utilization and perceptions of underutilization of health services by members of their community. Responses showed utilization rates of folk providers were minimal and financial difficulties was the most significant reason given for never having visited private…

  3. Utility of the auditory evoked potentials index as an indicator for endotracheal intubation.

    PubMed

    Kuo, Chang-Po; Chen, Kuo-Mei; Wu, Ching-Tang; Horng, Huei-Chi; Cherng, Chen-Hwan; Yu, Cherng-Jyh; Wong, Chih-Shung

    2006-12-01

    The A-line ARX Index (AAI) has been used as an indicator of depth of anesthesia. The study examined whether AAI-guided endotracheal intubation (EI), compared with experience guidance, could provide better hemodynamic stability during general anesthesia (GA). One hundred and four patients were included in this study. In the control group, EI was performed based on the judgment of the anesthesiologist by clinical experience. In the study groups, EI was performed at an AAI value of either 15, 20, or 30. GA was induced with cisatracurium, lidocaine, fentanyl, thiamylal and succinylcholine. Heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline, 1 min before and 1 and 3 min after intubation. The change of hemodynamics over 20% in the space between 1 min before and after intubation was defined as severe change. The incidences of severe changes of HR and MAP in the AAI-15 and AAI-20 groups were significantly lower than those in the control group (19% and 39% vs. 68%, P < 0.01 and 0.05; 52% and 52% vs. 91%, P < 0.01, respectively). The induction time was significantly shorter in the control group than that in the study groups (183 +/- 47 vs. 366 +/- 151, 248 +/- 53, and 255 +/- 85 sec, P < 0.01). Highest dose of thiamylal and longest induction time were needed in the AAI-15 group. Compared with the routine clinical practice, AAI monitoring helps to achieve better condition for EI during induction with less hemodynamic changes. The AAI value of 20 is suggested as an optimal indicator for EI.

  4. Physical health, mental health, and utilization of complementary and alternative medicine services among Gulf War veterans.

    PubMed

    Holliday, Stephanie Brooks; Hull, Amanda; Lockwood, Courtney; Eickhoff, Christine; Sullivan, Patrick; Reinhard, Matthew

    2014-12-01

    Gulf War veterans represent a unique subset of the veteran population. It has been challenging to identify interventions that result in improvements in physical and mental health for this population. Recently, there has been recognition of a potential role for complementary and alternative medicine (CAM) interventions. This paper examines the characteristics of Gulf War and non-Gulf War veterans referred to a CAM clinic, and explores the utilization of services by this population. Participants included 226 veterans enrolled in a CAM clinic at a Veterans Affairs medical center, 42 of whom were Gulf War veterans. Self-report measures of physical/mental health were administered, and service utilization was obtained from participants' medical records for a 6-month period. Gulf War veterans enrolled in the program reported more severe physical and mental health symptoms than non-Gulf War veterans. However, examining only veterans who participated in services in the 6 months following enrollment, the 2 groups reported similar symptom severity. Both groups were similar in their attendance of individual acupuncture and iRest yoga nidra, although Gulf War veterans attended fewer sessions of group acupuncture. Although Gulf War veterans who enroll in a CAM program may have more severe symptoms than non-Gulf War veterans, those who actually participate in services are similar to non-Gulf War veterans on these measures. These groups also differ in their pattern of service utilization. Future research should explore the reasons for these differences, and to identify ways to promote treatment engagement with this population.

  5. Effect of the glycemic index of pre-exercise snack bars on substrate utilization during subsequent exercise.

    PubMed

    Sun, Feng-Hua; O'Reilly, John; Li, Liang; Wong, Stephen Heung-Sang

    2013-12-01

    To investigate the effect of the glycemic index (GI) of pre-exercise snack bars on substrate utilization during subsequent moderate intensity exercise. Fourteen male participants (Age: 27 ± 5 yr; BMI: 22.5 ± 2.7 kg m(-2); [Formula: see text]: 48.7 ± 6.1 mL kg(-1 )min(-1)) completed two trials in a randomized and counterbalanced crossover design. Two iso-caloric snack bars with different GI values (20, LGI versus 68, HGI) were provided to the participants. Ninety minutes later, all participants completed 45 minutes of ergometer cycling at 65% [Formula: see text]. Substrate utilization was measured using indirect calorimetry. During exercise, higher fat oxidation and lower carbohydrate (CHO) oxidation were observed in the LGI trial (LGI versus HGI: CHO, 87.3 ± 20.1 versus 99.2 ± 19.0 g, p < 0.05; Fat, 15.0 ± 5.8 versus 9.7 ± 7.0 g, p < 0.05). Compared with an iso-caloric HGI snack bar, pre-exercise LGI snack bar consumption may facilitate a shift of substrate utilization from CHO to fat during subsequent moderate intensity exercise.

  6. Utilization of eye health-care services in Australia: the National Eye Health Survey.

    PubMed

    Foreman, Joshua; Xie, Jing; Keel, Stuart; Taylor, Hugh R; Dirani, Mohamed

    2017-08-09

    National data on eye health-care service utilization will inform Australia's eye health policy. To investigate the utilization of eye health-care services by Australians. Cross-sectional survey. Indigenous Australians aged 40 years and older and non-Indigenous Australians aged 50 years and older. One thousand seven hundred thirty-eight Indigenous Australians and 3098 non-Indigenous Australians were recruited from 30 randomly selected sites, stratified by remoteness. Sociodemographic, ocular history and eye health-care service utilization data were collected, and an eye examination was conducted. Recentness of eye examinations, types of providers used and associated risk factors. Approximately 67.0% of Indigenous Australians and 82.5% of non-Indigenous Australians underwent an eye examination within the previous 2 years. Indigenous status (P < 0.001), male gender (P < 0.001), Outer Regional (P < 0.001) and Very Remote (P < 0.001) residence were associated with less recent examinations. Participants with >self-reported eye disease or diabetes were most likely to have been examined within the past year (P < 0.001). For Indigenous Australians, older age was associated with recent eye testing (P = 0.001). Those with retinal disease and cataract were more likely to see an ophthalmologist (P < 0.001), and those with refractive error were more likely to see an optometrist (P < 0.001). In Regional Australia, non-Indigenouspeople were more likely to see optometrists (P < 0.001), and Indigenous Australians were more likely to utilize other, non-specialistservices (P < 0.001). Eye examination frequency has improved in Indigenous and non-Indigenous Australians compared with previous population-based research. Further improvements are required in risk groups including Indigenous Australians and those living in Regional and Remote areas. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

  7. Implementation of CDC's School Health Index in 3 Midwest Middle Schools: Motivation for Change

    ERIC Educational Resources Information Center

    Sherwood-Puzzello, Catherine M.; Miller, Michelle; Lohrmann, David; Gregory, Patricia

    2007-01-01

    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…

  8. Implementation of CDC's School Health Index in 3 Midwest Middle Schools: Motivation for Change

    ERIC Educational Resources Information Center

    Sherwood-Puzzello, Catherine M.; Miller, Michelle; Lohrmann, David; Gregory, Patricia

    2007-01-01

    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…

  9. Body Mass Index and the Use of the Internet for Health Information

    ERIC Educational Resources Information Center

    Faith, Jennifer; Thorburn, Sheryl; Smit, Ellen

    2016-01-01

    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…

  10. Body Mass Index, Nutrient Intakes, Health Behaviours and Nutrition Knowledge: A Quantile Regression Application in Taiwan

    ERIC Educational Resources Information Center

    Chen, Shih-Neng; Tseng, Jauling

    2010-01-01

    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…

  11. Applying the School Health Index to a Nationally Representative Sample of Schools: Update for 2006

    ERIC Educational Resources Information Center

    Brener, Nancy D.; Pejavara, Anu; McManus, Tim

    2011-01-01

    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…

  12. School Social Capital and Body Mass Index in the National Longitudinal Study of Adolescent Health

    ERIC Educational Resources Information Center

    Richmond, Tracy K.; Milliren, Carly; Walls, Courtney E.; Kawachi, Ichiro

    2014-01-01

    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…

  13. A quantitative health assessment index for rapid evaluation of fish condition in the field

    SciTech Connect

    Adams, S.M. ); Brown, A.M. ); Goede, R.W. )

    1993-01-01

    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.

  14. Body Mass Index and the Use of the Internet for Health Information

    ERIC Educational Resources Information Center

    Faith, Jennifer; Thorburn, Sheryl; Smit, Ellen

    2016-01-01

    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…

  15. School Social Capital and Body Mass Index in the National Longitudinal Study of Adolescent Health

    ERIC Educational Resources Information Center

    Richmond, Tracy K.; Milliren, Carly; Walls, Courtney E.; Kawachi, Ichiro

    2014-01-01

    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…

  16. Applying the School Health Index to a Nationally Representative Sample of Schools: Update for 2006

    ERIC Educational Resources Information Center

    Brener, Nancy D.; Pejavara, Anu; McManus, Tim

    2011-01-01

    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…

  17. Body Mass Index, Nutrient Intakes, Health Behaviours and Nutrition Knowledge: A Quantile Regression Application in Taiwan

    ERIC Educational Resources Information Center

    Chen, Shih-Neng; Tseng, Jauling

    2010-01-01

    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…

  18. Market-oriented, demand-driven health care reforms and equity in health and health care utilization in Sweden.

    PubMed

    Burström, Bo

    2009-01-01

    In international comparisons, the Swedish health care system has been seen to perform well. In recent years, market-oriented, demand-driven health care reforms aimed at free choice of provider by patients and free establishment of doctors are increasingly promoted in Sweden. The stated objective is to improve access and efficiency in health services and to provide more and/or better services for the money. Swedish health policy aims to provide equal access to care, based on equal need. However, the social and economic gradient in disease and ill health does not translate into the same social and economic gradient in demand for health services. A market-oriented, demand-driven health care system runs the risk of defeating the health policy aims and of further increasing gaps between social groups in access and utilization of health care services, to the detriment of those with greater needs, unless it is coupled with need-based allocation of resources and empowerment of these groups.

  19. Marching toward the Millennium Development Goals: what about health systems, health-seeking behaviours and health service utilization in Pakistan?

    PubMed

    Shaikh, Babar T

    2008-01-01

    Attaining the ambitious targets pronounced in the Millennium Development Goals (MDGs) will necessitate radical changes in policy as well as extensive reforms and strong inter-sectoral coordination in the healthcare system of Pakistan. While aiming for such macro-level achievements, it is imperative to analyze the on-the-ground realities of any health system. Improving health systems has the potential to assist progress toward MDGs in the near term by promoting more equitable access and introducing effective interventions. More money allocation and more health spending would not necessarily mean better health for Pakistanis. The complex composition of the healthcare system drives us to study the intricate phenomena of health service utilization and healthcare-seeking behaviours. Such an approach will thus provide evidence to sensitize health personnel to provide more empathetic care and to encourage the community at large to start seeking appropriate and timely healthcare. This paper advocates thinking beyond health services provision by reaching out to people and understanding their perceptions, practices and health-seeking behaviours. Achieving millennium development goals will necessitate interventions that address health issues of women, children and all other vulnerable groups in Pakistan.

  20. Health status: types of validity and the index of well-being.

    PubMed Central

    Kaplan, R M; Bush, J W; Berry, C C

    1976-01-01

    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

  1. Beyond the Normalized Difference Vegetation Index (NDVI): Developing a Natural Space Index for population-level health research.

    PubMed

    Rugel, Emily J; Henderson, Sarah B; Carpiano, Richard M; Brauer, Michael

    2017-11-01

    Natural spaces can provide psychological benefits to individuals, but population-level epidemiologic studies have produced conflicting results. Refining current exposure-assessment methods is necessary to advance our understanding of population health and to guide the design of health-promoting urban forms. The aim of this study was to develop a comprehensive Natural Space Index that robustly models potential exposure based on the presence, form, accessibility, and quality of multiple forms of greenspace (e.g., parks and street trees) and bluespace (e.g., oceans and lakes). The index was developed for greater Vancouver, Canada. Greenness presence was derived from remote sensing (NDVI/EVI); forms were extracted from municipal and private databases; and accessibility was based on restrictions such as private ownership. Quality appraisals were conducted for 200 randomly sampled parks using the Public Open Space Desktop Appraisal Tool (POSDAT). Integrating these measures in GIS, exposure was assessed for 60,242 postal codes using 100- to 1,600-m buffers based on hypothesized pathways to mental health. A single index was then derived using principal component analysis (PCA). Comparing NDVI with alternate approaches for assessing natural space resulted in widely divergent results, with quintile rankings shifting for 22-88% of postal codes, depending on the measure. Overall park quality was fairly low (mean of 15 on a scale of 0-45), with no significant difference seen by neighborhood-level household income. The final PCA identified three main sets of variables, with the first two components explaining 68% of the total variance. The first component was dominated by the percentages of public and private greenspace and bluespace and public greenspace within 250m, while the second component was driven by lack of access to bluespace within 1 km. Many current approaches to modeling natural space may misclassify exposures and have limited specificity. The Natural Space Index

  2. Selected areas of health and health care utilization by immigrants living in the Czech Republic.

    PubMed

    Brabcová, Iva; Kajanová, Alena

    2015-01-01

    This investigation examined to what extent a selected group of immigrants in the Czech Republic receive healthcare for primary prevention and inpatient care. A partial aim of the research was to confirm the connection between immigrant health and their social situation. Using a quantitative study technique, 1,014 legally established immigrants (Vietnamese, Polish, Ukrainian, Russian, and Slovak) between 18-65 years of age were interviewed. The selection of respondents was conducted using purposive selection. The stratification of the group was determined by nationality, age, and gender. Long-term illnesses were found significantly more frequently among Ukrainian immigrants and less frequently among Vietnamese immigrants. About half of the respondents had visited a GP and dentist in the previous year and 11.5% of respondents had been hospitalized in inpatient departments. Most of the surveyed immigrants had public health insurance (77.9%), one-fifth had contractual health insurance (19.6%) and 2.5% did not have health insurance. In statistical terms, Vietnamese, Ukrainian, and Russian immigrants had commercial insurance more often than Polish and Slovak immigrants. The utilization of public health insurance and healthcare among immigrants grew significantly in correlation with length of residency. The use of GPs for preventive health care also grew in correlation with knowledge of the Czech language. We found that less than nine percent of immigrants reported needing hospitalization for an illness, but were not hospitalized. Currently, immigration represents one of the most burning and sensitive global challenges. The outcome of this research clearly shows that improving immigrant Czech language skills and giving all legally established immigrants access to Czech public health insurance are important steps needed to increase access to healthcare for immigrants in the Czech Republic.

  3. Health and functional status and utilization of health care services among holocaust survivors and their counterparts in Israel.

    PubMed

    Iecovich, Esther; Carmel, Sara

    2010-01-01

    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.

  4. MOVE: weight management program across the veterans health administration: patient- and facility-level predictors of utilization

    PubMed Central

    2013-01-01

    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

  5. Patterns of health care utilization and cost before and after opioid overdose: findings from 10-year longitudinal health plan claims data.

    PubMed

    Maeng, Daniel D; Han, John J; Fitzpatrick, Michael H; Boscarino, Joseph A

    2017-01-01

    To describe the longitudinal pattern of health care utilization and cost of care before and after opioid overdose (OD) over a 10-year period using health plan claims data. Patients who had experienced opioid ODs between April 2005 and March 2015 were identified from Geisinger Health System's electronic health records. Among these patients, a subgroup of patients who were Geisinger Health Plan (GHP) members at any point between January 2006 and December 2015 were also identified. From the corresponding GHP claims data, their all-cause health care utilization (inpatient admissions, emergency department [ED] visits, and physician office visits) and total medical costs, excluding prescription medication cost, were obtained. Per-member-per-month estimates for each month before and after the index date of opioid OD were calculated, adjusting for age, gender, plan type, year, and comorbidity via multivariate regression models. A total of 942 opioid OD patients with an average GHP enrollment period of 41.4 months were identified. ED visit rates rose rapidly starting around 19-24 months prior to the opioid OD date. Acute inpatient admission rates and total medical cost also rose rapidly starting around 12 months prior. After the OD date, the utilization rates and cost declined but tended to remain above those of the pre-OD period. Opioid OD is preceded by sharp increases in utilization of acute care and cost well before the actual OD. These findings therefore suggest that early signals of OD may be detected from patterns of acute care utilization, particularly the ED visits.

  6. Substrate utilization during brisk walking is affected by glycemic index and fructose content of a pre-exercise meal.

    PubMed

    Sun, Feng-Hua; Wong, Stephen Heung-Sang; Huang, Ya-Jun; Chen, Ya-Jun; Tsang, Ka-Fai

    2012-07-01

    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.

  7. Health Literacy INDEX: development, reliability, and validity of a new tool for evaluating the health literacy demands of health information materials.

    PubMed

    Kaphingst, Kimberly A; Kreuter, Matthew W; Casey, Chris; Leme, Luisa; Thompson, Tess; Cheng, Meng-Ru; Jacobsen, Heather; Sterling, Ryan; Oguntimein, Joy; Filler, Carl; Culbert, Arthur; Rooney, Megan; Lapka, Christy

    2012-01-01

    There is no consensus on how best to assess the health literacy demands of health information materials. Comprehensive, reliable, and valid assessment tools are needed. The authors report on the development, refinement, and testing of Health Literacy INDEX, a new tool reflecting empirical evidence and best practices. INDEX is comprised of 63 indicators organized into 10 criteria: plain language, clear purpose, supporting graphics, user involvement, skill-based learning, audience appropriateness, user instruction, development details, evaluation methods, and strength of evidence. In a sample of 100 materials, intercoder agreement was high: 90% or better for 52% of indicators, and above 80% for nearly all others. Overall scores generated by INDEX were highly correlated with average ratings from 12 health literacy experts (r = 0.89, p < .0001). Additional research is warranted to examine the association between evaluation ratings generated by INDEX and individual understanding, behaviors, and improved health. Health Literacy INDEX is a comprehensive tool with evidence for reliability and validity that can be used to evaluate the health literacy demands of health information materials. Although improvement in health information materials is just one aspect of mitigating the effects of limited health literacy on health outcomes, it is an essential step toward a more health literate public.

  8. Health care utilization and cost burden of herpes zoster in a community population.

    PubMed

    Yawn, Barbara P; Itzler, Robbin F; Wollan, Peter C; Pellissier, James M; Sy, Lina S; Saddier, Patricia

    2009-09-01

    To conduct a population-based study to assess health care utilization (HCU) and costs associated with herpes zoster (HZ) and its complications, including postherpetic neuralgia (PHN) and nonpain complications, in adults aged 22 years and older. Medical record data on HCU were abstracted for all confirmed new cases of HZ from January 1, 1996, through December 31, 2001, among residents of Olmsted County, Minnesota. Herpes zoster-related costs were estimated by applying the Medicare Payment Fee Schedule to health care encounters and mean wholesale prices to medications. All costs were adjusted to 2006 US dollars using the medical care component of the Consumer Price Index. The HCU and cost of the 1669 incident HZ cases varied, depending on the complications involved. From 3 weeks before to 1 year after initial diagnosis, there were a mean of 1.8 outpatient visits and 3.1 prescribed medications at a cost of $720 for cases without PHN or nonpain complications compared with 7.5 outpatient visits and 14.7 prescribed medications at a cost of $3998 when complications, PHN, or nonpain complications were present. The annual medical care cost of treating incident HZ cases in the United States, extrapolated from the results of this study in Olmsted County, is estimated at $1.1 billion. Most of the costs are for the care of immunocompetent adults with HZ, especially among those 50 years and older.

  9. Health Care Utilization and Cost Burden of Herpes Zoster in a Community Population

    PubMed Central

    Yawn, Barbara P.; Itzler, Robbin F.; Wollan, Peter C.; Pellissier, James M.; Sy, Lina S.; Saddier, Patricia

    2009-01-01

    OBJECTIVE: To conduct a population-based study to assess health care utilization (HCU) and costs associated with herpes zoster (HZ) and its complications, including postherpetic neuralgia (PHN) and nonpain complications, in adults aged 22 years and older. PATIENTS AND METHODS: Medical record data on HCU were abstracted for all confirmed new cases of HZ from January 1, 1996, through December 31, 2001, among residents of Olmsted County, Minnesota. Herpes zoster-related costs were estimated by applying the Medicare Payment Fee Schedule to health care encounters and mean wholesale prices to medications. All costs were adjusted to 2006 US dollars using the medical care component of the Consumer Price Index. RESULTS: The HCU and cost of the 1669 incident HZ cases varied, depending on the complications involved. From 3 weeks before to 1 year after initial diagnosis, there were a mean of 1.8 outpatient visits and 3.1 prescribed medications at a cost of $720 for cases without PHN or nonpain complications compared with 7.5 outpatient visits and 14.7 prescribed medications at a cost of $3998 when complications, PHN, or nonpain complications were present. CONCLUSION: The annual medical care cost of treating incident HZ cases in the United States, extrapolated from the results of this study in Olmsted County, is estimated at $1.1 billion. Most of the costs are for the care of immunocompetent adults with HZ, especially among those 50 years and older. PMID:19720776

  10. Characterizing Health Care Utilization, Direct Costs, and Comorbidities Associated with Interstitial Cystitis: A Retrospective Claims Analysis.

    PubMed

    Tung, Amy; Hepp, Zsolt; Bansal, Aasthaa; Devine, Emily Beth

    2017-04-01

    Interstitial cystitis (IC) is a debilitating condition that affects up to 5% of the U.S. This condition is characterized by bladder pain, urinary urgency and frequency, nocturia, and, in some patients, bladder lesions called Hunner's lesions (HL). IC patients who have HL experience a clinical course that is distinct from those without HL and, as a result, respond differently to existing treatments. Without effective and lasting therapeutic options, IC patients are expected to experience a reduced quality of life and be a significant economic burden. Previous research describing the burden of IC is not only outdated but lacks stratification by HL. To (a) characterize health care utilization, direct costs, and comorbidities associated with IC and (b) elucidate differences between patients with and without HL. A retrospective analysis was conducted using health care claims from the Truven Health MarketScan Research Databases. Adults with an incident IC diagnosis between 2009 and 2014 were identified and matched 1:4 to non-IC patients on age, gender, and geographic region. Health care utilization, direct costs, and comorbidities during the first 12 months after diagnosis were compared between the 2 groups, as well as between IC subgroups with and without HL. Associations were evaluated after adjustment for potential confounders using regression models. A total of 24,836 IC patients were identified and matched to 99,344 non-IC patients. Patients were predominantly female (92%), with a mean age of 49.0 (SD = 15.3) years. IC patients used significantly more health care resources across all categories compared with non-IC patients. On average, having IC was associated with $7,223 higher total health care costs than not having IC (95% CI = $6,650-$7,796), with outpatient costs contributing to 71% of the difference, after adjusting for baseline age, gender, region, insurance type, plan type, and Charlson Comorbidity Index (CCI) score. The odds of developing select

  11. African Americans: Disparities in Health Care Access and Utilization

    ERIC Educational Resources Information Center

    Copeland, Valire Carr

    2005-01-01

    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…

  12. Military Health System Utilization Management Program at Medical Centers.

    DTIC Science & Technology

    2007-11-02

    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

  13. Update: Health Insurance and Utilization of Care among Rural Adolescents

    ERIC Educational Resources Information Center

    Probst, Janice C.; Moore, Charity G.; Baxley, Elizabeth G.

    2005-01-01

    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:…

  14. African Americans: Disparities in Health Care Access and Utilization

    ERIC Educational Resources Information Center

    Copeland, Valire Carr

    2005-01-01

    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…

  15. Utilizing a Health Impact Assessment (HIA) to Connect Natural ...

    EPA Pesticide Factsheets

    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

  16. Use of Severity of Illness Indexes for Assessing Health Care Provider Performance

    DTIC Science & Technology

    1985-07-01

    Army-Baylor University (If applicable) " Graduate Program in Health Car Admin/HSHA-IHC 6c. ADDRESS (City, State, and ZIP Code) 7b. ADDRESS (City...ACCESSION NO. 11. TITLE (Include Security Classification) USE OF SEVERITY OF ILLNESS INDEXES FOR ASSESSING HEALTH CARE PROVIDER PERFORMANCE 12...GROUP SUB-GROUP Health Care, Quality Assessment - # ... 19. ABSTRACT (Continue on reverse if necessary and identify by block number) This study was

  17. Emergency Department Utilization for Mental Health in American Indian Children

    PubMed Central

    Pickner, Wyatt J.; Puumala, Susan E.; Chaudhary, Kaushal R.; Burgess, Katherine M.; Payne, Nathaniel R.; Kharbanda, Anupam B.

    2016-01-01

    Objectives To examine emergency department (ED) visits for mental health concerns by American Indian children in a multi-center cohort. To analyze demographic and clinical factors, the types of MH concerns and repeat mental health visits. Study design Cross-sectional study of children 5 to 18 years old who visited one of six EDs in the Upper Midwest from June 2011 to May 2012 and self-identified as White or American Indian. Mental health visits were identified by primary diagnosis and reasons for visit and were categorized into diagnostic groups. We explored racial differences in ED visits for mental health, diagnostic groups, and repeat mental health visits. Analysis involved Chi-squared tests, Cochran–Mantel–Haenszel tests, and regression models including age, triage, timing, and insurance and their interactions with race. Results We identified 26,004 visits with 1545 (5.94%) for mental health. The proportion of visits for mental health differed by race and age. American Indian children had lower odds of a mental health visit for 5–10 year olds (Odds Ratio (OR) =0.40, 95% Confidence Interval (CI) =0.26–0.60), but higher odds for 11–17 year olds (OR=1.62, 95% CI = 1.34–1.95). In the older age group, American Indian children were primarily seen for depression and trauma- and stressor-related disorders, whereas White children were primarily seen for depression and disruptive, impulse-control, and conduct disorders. Repeat visits were not different by race. Conclusion Differences were noted in mental health visits between American Indian and White children and were influenced by age. These findings warrant further investigation into care seeking patterns and treatment for mental health in American Indian children. PMID:27131404

  18. Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan

    PubMed Central

    Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Oweis, Arwa; Al Ward, Nada; Burton, Ann

    2016-01-01

    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

  19. Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan.

    PubMed

    Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Oweis, Arwa; Al Ward, Nada; Burton, Ann

    2016-01-01

    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. 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. 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. 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.

  20. The Impact of Medicare Coverage Policies on Health Care Utilization

    PubMed Central

    Foote, Susan Bartlett; Virnig, Beth A; Town, Robert J; Hartman, Lacey

    2008-01-01

    Objective To determine whether Medicare coverage policies affect utilization of services in Medicare. Data Sources We constructed an analysis data set for eight different procedures using secondary data obtained from Medicare claims (1999–2002) and Medicare coverage policies posted on Center for Medicare and Medicaid Services website. Study Design We analyzed the impact of coverage policies using difference-in-difference approach in a regression framework. Principal Findings We found that in only one case (transesophageal echocardiography) out of eight did utilization change (reduced by 13.6 percent) after the effective date of the local policies. There is no systematic pattern that policies affect utilization, and the type of coverage policy does not seem to play an important role in its impact. Conclusions Coverage policies have the potential but do not consistently impact utilization as policy makers intend and expect them to do. These findings raise significant policy questions about the effectiveness of Medicare coverage policies, which deserve further study. PMID:18479413

  1. Medical innovation and age-specific trends in health care utilization: findings and implications.

    PubMed

    Wong, Albert; Wouterse, Bram; Slobbe, Laurentius C J; Boshuizen, Hendriek C; Polder, Johan J

    2012-01-01

    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.

  2. An investigation into the effect of alcohol consumption on health status and health care utilization in Ireland.

    PubMed

    Ormond, Gillian; Murphy, Rosemary

    2017-03-01

    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.

  3. Impact of Predicting Health Care Utilization Via Web Search Behavior: A Data-Driven Analysis

    PubMed Central

    Zhang, Liangliang; Zhu, Josh; Fang, Shiyuan; Cheng, Tim; Hong, Chloe; Shah, Nigam H

    2016-01-01

    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

  4. Impact of Predicting Health Care Utilization Via Web Search Behavior: A Data-Driven Analysis.

    PubMed

    Agarwal, Vibhu; Zhang, Liangliang; Zhu, Josh; Fang, Shiyuan; Cheng, Tim; Hong, Chloe; Shah, Nigam H

    2016-09-21

    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. 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. 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 conversion rate and predicted

  5. Measuring the Safety of Excreta Disposal Behavior in India with the New Safe San Index: Reliability, Validity and Utility

    PubMed Central

    Jenkins, Marion W.; Freeman, Matthew C.; Routray, Parimita

    2014-01-01

    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

  6. Measuring the safety of excreta disposal behavior in India with the new Safe San Index: reliability, validity and utility.

    PubMed

    Jenkins, Marion W; Freeman, Matthew C; Routray, Parimita

    2014-08-15

    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.

  7. Perceived discrimination outside health care settings and health care utilization of Turkish and Moroccan GP patients in the Netherlands.

    PubMed

    Lamkaddem, Majda; Essink-Bot, Marie-Louise; Devillé, Walter; Foets, Marleen; Stronks, Karien

    2012-08-01

    Problematic interethnic relationships, expressed by feelings of discrimination, may contribute to ethnic variations in health and health care utilization. The impact of daily perceived discrimination on (mental) health has been shown. Less is known about the effect of everyday discrimination on the health care utilization. We examined the relationship between perceived discrimination of Turkish and Moroccan patients on GP health care utilization in the Netherlands and on health services use in the home country. Cohort study within the second Dutch National Survey of General Practice (2001). Interviews were conducted with 416 Turkish and 381 Moroccan respondents, and repeated in 2005 among respectively 118 and 102 participants. Linear, logistic and zero-inflated binomial regression models were used for the analyses. Perceived discrimination was associated with non-attendance to the GP. Perceived quality of GP care was not a mediator in this relationship. No evidence was found for substitution of health care utilization in the home country to health care in the host country. GP attenders had higher odds of using health care in the home country than non-attenders. Over time, a lasting discrimination feeling was related to persistent non-attendance at the GP practice. Ethnic minority patients who feel discriminated may avoid GP health care. Further research is warranted on magnitude and health effects of such potential underutilization. Information on perceived discrimination within health care settings would increase insight into the profile of non-attenders, and on possible measures to better target interventions at a group at risk of underutilization.

  8. Disability, Health Insurance Coverage, and Utilization of Acute Health Services in the United States. Disability Statistics Report 4.

    ERIC Educational Resources Information Center

    LaPlante, Mitchell P.

    This report uses data from the 1989 National Health Interview Survey to estimate health insurance coverage of children and nonelderly adults with disabilities and their utilization of physician and hospital care as a function of health insurance status. In part 1, national statistics on disability and insurance status are provided for different…

  9. Impact of lung function on exacerbations, health care utilization, and costs among patients with COPD

    PubMed Central

    Ke, Xuehua; Marvel, Jessica; Yu, Tzy-Chyi; Wertz, Debra; Geremakis, Caroline; Wang, Liya; Stephenson, Judith J; Mannino, David M

    2016-01-01

    Objective To evaluate the impact of lung function, measured as forced expiratory volume in 1 second (FEV1) % predicted, on health care resource utilization and costs among patients with COPD in a real-world US managed-care population. Methods This observational retrospective cohort study utilized administrative claim data augmented with medical record data. The study population consisted of patients with one or more medical claims for pre- and postbronchodilator spirometry during the intake period (July 1, 2012 to June 30, 2013). The index date was the date of the earliest medical claim for pre- and postbronchodilator spirometry. Spirometry results were abstracted from patients’ medical records. Patients were divided into two groups (low FEV1% predicted [,50%] and high FEV1% predicted [≥50%]) based on the 2014 Global Initiative for Chronic Obstructive Lung Disease report. Health care resource utilization and costs were based on the prevalence and number of discrete encounters during the 12-month postindex follow-up period. Costs were adjusted to 2014 US dollars. Results A total of 754 patients were included (n=297 low FEV1% predicted group, n=457 high FEV1% predicted group). COPD exacerbations were more prevalent in the low FEV1% predicted group compared with the high group during the 12-month pre- (52.5% vs 39.6%) and postindex periods (49.8% vs 36.8%). Mean (standard deviation) follow-up all-cause and COPD-related costs were $27,380 ($38,199) and $15,873 ($29,609) for patients in the low FEV1% predicted group, and $22,075 ($28,108) and $10,174 ($18,521) for patients in the high group. In the multivariable analyses, patients in the low FEV1% predicted group were more likely to have COPD exacerbations and tended to have higher COPD-related costs when compared with patients in the high group. Conclusion Real-world data demonstrate that patients with COPD who have low FEV1% predicted levels use more COPD medications, have more COPD exacerbations, and incur higher

  10. The Air Quality Health Index and Emergency Department Visits for Otitis Media.

    PubMed

    Kousha, Termeh; Castner, Jessica

    2016-03-01

    The purpose of this study was to explore novel multipollutant exposure assessments using the Air Quality Health Index in relation to emergency department visits for otitis media (OM). This study was a retrospective analysis using information from emergency department visits for OM, air pollution, and weather databases. For children 3 years of age or younger, there were 4,815 emergency department visits for OM over a 6-year period across hospitals in Windsor, Ontario, Canada. Both time-stratified case-crossover and nonlinear time series distributed lag analyses were applied to investigate the association between the Air Quality Health Index and visits for OM. Using case-crossover analysis, there was an increase in emergency department visits with OM diagnoses 6 to 7 days postexposure to increased ozone and 3 to 4 days after exposure to increased particulate matter. For every 1 unit increase in the Air Quality Health Index, discharge diagnosis of OM increased 5% to 6% three days postexposure. Effects were stronger using the nonlinear time series analysis. The overall risk for OM, in the first 15 days after an increase in the Air Quality Health Index, was 1.22 times the risk of OM on days following no increase in exposures. These findings confirm that there is an association between the multipollutant Air Quality Health Index and emergency department visits for OM. The findings can be used to inform risk communication, patient education, and policy. Clinicians can use the Air Quality Health Index as an education and advocacy tool to promote and protect the health of those at high risk for OM to reduce exposures. © 2016 Sigma Theta Tau International.

  11. The psychosocial work environment and evidence utilization by health professionals.

    PubMed

    Lavoie-Tremblay, Mélanie; Sounan, Charles; Lavigne, Geneviève L; Bonin, Jean-Pierre; Lesage, Alain D; Denis, Pascale L; Renaud, Martine; Maisy, Nadège; Farand, Lambert; Racine, Hélène

    2008-12-01

    The purpose of this study was to investigate the relationships between dimensions of the psychosocial work environment and health professionals' use of evidence in their practice. A correlational descriptive design was developed. Health professionals working in mental health units at 2 hospitals were asked to complete a questionnaire about their perceptions of the psychosocial work environment and their use of evidence. Correlations and regression analyses were performed. Use of evidence was found to be correlated with social support and decision latitude. Results of multiple regression analyses found perceived social support (beta = .27, p < .01) and perceived decision latitude (beta = .25,p < .01) to be significant predictors of the use of evidence. The authors conclude that good social support and decision latitude among interprofessional groups may promote use of evidence by health professions in their practice.

  12. Factors Associated with Mental Health Service Utilization among Korean American Immigrants

    PubMed Central

    Park, So-Youn; Cho, Sunhee; Park, Yeddi; Bernstein, Kunsook S.; Shin, Jinah K.

    2014-01-01

    This study adapted Andersen's Health Belief Model to examine the predictors of mental health services utilization among Korean American (KA) immigrants. A cross-sectional survey was used to gather data on 363 KA immigrants 18 years and older residing in New York City. Predisposing factors included gender, age, marital status, education, length of stay in the US, and religion; the need factor was depression; and enabling factors included health insurance, English proficiency, income, and perceived need for help. Approximately 8.5 % of participants reported having utilized mental health services, while 23 % reported having depressive symptoms. Shorter duration of residence in the US, lower income, and the presence of perceived need for help were significantly related to use of mental health services. The perceived need for help mediated the relationship between depression and mental health service utilization. Failure to perceive the need for psychological help continues to be a major reason that KA immigrants do not use mental health services. PMID:23417654

  13. Disparity in Health Screening and Health Utilization according to Economic Status.

    PubMed

    Kim, Min Jung; Lee, Hyejin; Kim, Eun Ha; Cho, Mi Hee; Shin, Dong Wook; Yun, Jae Moon; Shin, Jung-Hyun

    2017-07-01

    Cardiovascular disease (CVD) has become the most common cause of mortality and morbidity worldwide. Health screening is associated with higher outpatient visits for detection and treatment of CVD-related diseases (diabetes mellitus, hypertension, and dyslipidemia). We examined the association between health screening, health utilization, and economic status. A sampled cohort database from the National Health Insurance Corporation was used. We included 306,206 participants, aged over 40 years, without CVD (myocardial infarction, stroke, and cerebral hemorrhage), CVD-related disease, cancer, and chronic renal disease. The follow-up period was from January 1, 2003 through December 31, 2005. Totally, 104,584 participants received at least one health screening in 2003-2004. The odds ratio of the health screening attendance rate for the five economic status categories was 1.27 (95% confidence interval [CI], 1.24 to 1.31), 1.05 (95% CI, 1.02 to 1.08), 1, 1.16 (95% CI, 1.13 to 1.19) and 1.50 (95% CI, 1.46 to 1.53), respectively. For economic status 1, 3, and 5, respectively, the diagnostic rate after health screening was as follows: diabetes mellitus: 5.94%, 5.36%, and 3.77%; hypertension: 32.75%, 30.16%, and 25.23%; and dyslipidemia: 13.43%, 12.69%, and 12.20%. The outpatient visit rate for attendees diagnosed with CVD-related disease was as follows for economic status 1, 3, and 5, respectively: diabetes mellitus: 37.69%, 37.30%, and 43.70%; hypertension: 34.44%, 30.09%, and 32.31%; and dyslipidemia: 18.83%, 20.35%, and 23.48%. Thus, higher or lower economic status groups had a higher health screening attendance rate than the middle economic status group. The lower economic status group showed lower outpatient visits after screening, although it had a higher rate of CVD diagnosis.

  14. Comparison of Voice Handicap Index Scores Between Female Students of Speech Therapy and Other Health Professions.

    PubMed

    Tafiadis, Dionysios; Chronopoulos, Spyridon K; Siafaka, Vassiliki; Drosos, Konstantinos; Kosma, Evangelia I; Toki, Eugenia I; Ziavra, Nausica

    2017-09-01

    Students' groups (eg, teachers, speech language pathologists) are presumably at risk of developing a voice disorder due to misuse of their voice, which will affect their way of living. Multidisciplinary voice assessment of student populations is currently spread widely along with the use of self-reported questionnaires. This study compared the Voice Handicap Index domains and item scores between female students of speech and language therapy and of other health professions in Greece. We also examined the probability of speech language therapy students developing any vocal symptom. Two hundred female non-dysphonic students (aged 18-31) were recruited. Participants answered the Voice Evaluation Form and the Greek adaptation of the Voice Handicap Index. Significant differences were observed between the two groups (students of speech therapy and other health professions) through Voice Handicap Index (total score, functional and physical domains), excluding the emotional domain. Furthermore, significant differences for specific Voice Handicap Index items, between subgroups, were observed. In conclusion, speech language therapy students had higher Voice Handicap Index scores, which probably could be an indicator for avoiding profession-related dysphonia at a later stage. Also, Voice Handicap Index could be at a first glance an assessment tool for the recognition of potential voice disorder development in students. In turn, the results could be used for indirect therapy approaches, such as providing methods for maintaining vocal health in different student populations. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  15. Relationship Between Physical Activity and Health-Related Utility Among Knee Osteoarthritis Patients

    PubMed Central

    Manheim, Larry M.; Dunlop, Dorothy; Song, Jing; Semanik, Pamela; Lee, Jungwha; Chang, Rowland W.

    2012-01-01

    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

  16. Understanding observed and unobserved health care access and utilization disparities among US Latino adults.

    PubMed

    Vargas Bustamante, Arturo; Fang, Hai; Rizzo, John A; Ortega, Alexander N

    2009-10-01

    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.

  17. A REFERENCE-INVARIANT HEALTH DISPARITY INDEX BASED ON RÉNYI DIVERGENCE

    PubMed Central

    Talih, Makram

    2015-01-01

    One of four overarching goals of Healthy People 2020 (HP2020) is to achieve health equity, eliminate disparities, and improve the health of all groups. In health disparity indices (HDIs) such as the mean log deviation (MLD) and Theil index (TI), disparities are relative to the population average, whereas in the index of disparity (IDisp) the reference is the group with the least adverse health outcome. Although the latter may be preferable, identification of a reference group can be affected by statistical reliability. To address this issue, we propose a new HDI, the Rényi index (RI), which is reference-invariant. When standardized, the RI extends the Atkinson index, where a disparity aversion parameter can incorporate societal values associated with health equity. In addition, both the MLD and TI are limiting cases of the RI. Also, a symmetrized Rényi index (SRI) can be constructed, resulting in a symmetric measure in the two distributions whose relative entropy is being evaluated. We discuss alternative symmetric and reference-invariant HDIs derived from the generalized entropy (GE) class and the Bregman divergence, and argue that the SRI is more robust than its GE-based counterpart to small changes in the distribution of the adverse health outcome. We evaluate the design-based standard errors and bootstrapped sampling distributions for the SRI, and illustrate the proposed methodology using data from the National Health and Nutrition Examination Survey (NHANES) on the 2001–04 prevalence of moderate or severe periodontitis among adults aged 45–74, which tracks Oral Health objective OH-5 in HP2020. Such data, which uses a binary individual-level outcome variable, are typical of HP2020 data. PMID:26568778

  18. Health Care Utilization among Migrant Latino Farmworkers: The Case of Skin Disease

    ERIC Educational Resources Information Center

    Feldman, Steven R.; Vallejos, Quirina M.; Quandt, Sara A.; Fleischer, Alan B., Jr.; Schulz, Mark R.; Verma, Amit; Arcury, Thomas A.

    2009-01-01

    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…

  19. Effect of Personality on the Use and Perceived Utility of Web-Based Health Resources

    ERIC Educational Resources Information Center

    Hruska, Natalie

    2012-01-01

    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…

  20. The Rural-Urban Divide: Health Services Utilization among Older Mexicans in Mexico

    ERIC Educational Resources Information Center

    Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.

    2010-01-01

    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…

  1. Health Care Utilization among Migrant Latino Farmworkers: The Case of Skin Disease

    ERIC Educational Resources Information Center

    Feldman, Steven R.; Vallejos, Quirina M.; Quandt, Sara A.; Fleischer, Alan B., Jr.; Schulz, Mark R.; Verma, Amit; Arcury, Thomas A.

    2009-01-01

    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…

  2. The Rural-Urban Divide: Health Services Utilization among Older Mexicans in Mexico

    ERIC Educational Resources Information Center

    Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.

    2010-01-01

    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…

  3. Effect of Personality on the Use and Perceived Utility of Web-Based Health Resources

    ERIC Educational Resources Information Center

    Hruska, Natalie

    2012-01-01

    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…

  4. The utility of fat mass index vs. body mass index and percentage of body fat in the screening of metabolic syndrome

    PubMed Central

    2013-01-01

    Background It has been well documented that obesity is closely associated with metabolic syndrome (MetS). Although body mass index (BMI) is the most frequently used method to assess overweightness and obesity, this method has been criticized because BMI does not always reflect true body fatness, which may be better evaluated by assessment of body fat and fat-free mass. The objective of this study was to investigate the best indicator to predict the presence of MetS among fat mass index, BMI and percentage of body fat (BF %) and determine its optimal cut-off value in the screening of MetS in practice. Methods A cross-sectional study of 1698 subjects (aged 20–79 years) who participated in the annual health check-ups was employed. Body composition was measured by bioelectrical impedance analysis (BIA). Fat mass index (FMI) was calculated. Sex-specific FMI quartiles were defined as follows: Q1: <4.39, Q2:4.39- < 5.65, Q3:5.65- < 7.03, Q4:≥7.03,in men; and Q1:<5.25, Q2:5.25- < 6.33, Q3:6.33- < 7.93,Q4:≥7.93, in women. MetS was defined by National Cholesterol Education Program/Adult Treatment Panel III criteria. The association between FMI quartiles and MetS was assessed using Binary logistic regression. Receiver operating curve(ROC) analysis was used to determine optimal cutoff points for BMI,BF% and FMI in relation to the area under the curve(AUC),sensitivity and specificity in men and women. Results The adjusted odds ratios (95% CI) for the presence of MetS in the highest FMI quartile versus lowest quartile were 79.143(21.243-294.852) for men( P < 0.01) and 52.039(4.144-653.436) for women( P < 0.01) after adjusting age, BMI, BF%, TC, LDL, CRP, smoking status and exercise status, and the odds ratios were 9.166(2.157-38.952) for men( P < 0.01) and 25.574(1.945-336.228) for women( P < 0.05) when WC was also added into the adjustment. It was determined that BMI values of 27.45 and 23.85 kg/m2, BF% of 23.95% and 31.35% and FMI of 7

  5. The Health Heterogeneity of and Health Care Utilization by the Elderly in Taiwan

    PubMed Central

    Liu, Li-Fan

    2014-01-01

    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

  6. Effect of Pediatric Behavioral Health Screening and Colocated Services on Ambulatory and Inpatient Utilization.

    PubMed

    Hacker, Karen A; Penfold, Robert B; Arsenault, Lisa N; Zhang, Fang; Soumerai, Stephen B; Wissow, Lawrence S

    2015-11-01

    The study sought to determine the impact of a pediatric behavioral health screening and colocation model on utilization of behavioral health care. In 2003, Cambridge Health Alliance, a Massachusetts public health system, introduced behavioral health screening and colocation of social workers sequentially within its pediatric practices. An interrupted time-series study was conducted to determine the impact on behavioral health care utilization in the 30 months after model implementation compared with the 18 months prior. Specifically, the change in trends of ambulatory, emergency, and inpatient behavioral health utilization was examined. Utilization data for 11,223 children ages ≥4 years 9 months to <18 years 3 months seen from 2003 to 2008 contributed to the study. In the 30 months after implementation of pediatric behavioral health screening and colocation, there was a 20.4% cumulative increase in specialty behavioral health visit rates (trend of .013% per month, p=.049) and a 67.7% cumulative increase in behavioral health primary care visit rates (trend of .019% per month, p<.001) compared with the expected rates predicted by the 18-month preintervention trend. In addition, behavioral health emergency department visit rates increased 245% compared with the expected rate (trend .01% per month, p=.002). After the implementation of a behavioral health screening and colocation model, more children received behavioral health treatment. Contrary to expectations, behavioral health emergency department visits also increased. Further study is needed to determine whether this is an effect of how care was organized for children newly engaged in behavioral health care or a reflection of secular trends in behavioral health utilization or both.

  7. Utilizing health information technology to improve vaccine communication and coverage.

    PubMed

    Stockwell, Melissa S; Fiks, Alexander G

    2013-08-01

    Vaccination coverage is still below the Healthy People 2010 and 2020 goals. Technology use in the US is widespread by patients and providers including text message, email, internet, social media and electronic health records. Health information technology (IT) interventions can facilitate the rapid or real-time identification of children in need of vaccination and provide the foundation for vaccine-oriented parental communication or clinical alerts in a flexible and tailored manner. There has been a small but burgeoning field of work integrating IT into vaccination interventions including reminder/recall using non-traditional methods, clinical decision support for providers in the electronic health record, use of technology to affect work-flow and the use of social media. The aim of this review is to introduce and present current data regarding the effectiveness of a range of technology tools to promote vaccination, describe gaps in the literature and offer insights into future directions for research and intervention.

  8. Utilizing health information technology to improve vaccine communication and coverage

    PubMed Central

    Stockwell, Melissa S; Fiks, Alexander G

    2013-01-01

    Vaccination coverage is still below the Healthy People 2010 and 2020 goals. Technology use in the US is widespread by patients and providers including text message, email, internet, social media and electronic health records. Health information technology (IT) interventions can facilitate the rapid or real-time identification of children in need of vaccination and provide the foundation for vaccine-oriented parental communication or clinical alerts in a flexible and tailored manner. There has been a small but burgeoning field of work integrating IT into vaccination interventions including reminder/recall using non-traditional methods, clinical decision support for providers in the electronic health record, use of technology to affect work-flow and the use of social media. The aim of this review is to introduce and present current data regarding the effectiveness of a range of technology tools to promote vaccination, describe gaps in the literature and offer insights into future directions for research and intervention. PMID:23807361

  9. The impact of integrated obstetric and neonatal services on utilization of postpartum maternal health care services

    PubMed Central

    Vural, Fisun; Yildirim, Filiz; Vural, Birol

    2015-01-01

    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

  10. Factors affecting utilization of health centers in a rural area of Chon Buri Province, Thailand.

    PubMed

    Shrestha, D R; Ittiravivongs, A

    1994-06-01

    A descriptive study was carried out in two subdistricts of Nong Heng and Nong Kakha, Phan Thong District, Chon Buri Province eastern Thailand with the aim to determine factors affecting health center utilization. A cross-sectional survey was conducted on 206 randomly selected households in which household head or senior person in each household was interviewed using a structured questionnaire. The study household was classified as either high or low health center utilization group on the basis of using health services more than 50% of total health services needed in each household. The results revealed that age group, sex, education, family size, and distance from household to health center were not associated with the utilization of health center, whereas occupation, economic status, knowledge and attitude towards health center and quality as well as convenience of health services were found to be associated with health center utilization. It was seemed that underutilization of health centers was multifactorial, in which some factors were related with the personality of individual whereas others were concerned with the health center itself.

  11. Factors affecting mental health service utilization among deployed military personnel.

    PubMed

    Christensen, Brandon N; Yaffe, Joanne

    2012-03-01

    This study contrasts the characteristics of clients using military mental health services in deployed and nondeployed settings, the communications between their mental health providers and commanders, and the impact of mental health services on their military duties. The study explored the rates of command communication and duty restrictions across settings and referral sources. The study used secondary data from two predominantly Air Force sources: (1) deployed data collected in 2005 at Al Udeid Air Base, Qatar; and (2) nondeployed data collected in 2001 at various nondeployed settings. Chi2 analyses were used to compare the demographic variables, command communication, and duty restrictions. Among self-referrals, there were higher rates of command communication and duty restrictions in the deployed setting. Further analysis found that the rate of self-referral to mental health services did not vary significantly across settings despite the barriers of increased command communications and duty restrictions in the deployed setting. This study extends the findings of Rowan and Campise's 2006 initial nondeployed study into the deployed environment.

  12. Utilizing Codes of Ethics in Health Professions Education

    ERIC Educational Resources Information Center

    Dahnke, Michael D.

    2014-01-01

    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,…

  13. Utilizing Codes of Ethics in Health Professions Education

    ERIC Educational Resources Information Center

    Dahnke, Michael D.

    2014-01-01

    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,…

  14. OCLC Utilization in Health Sciences Libraries. CE 35, Revised Edition.

    ERIC Educational Resources Information Center

    Armes, Patti

    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…

  15. Health resource utilization and cost associated with myeloproliferative neoplasms in a large United States health plan.

    PubMed

    Mehta, Jyotsna; Wang, Hongwei; Fryzek, Jon P; Iqbal, Sheikh Usman; Mesa, Ruben

    2014-10-01

    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.

  16. Integrating Primary Care Into Community Mental Health Centers: Impact on Utilization and Costs of Health Care.

    PubMed

    Krupski, Antoinette; West, Imara I; Scharf, Deborah M; Hopfenbeck, James; Andrus, Graydon; Joesch, Jutta M; Snowden, Mark

    2016-11-01

    This evaluation was designed to assess the impact of providing integrated primary and mental health care on utilization and costs for outpatient medical, inpatient hospital, and emergency department treatment among persons with serious mental illness. Two safety-net, community mental health centers that received a Substance Abuse and Mental Health Services Administration Primary and Behavioral Health Care Integration (PBHCI) grant were the focus of this study. Clinic 1 had a ten-year history of providing integrated services whereas clinic 2 began integrated services with the PBHCI grant. Difference-in-differences (DID) analyses were used to compare individuals enrolled in the PBHCI programs (N=373, clinic 1; N=389, clinic 2) with propensity score-matched comparison groups of equal size at each site by using data obtained from medical records. Relative to the comparison groups, a higher proportion of PBHCI clients used outpatient medical services at both sites following program enrollment (p<.003, clinic 1; p<.001, clinic 2). At clinic 1, PBHCI was also associated with a reduction in the proportion of clients with an inpatient hospital admission (p=.04) and a trend for a reduction in inpatient hospital costs per member per month of $217.68 (p=.06). Hospital-related cost savings were not observed for PBHCI clients at clinic 2 nor were there significant differences between emergency department use or costs for PBHCI and comparison groups at either clinic. Investments in PBHCI can improve access to outpatient medical care for persons with severe mental illness and may also curb hospitalizations and associated costs in more established programs.

  17. Corporate health benefits and the indexing of the personal income tax.

    PubMed

    Morrisey, M A

    1983-01-01

    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.

  18. Variations in Student Mental Health and Treatment Utilization Across US Colleges and Universities.

    PubMed

    Ketchen Lipson, Sarah; Gaddis, S Michael; Heinze, Justin; Beck, Kathryn; Eisenberg, Daniel

    2015-01-01

    On US college campuses, mental health problems are highly prevalent, appear to be increasing, and are often untreated. Concerns about student mental health are well documented, but little is known about potential variations across the diversity of institutions of higher education. Participants were 43,210 undergraduates at 72 campuses that participated in the Healthy Minds Study from 2007 to 2013. Multivariable logistic regressions focus on associations between institutional characteristics and student mental health and treatment utilization. The following institutional characteristics are associated with worse mental health: doctoral-granting, public, large enrollment, nonresidential, less competitive, and lower graduation rates. Among students with apparent mental health problems, treatment utilization is higher at doctorate-granting institutions, baccalaureate colleges, institutions with small enrollments, and schools with strong residential systems. Although high rates of mental health problems and low treatment utilization are major concerns at all types of institutions of higher education, substantial variation occurs across campuses.

  19. Impact of a comprehensive worksite wellness program on health risk, utilization, and health care costs.

    PubMed

    Hochart, Cindy; Lang, Michelle

    2011-06-01

    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.

  20. Medicare home health utilization as a function of nursing home market factors.

    PubMed

    Swan, J H; Benjamin, A E

    1990-08-01

    Rapid increases in the size and costs of the home health market, unknown impacts of Medicare's DRG hospital reimbursement on the posthospital market, and general lack of knowledge about factors that explain interstate variation in home health utilization all suggest the importance of developing and testing models of Medicare home health use. This article proposes and tests a model of state home health utilization as a function of the nursing home market. This model proposes that home health utilization is a function of nursing home bed capacity, of the utilization of nursing home beds by Medicaid patients, of other demand factors, and of supply factors. This model is supported by the data. Specifically, Medicare home health use in the 1978-1984 period was found to be negatively related to nursing home bed stock, positively related to Medicaid nursing home utilization, and related to several other supply and demand factors, as hypothesized by the model. The further model assumption that home health utilization does not affect the nursing home market could not be tested in this analysis, but will be addressed in future research by the authors.

  1. Health status and socio-economic factors associated with health facility utilization in rural and urban areas in Zambia

    PubMed Central

    2012-01-01

    Abstracts Background With regards to equity, the objective for health care systems is “equal access for equal needs”. We examined associations of predisposing, enabling and need factors with health facility utilization in areas with high HIV prevalence and few people being aware of their HIV status. Methods The data is from a population-based survey among adults aged 15years or older conducted in 2003. The current study is based on a subset of this data of adults 15–49 years with a valid HIV test result. A modified Health behaviour model guided our analytical approach. We report unadjusted and adjusted odds ratios and their 95% confidence intervals from logistic regression analyses. Results Totals of 1042 males and 1547 females in urban areas, and 822 males and 1055 females in rural areas were included in the study. Overall, 53.1% of urban and 56.8% of rural respondents utilized health facilities past 12 months. In urban areas, significantly more females than males utilized health facilities (OR=1.4 (95% CI [1.1, 1.6]). Higher educational attainment (10+ years of schooling) was associated with utilization of health facilities in both urban (OR=1.7, 95% CI [1.3, 2.1]) and rural (OR=1.4, 95% CI [1.0, 2.0]) areas compared to respondents who attained up to 7 years of schooling. Respondents who self-rated their health status as very poor/ poor/fair were twice more likely to utilize health facilities compared to those who rated their health as good/excellent. Respondents who reported illnesses were about three times more likely to utilize health facilities compared to those who did not report the illnesses. In urban areas, respondents who had mental distress were 1.7 times more likely to utilize health facilities compare to those who had no mental distress. Compared to respondents who were HIV negative, respondents who were HIV positive were 1.3 times more likely to utilize health facilities. Conclusion The health care needs were the factors most strongly

  2. Social Factors Related to the Utilization of Health Care Among Prison Inmates.

    PubMed

    Nowotny, Kathryn M

    2016-04-01

    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. © The Author(s) 2016.

  3. Wealth Index association with gender issues and the reproductive health of Egyptian women.

    PubMed

    Afifi, Mustafa

    2009-03-01

    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.

  4. Applying the School Health Index to a nationally representative sample of schools.

    PubMed

    Brener, Nancy D; Pejavara, Anu; Barrios, Lisa C; Crossett, Linda; Lee, Sarah M; McKenna, Mary; Michael, Shannon; Wechsler, Howell

    2006-02-01

    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.

  5. Low-versus high-glycemic index diets in women: effects on caloric requirement, substrate utilization and insulin sensitivity.

    PubMed

    Clapp, James F; Lopez, Beth

    2007-09-01

    Lowering dietary glycemic index appears to have positive health effects in obese and/or insulin resistant individuals. However, detailed studies in lean young men show no effect. This study was designed to test the null hypothesis that a diet rich in low-glycemic carbohydrate has no effect on lipid profile, caloric requirements, fat oxidation, or insulin sensitivity in adult women when compared to one rich in high-glycemic carbohydrate. The metabolic feeding protocol used was conducted in both a free-living and in-patient setting using a randomized crossover design. Seven women were studied on each of 2 diets in which 60% of the calories were from either high- or low-glycemic carbohydrate sources. Each diet lasted 20 days with measurements of caloric requirement, resting metabolic rate, glucose and insulin responses to diet and activity, insulin sensitivity, and lipid profile over the last 7 days. Caloric requirement was determined by bomb calorimetry. Other techniques included indirect calorimetry, hydrodensitometry, stable isotope tracers, and the euglycemic clamp. On the low-glycemic index diet the women's caloric requirements were 11% +/- 1% higher, fat oxidation at fasted rest supplied an average of 45% +/- 4% versus 28% +/- 5% of oxidative requirements, average glucose and insulin levels were approximately 40% lower, low density lipoproteins (LDL) and leptin concentrations were lower, and various indices of insulin sensitivity were > 20% higher. In this group of adult women, a diet that lowered glycemic index well below that typically found in western diets increased both daily caloric requirement and fat oxidation, decreased insulin and glucose concentrations and increased insulin sensitivity.

  6. A Cross-Sectional Analytic Study of Postpartum Health Care Service Utilization in the Philippines

    PubMed Central

    Yamashita, Tadashi; Suplido, Sherri Ann; Ladines-Llave, Cecilia; Tanaka, Yuko; Senba, Naomi; Matsuo, Hiroya

    2014-01-01

    Background The maternal mortality ratio in the Philippines remains high; thus, it will be difficult to achieve the Millennium Development Goals 5 by 2015. Approximately two-thirds of all maternal deaths occur during the postpartum period. Therefore, we conducted the present study to examine the current state of postpartum health care service utilization in the Philippines, and identify challenges to accessing postpartum care. Methods A questionnaire and knowledge test were distributed to postpartum women in the Philippines. The questionnaire collected demographical characteristics and information about their utilization of health care services during pregnancy and the postpartum period. The knowledge test consisted of 11 questions regarding 6 topics related to possible physical and mental symptoms after delivery. Sixty-four questionnaires and knowledge tests were analyzed. Results The mean time of first postpartum health care visit was 5.1±5.2 days after delivery. Postpartum utilization of health care services was significantly correlated with delivery location (P<0.01). Women who delivered at home had a lower rate of postpartum health care service utilization than women who delivered at medical facilities. The majority of participants scored low on the knowledge test. Conclusion We found inadequate postpartum health care service utilization, especially for women who delivered at home. Our results also suggest that postpartum women lack knowledge about postpartum health concerns. In the Philippines, Barangay health workers may play a role in educating postpartum women regarding health care service utilization to improve their knowledge of possible concerns and their overall utilization of health care services. PMID:24465626

  7. A structured review of health utility measures and elicitation in advanced/metastatic breast cancer.

    PubMed

    Hao, Yanni; Wolfram, Verena; Cook, Jennifer

    2016-01-01

    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. 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. 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 within the journal articles. Most

  8. A structured review of health utility measures and elicitation in advanced/metastatic breast cancer

    PubMed Central

    Hao, Yanni; Wolfram, Verena; Cook, Jennifer

    2016-01-01

    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

  9. Patterns of Urban Health Utilization in Patan, Nepal

    DTIC Science & Technology

    1992-01-01

    deliveries are also performed by Western trained midwives. Finally, there are the ayurvedic he:alers who use natural medicines (such as plants or goat...about 30 ayurvedic healerc per year. However, most of them are trained by others in the rural setting. These people are viewed as the general...may involve reciting a mantra (verse), changing a diet, or giving a medicinal potion. There is a 50 bed ayurvedic hospital in Patan. * Community Health

  10. Women's veteran identity and utilization of VA health services.

    PubMed

    Di Leone, Brooke A L; Wang, Joyce M; Kressin, Nancy; Vogt, Dawne

    2016-02-01

    Women have participated in the United States military since its founding. However, until the mid-20th century, there had been limited recognition of women as official members of the military, and women remain a statistical minority within military and veteran populations. It is therefore important to better understand women's veteran identity (which we define here as one's self-concept as derived from their veteran status) and associated implications for service use and experiences in the Department of Veterans Affairs (VA) health care setting. The present research examined the centrality of, and positive regard for, women's veteran identity among 407 female veterans deployed in support of the recent wars in Iraq and Afghanistan. Data were collected via a mailed national survey. Positive regard for veteran identity, but not veteran identity centrality,was positively associated with participants' age and length of time spent in the military. Results also showed that the centrality of women's veteran identity was positively related to their choice to use VA for health care and their feelings of belonging within VA, and that veteran identity centrality and positive regard for veteran identity are differentially associated with participants' military experiences (e.g., combat exposure, deployment sexual harassment) and mental health symptomatology (e.g., depression). (c) 2016 APA, all rights reserved).

  11. [Prescribing and drug utilization at community health centers].

    PubMed

    Diawara, A; Sangho, H; Maiga, D; Kone, A B D; Maiga, M D; Simaga, S Y

    2007-01-01

    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.

  12. Claw health index for Dutch dairy cattle based on claw trimming and conformation data.

    PubMed

    van der Linde, C; de Jong, G; Koenen, E P C; Eding, H

    2010-10-01

    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.

  13. Factors Affecting Health Care Utilization in OEF/OIF Veterans: The Impact of PTSD and Pain.

    PubMed

    Lang, Katie P; Veazey-Morris, Katherine; Berlin, Kristoffer S; Andrasik, Frank

    2016-01-01

    Returning Operation Enduring Freedom and Operation Iraqi Freedom veterans are at a high risk for physical and mental health symptoms including pain (90%) and post-traumatic stress disorder (PTSD) (58%). These often present concurrently and result in many health problems, functional impairments, and overall poor rehabilitation. To address postdeployment health, effective and efficient allocation of health care resources is needed. Retrospective study of 144 veterans who completed a second-level screening in the Polytrauma clinic. Veterans completed the PTSD Checklist-Civilian Version. Their pain rating and health care utilization (sum of visits during 12 months, categorized as medical or mental health) was extracted through chart review. The majority of veterans reported significant PTSD (72%) and pain (87%) symptoms; 45% received adequate mental health treatment, defined as ≥8 sessions in 12 months. PTSD and the interaction with pain predicted medical utilization; at high pain levels veterans' PTSD severity predicted utilization. PTSD alone predicted mental health utilization. The results show the increased influence of PTSD symptoms on medical health care services when pain ratings are high and suggest the need for interdisciplinary pain clinics that are able to address the overlapping symptoms of pain and common mental health conditions. Implication of results for VA planning are discussed. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  14. The impact of economic growth on health care utilization: a longitudinal study in rural Vietnam.

    PubMed

    Thoa, Nguyen Thi Minh; Thanh, Nguyen Xuan; Chuc, Nguyen Thi Kim; Lindholm, Lars

    2013-03-16

    In many developing countries, including Vietnam, out-of-pocket payment is the principal source of health financing. The economic growth is widening the gap between rich and poor people in many aspects, including health care utilization. While inequities in health between high- and low-income groups have been well investigated, this study aims to investigate how the health care utilization changes when the economic condition is changing at a household level. We analysed a panel data of 11,260 households in a rural district of Vietnam. Of the sample, 74.4% having an income increase between 2003 and 2007 were defined as households with economic growth. We used a double-differences propensity score matching technique to compare the changes in health care expenditure as percentage of total expenditure and health care utilization from 2003 to 2005, from 2003 to 2007, and from 2005 to 2007, between households with and without economic growth. Households with economic growth spent less percentage of their expenditure for health care, but used more provincial/central hospitals (higher quality health care services) than households without economic growth. The differences were statistically significant. The results suggest that households with economic growth are better off also in terms of health services utilization. Efforts for reducing inequalities in health should therefore consider the inequality in income growth over time.

  15. One of many lessons from the European Mental Health Integration Index.

    PubMed

    Murawiec, Sławomir; Krysta, Krzysztof

    2015-09-01

    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

  16. Medicare-Certified Home Health Care: Urban-Rural Differences in Utilization

    ERIC Educational Resources Information Center

    Hartman, Lacey; Jarosek, Stephanie L.; Virnig, Beth A.; Durham, Sara

    2007-01-01

    Context: Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail. Purpose: To examine urban-rural differences in Medicare HHC utilization. Methods: The 2002 100% Medicare HHC claims and denominator files were…

  17. The Evolution and Utility of the Burn Specific Health Scale: A Systematic Review

    DTIC Science & Technology

    2010-01-01

    perceived need for care and degree of utilization of care in a group of severely burned patients with indications of health problems several years after ...BSHS-B subscales ( p < 0.001) - All participants had utilized health care after discharge from burn care (54% with general practitioner, 73% with plastic...G, Silverstein P. Patient perception of quality of life after burn injury: results of an eleven-year survey. J Burn Care Rehabil 1990;11:330–3. [5

  18. Perspectives on utilization of community based health information systems in Western Kenya.

    PubMed

    Flora, Otieno Careena; Margaret, Kaseje; Dan, Kaseje

    2017-01-01

    Health information systems (HIS) are considered fundamental for the efficient delivery of high quality health care. However, a large number of legal and practical constraints influence the design and introduction of such systems. The inability to quantify and analyse situations with credible data and to use data in planning and managing service delivery plagues Africa. Establishing effective information systems and using this data for planning efficient health service delivery is essential to district health systems' performance improvement. Community Health Units in Kenya are central points for community data collection, analysis, dissemination and use. In Kenya, data tend to be collected for reporting purposes and not for decision-making at the point of collection. This paper describes the perspectives of local users on information use in various socio-economic contexts in Kenya. Information for this study was gathered through semi-structured interviews. The interviewees were purposefully selected from various community health units and public health facilities in the study area. The data were organized and analysed manually, grouping them into themes and categories. Information needs of the community included service utilization and health status information. Dialogue was the main way of information utilization in the community. However, health systems and personal challenges impeded proper collection and use of information. The challenges experienced in health information utilization may be overcome by linkages and coordination between the community and the health facilities. The personal challenges can be remedied using a motivational package that includes training of the Community Health Workers.

  19. Perspectives on utilization of community based health information systems in Western Kenya

    PubMed Central

    Flora, Otieno Careena; Margaret, Kaseje; Dan, Kaseje

    2017-01-01

    Introduction Health information systems (HIS) are considered fundamental for the efficient delivery of high quality health care. However, a large number of legal and practical constraints influence the design and introduction of such systems. The inability to quantify and analyse situations with credible data and to use data in planning and managing service delivery plagues Africa. Establishing effective information systems and using this data for planning efficient health service delivery is essential to district health systems' performance improvement. Community Health Units in Kenya are central points for community data collection, analysis, dissemination and use. In Kenya, data tend to be collected for reporting purposes and not for decision-making at the point of collection. This paper describes the perspectives of local users on information use in various socio-economic contexts in Kenya. Methods Information for this study was gathered through semi-structured interviews. The interviewees were purposefully selected from various community health units and public health facilities in the study area. The data were organized and analysed manually, grouping them into themes and categories. Results Information needs of the community included service utilization and health status information. Dialogue was the main way of information utilization in the community. However, health systems and personal challenges impeded proper collection and use of information. Conclusion The challenges experienced in health information utilization may be overcome by linkages and coordination between the community and the health facilities. The personal challenges can be remedied using a motivational package that includes training of the Community Health Workers. PMID:28904707

  20. An index to assess the health and benefits of the global ocean.

    PubMed

    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

    2012-08-30

    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.

  1. Health care utilization of patients diagnosed with idiopathic thrombotic thrombocytopenic purpura in a commercially insured population in the United States.

    PubMed

    Wahl, Peter M; Bohn, Rhonda L; Terrell, Deirdra R; George, James N; Ewenstein, Bruce

    2012-07-01

    Incident idiopathic thrombotic thrombocytopenic purpura (TTP) is an uncommon, potentially fatal blood disorder for which there are little or no data on health care costs. Patients satisfying a validated claims-based algorithm including an inpatient diagnosis of TTP and plasma exchange (PE) procedure during the period January 1, 2001 to May 31, 2008 were identified in the HealthCore Integrated Research Database. To characterize patterns of treatment and payments, a quantitative evaluation of comorbidities and treatments, health care utilization, and payments among this population of patients was conducted. All patients were followed until death, end of health plan enrollment, or 365 days after the TTP hospitalization, whichever occurred first. One hundred fifty-one patients met the claims coding algorithm. Mean total health care payments for the TTP hospitalization were $56,347 (standard deviation [SD] $80,230). Ten patients (6.6%) died during the hospitalization for TTP. Mean payments for PE services in the month following discharge were $9127 (SD $20,840). Several patients required prolonged PE during the acute TTP phase (up to 116 separate exchanges over a period of 365 days), prolonging required treatment and skewing payments and resource utilization during the 365-day period following discharge from the index TTP hospitalization. These data document the health care resource utilization by patients with idiopathic TTP, demonstrating that management of these patients is not only expensive but also skewed, with some patients requiring prolonged treatment. These data can contribute to cost-effectiveness models when new treatments for TTP become available. © 2012 American Association of Blood Banks.

  2. Community perceptions and factors influencing utilization of health services in Uganda

    PubMed Central

    Bakeera, Solome K; Wamala, Sarah P; Galea, Sandro; State, Andrew; Peterson, Stefan; Pariyo, George W

    2009-01-01

    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

  3. Elevated Prostate Health Index (phi) and Biopsy Reclassification During Active Surveillance of Prostate Cancer.

    PubMed

    Andreas, Darian; Tosoian, Jeffrey J; Landis, Patricia; Wolf, Sacha; Glavaris, Stephanie; Lotan, Tamara L; Schaeffer, Edward M; Sokoll, Lori J; Ross, Ashley E

    2016-07-01

    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.

  4. Informing food choices and health outcomes by use of the dietary glycemic index

    USDA-ARS?s Scientific Manuscript database

    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...

  5. Good reliability and validity for a new utility instrument measuring the birth experience, the Labor and Delivery Index.

    PubMed

    Gärtner, Fania R; de Miranda, Esteriek; Rijnders, Marlies E; Freeman, Liv M; Middeldorp, Johanna M; Bloemenkamp, Kitty W M; Stiggelbout, Anne M; van den Akker-van Marle, M Elske

    2015-10-01

    To validate the Labor and Delivery Index (LADY-X), a new delivery-specific utility measure. In a test-retest design, women were surveyed online, 6 to 8 weeks postpartum and again 1 to 2 weeks later. For reliability testing, we assessed the standard error of measurement (S.E.M.) and the intraclass correlation coefficient (ICC). For construct validity, we tested hypotheses on the association with comparison instruments (Mackey Childbirth Satisfaction Rating Scale and Wijma Delivery Experience Questionnaire), both on domain and total score levels. We assessed known-group differences using eight obstetrical indicators: method and place of birth, induction, transfer, control over pain medication, complications concerning mother and child, and experienced control. The questionnaire was completed by 308 women, 257 (83%) completed the retest. The distribution of LADY-X scores was skewed. The reliability was good, as the ICC exceeded 0.80 and the S.E.M. was 0.76. Requirements for good construct validity were fulfilled: all hypotheses for convergent and divergent validity were confirmed, and six of eight hypotheses for known-group differences were confirmed as all differences were statistically significant (P-values: <0.001-0.023), but for two tests, difference scores did not exceed the S.E.M. The LADY-X demonstrates good reliability and construct validity. Despite its skewed distribution, the LADY-X can discriminate between groups. With the preference weights available, the LADY-X might fulfill the need for a utility measure for cost-effectiveness studies for perinatal care interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Acute and chronic impact of cardiovascular events on health state utilities.

    PubMed

    Matza, Louis S; Stewart, Katie D; Gandra, Shravanthi R; Delio, Philip R; Fenster, Brett E; Davies, Evan W; Jordan, Jessica B; Lothgren, Mickael; Feeny, David H

    2015-04-22

    Cost-utility models are frequently used to compare treatments intended to prevent or delay the onset of cardiovascular events. Most published utilities represent post-event health states without incorporating the disutility of the event or reporting the time between the event and utility assessment. Therefore, this study estimated health state utilities representing cardiovascular conditions while distinguishing between acute impact including the cardiovascular event and the chronic post-event impact. Health states were drafted and refined based on literature review, clinician interviews, and a pilot study. Three cardiovascular conditions were described: stroke, acute coronary syndrome (ACS), and heart failure. One-year acute health states represented the event and its immediate impact, and post-event health states represented chronic impact. UK general population respondents valued the health states in time trade-off tasks with time horizons of one year for acute states and ten years for chronic states. A total of 200 participants completed interviews (55% female; mean age = 46.6 y). Among acute health states, stroke had the lowest utility (0.33), followed by heart failure (0.60) and ACS (0.67). Utility scores for chronic health states followed the same pattern: stroke (0.52), heart failure (0.57), and ACS (0.82). For stroke and ACS, acute utilities were significantly lower than chronic post-event utilities (difference = 0.20 and 0.15, respectively; both p < 0.0001). Results add to previously published utilities for cardiovascular events by distinguishing between chronic post-event health states and acute health states that include the event and its immediate impact. Findings suggest that acute versus chronic impact should be considered when selecting scores for use in cost-utility models. Thus, the current utilities provide a unique option that may be used to represent the acute and chronic impact of cardiovascular conditions in economic models

  7. The differences in health care utilization between Medical Aid and health insurance: a longitudinal study using propensity score matching.

    PubMed

    Kim, Jae-Hyun; Lee, Kwang-Soo; Yoo, Ki-Bong; Park, Eun-Cheol

    2015-01-01

    Health care utilization has progressively increased, especially among Medical Aid beneficiaries in South Korea. The Medical Aid classifies beneficiaries into two categories, type 1 and 2, on the basis of being incapable (those under 18 or over 65 years of age, or disabled) or capable of working, respectively. Medical Aid has a high possibility for health care utilization due to high coverage level. In South Korea, the national health insurance (NHI) achieved very short time to establish coverage for the entire Korean population. However there there remaine a number of problems to be solved. Therefore, the objective of this study was to investigate the differences in health care utilization between Medical Aid beneficiaries and Health Insurance beneficiaries. Data were collected from the Korean Welfare Panel Study from 2008 to 2012 using propensity score matching. Of the 2,316 research subjects, 579 had Medical Aid and 1,737 had health insurance. We also analyzed three dependent variables: days spent in the hospital, number of outpatient visits, and hospitalizations per year. Analysis of variance and longitudinal data analysis were used. The number of outpatient visits was 1.431 times higher (p<0.0001) in Medical Aid beneficiaries, the number of hospitalizations per year was 1.604 times higher (p<0.0001) in Medical Aid beneficiaries, and the number of days spent in the hospital per year was 1.282 times higher (p<0.268) for Medical Aid beneficiaries than in individuals with Health Insurance. Medical Aid patients had a 0.874 times lower frequency of having an unmet needs due to economic barrier (95% confidence interval: 0.662-1.156). Health insurance coverage has an impact on health care utilization. More health care utilization among Medical Aid beneficiaries appears to have a high possibility of a moral hazard risk under the Health Insurance program. Therefore, the moral hazard for Medical Aid beneficiaries should be avoided.

  8. Veterans Health Administration and Medicare Outpatient Health Care Utilization by Older Rural and Urban New England Veterans

    ERIC Educational Resources Information Center

    Weeks, William B.; Bott, David M.; Lamkin, Rebecca P.; Wright, Steven M.

    2005-01-01

    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…

  9. Veterans Health Administration and Medicare Outpatient Health Care Utilization by Older Rural and Urban New England Veterans

    ERIC Educational Resources Information Center

    Weeks, William B.; Bott, David M.; Lamkin, Rebecca P.; Wright, Steven M.

    2005-01-01

    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…

  10. College Health Surveillance Network: Epidemiology and Health Care Utilization of College Students at US 4-Year Universities

    ERIC Educational Resources Information Center

    Turner, James C.; Keller, Adrienne

    2015-01-01

    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…

  11. The Associations between Health Literacy, Reasons for Seeking Health Information, and Information Sources Utilized by Taiwanese Adults

    ERIC Educational Resources Information Center

    Wei, Mi-Hsiu

    2014-01-01

    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…

  12. The Associations between Health Literacy, Reasons for Seeking Health Information, and Information Sources Utilized by Taiwanese Adults

    ERIC Educational Resources Information Center

    Wei, Mi-Hsiu

    2014-01-01

    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…

  13. College Health Surveillance Network: Epidemiology and Health Care Utilization of College Students at US 4-Year Universities

    ERIC Educational Resources Information Center

    Turner, James C.; Keller, Adrienne

    2015-01-01

    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…

  14. Intestinal nitrogen recycling and utilization in health and disease.

    PubMed

    Bergen, Werner G; Wu, Guoyao

    2009-05-01

    The role of intestinal microflora in digestive and metabolic processes has received increasing attention from researchers and clinicians. Both enterocytes and small intestine luminal microorganisms can degrade peptides and amino acids (AA). Further, enterocytes can utilize ammonia via glutamate, glutamine, citrulline, and urea synthesis, whereas luminal microbes will deaminate AA, hydrolyze luminal urea, and recycle this ammonia by synthesis of new microbial cells. Although, undoubtedly, some indispensable AA may arise from N cycling and microbial synthesis in the intestinal lumen, the actual net impact on protein nutrition status appears to be limited in humans and animals. Moreover, potential contributions of the recycled N as colonic luminal microbial proteins to AA in blood depend on colonic protein digestion and AA absorption. Finally, new evidence indicates that gut microbial metabolism may be enhanced by prebiotics and probiotics, with the prospects of new treatment paradigms for eliminating undesirable secondary N metabolites and ameliorating complications in whole-body N metabolism under the conditions of intestinal stress, liver disease, and kidney failure.

  15. Use of the integrated health interview series: trends in medical provider utilization (1972-2008)

    PubMed Central

    2012-01-01

    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

  16. Personal and social determinants of health services utilization by Mexican older people.

    PubMed

    de Córdova, Maria Isabel Peñarrieta; Mier, Nelda; Curi, Ethel Jannet Mercado; Gómez, Tranquilina Gutiérrez; Quirarte, Nora Hilda Gonzales; Barrios, Florabel Flores

    2010-09-01

    Increased healthcare needs among older individuals around the world demands a better understanding of factors influencing healthcare service utilization patterns. To examine personal and social correlates to health services utilization among Mexican older persons. This was a cross-sectional study conducted between 2004 and 2006 with 2030 Mexican adults 60 years and older and based on a health services utilization framework. A two-stage cluster sampling with probability proportionate to size was used. Participants were randomly selected and recruited in four metropolitan areas in Northeastern Mexico. Chi-square and Pearson's chi-squared tests and logistic regression were used for data analyses. Significantly more women than men had lost a spouse and were illiterate. Also, females reported significantly poorer health, higher nutritional risk and lower ability to perform activities of daily and instrumental living than males. Predictors of healthcare utilization were: Having a caregiver during an illness; perceiving to have a health problem; being able to afford food, and having children. Predisposing, enabling and need factors are strong predictors of health services utilization among Mexican older persons. In addition, gender differences exist among this population in relation to health status, but not to health services demands. © 2009 Blackwell Publishing Ltd.

  17. Trends in Mental Health Services Utilization and Stigma in US Soldiers From 2002 to 2011

    PubMed Central

    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.

    2014-01-01

    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