WorldWideScience

Sample records for care population based

  1. Event detection using population-based health care databases in randomized clinical trials

    DEFF Research Database (Denmark)

    Thuesen, Leif; Jensen, Lisette Okkels; Tilsted, Hans Henrik; Mæng, Michael; Terkelsen, Christian; Thayssen, Per; Ravkilde, Jan; Christiansen, Evald Høj; Bøtker, Hans Erik; Madsen, Morten; Lassen, Jens F

    2013-01-01

    To describe a new research tool, designed to reflect routine clinical practice and relying on population-based health care databases to detect clinical events in randomized clinical trials.......To describe a new research tool, designed to reflect routine clinical practice and relying on population-based health care databases to detect clinical events in randomized clinical trials....

  2. Antibiotic prescribing patterns in out-of-hours primary care: A population-based descriptive study

    NARCIS (Netherlands)

    Huibers, L.; Moth, G.; Christensen, M.B.; Vedsted, P.

    2014-01-01

    Abstract Objective. To describe the frequency and characteristics of antibiotic prescribing for different types of contacts with the Danish out-of-hours (OOH) primary care service. Design. Population-based observational registry study using routine registry data from the OOH registration system on p

  3. Users’ dissatisfaction with dental care: a population-based household study

    Directory of Open Access Journals (Sweden)

    Andréa Maria Eleutério de Barros Lima Martins

    2015-01-01

    Full Text Available OBJECTIVE To examine whether demographic, socioeconomic conditions, oral health subjectivity and characterization of dental care are associated with users’ dissatisfaction with such are.METHODS Cross-sectional study of 781 people who required dental care in Montes Claros, MG, Southeastern Brazil, in 2012, a city with of medium-sized population situated in the North of Minas Gerais. Household interviews were conducted to assess the users’ dissatisfaction with dental care (dependent variable, demographic, socioeconomic conditions, oral health subjectivity and characterization of dental care (independent variables. Sample calculation was used for the finite population, with estimates made for proportions of dissatisfaction in 50.0% of the population, a 5.0% error margin, a non-response rate of 5.0% and a 2.0% design effect. Logistic regression was used, and the odds ratio was calculated with a 5% significance level and 95% confidence intervals.RESULTS Of the interviewed individuals, 9.0% (7.9%, with correction for design effect were dissatisfied with the care provided. These were associated with lower educational level; negative self-assessment of oral health; perception that the care provider was unable to give dental care; negative evaluation of the way the patient was treated, the cleanliness of the rooms, based on the examination rooms and the toilets, and the size of the waiting and examination rooms.CONCLUSIONS The rate of dissatisfaction with dental care was low. This dissatisfaction was associated with socioeconomic conditions, subjectivity of oral health, skill of the health professionals relating to the professional-patient relationship and facility infrastructure. Educational interventions are suggested that aim at improving the quality of care among professionals by responsible agencies as is improving the infrastructure of the care units.

  4. Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis

    OpenAIRE

    Scales, Damon C.; Thiruchelvam, Deva; Kiss, Alexander; Sibbald, William J; Donald A Redelmeier

    2008-01-01

    Introduction Intensive care unit (ICU) admission for bone marrow transplant recipients immediately following transplantation is an ominous event, yet the survival of these patients with subsequent ICU admissions is unknown. Our objective was to determine the long-term outcome of bone marrow transplant recipients admitted to an ICU during subsequent hospitalizations. Methods We conducted a population-based cohort analysis of all adult bone marrow transplant recipients who received subsequent I...

  5. Improving Population Health by Incorporating Chronic Disease and Injury Prevention Into Value-Based Care Models.

    Science.gov (United States)

    Petersen, Ruth; Rushing, Jill; Nelson, Sharon; Rhyne, Sharon

    2016-01-01

    Today's health system transformation provides a prime opportunity to leverage the capacity of public health to reduce the burden of chronic disease and injury, improve population health, and contain health care costs. Health care settings and organizations should support public health capacity as a key investment in population health. PMID:27422946

  6. Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey

    Directory of Open Access Journals (Sweden)

    Vikum Eirik

    2012-08-01

    Full Text Available Abstract Background In this study we investigated the distribution of self-reported health care utilisation by education and household income in a county population in Norway, in a universal public health care system based on ideals of equal access for all according to need, and not according to wealth. Methods The study included 24,147 women and 20,608 men aged 20 years and above in the third Nord-Trøndelag Health Survey (HUNT 3 of 2006–2008. Income-related horizontal inequity was estimated through concentration indexes, and inequity by both education and income was estimated as risk ratios through conventional regression. Results We found no overall pro-rich or pro-educated socioeconomic gradient in needs-adjusted utilisation of general practitioner or inpatient care. However, we found overall pro-rich and pro-educated inequity in utilisation of both private medical specialists and hospital outpatient care. For these services there were large differences in levels of inequity between younger and older men and women. Conclusion In contrast with recent studies from Norway, we found pro-rich and pro-educated social inequalities in utilisation of hospital outpatient services and not only private medical specialists. Utilisation of general practitioner and inpatient services, which have low access threshold or are free of charge, we found to be equitable.

  7. Population-centered Risk- and Evidence-based Dental Interprofessional Care Team (PREDICT): study protocol for a randomized controlled trial

    OpenAIRE

    Cunha-Cruz, Joana; Milgrom, Peter; Shirtcliff, R. Michael; Bailit, Howard L.; Huebner, Colleen E; Conrad, Douglas; Ludwig, Sharity; Mitchell, Melissa; Dysert, Jeanne; Allen, Gary; Scott, JoAnna; Mancl, Lloyd

    2015-01-01

    Background To improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health. Me...

  8. Equity of inpatient health care in rural Tanzania: a population- and facility-based survey

    Directory of Open Access Journals (Sweden)

    Ferry Grace A

    2012-02-01

    Full Text Available Abstract Objective To explore the equity of utilization of inpatient health care at rural Tanzanian health centers through the use of a short wealth questionnaire. Methods Patients admitted to four rural health centers in the Kigoma Region of Tanzania from May 2008 to May 2009 were surveyed about their illness, asset ownership and demographics. Principal component analysis was used to compare the wealth of the inpatients to the wealth of the region's general population, using data from a previous population-based survey. Results Among inpatients, 15.3% were characterized as the most poor, 19.6% were characterized as very poor, 16.5% were characterized as poor, 18.9% were characterized as less poor, and 29.7% were characterized as the least poor. The wealth distribution of all inpatients (p Conclusion The findings indicated that while current Tanzanian health financing policies may have improved access to health care for children under five, additional policies are needed to further close the equity gap, especially for obstetric inpatients.

  9. Did changing primary care delivery models change performance? A population based study using health administrative data

    Directory of Open Access Journals (Sweden)

    Klein-Geltink Julie

    2011-06-01

    Full Text Available Abstract Background Primary care reform in Ontario, Canada started with the introduction of new enrollment models, the two largest of which are Family Health Networks (FHNs, a capitation-based model, and Family Health Groups (FHGs, a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups. Methods This study used Ontario administrative claims data to compare performance measures in FHGs and FHNs. The study population included physicians who belonged to a FHN or FHG for at least two years. Patients were included in the analyses if they enrolled with a physician in the two years after the physician joined a FHN or FHG, and also if they saw the physician in a two year period prior to the physician joining a FHN or FHG. Performance was derived from the administrative data, and included measures of preventive screening for cancer (breast, cervical, colorectal and chronic disease management (diabetes, heart failure, asthma. Results Performance measures did not vary consistently between models. In some cases, performance approached current benchmarks (Pap smears, mammograms. In other cases it was improving in relation to previous measures (colorectal cancer screening. There were no changes in screening for cervical cancer or breast cancer after joining either a FHN or FHG. Colorectal cancer screening increased in both FHNs and FHGs. After enrolling in either a FHG or a FHN, prescribing performance measures for diabetes care improved. However, annual eye examinations decreased for younger people with diabetes after joining a FHG or FHN. There were no changes in performance measures for heart failure management or asthma care after enrolling in either a FHG or FHN. Conclusions Some improvements in preventive screening and diabetes management which were seen amongst people after they enrolled may be

  10. Variations of care quality for infectious pulmonary tuberculosis in Taiwan: a population based cohort study

    Directory of Open Access Journals (Sweden)

    Chang Ray-E

    2007-06-01

    Full Text Available Abstract Background Effective and efficient care is required to prevent the spread of infectious pulmonary tuberculosis (PTB. We attempted to compare care quality among different healthcare institutions in Southern Taiwan. Methods This study conducted population-based retrospective cohort design. One tuberculosis sanatorium, 2 medical centers, 11 regional hospitals, and 15 district hospitals and primary practitioners in the study area had reported tuberculosis cases, registered from January 1 to June 30 2003. Those cases with sputum positive PTB were followed 15 months after anti-tuberculosis treatment initiation. Meanwhile, Level of conformance with diagnostic guidelines, efficiency of diagnostic and treatment process, and treatment were measured as main outcome. Association was investigated using Chi-square tests, Kruskal Wallis tests, Mann-Whiteney U tests, and multiple logistic regression analysis to evaluate outcome differences among different levels of institutions. Results The analyses included 421 patients. In comparison with patients receiving treatment at medical centers, regional hospitals, and district hospitals/primary practitioners, patients at the Chest Specialty Hospital were more likely to provide at least three sputum specimens (74.1% vs. 48.2%, 36.8%, and 50.0%, shorter workdays examining sputum smears (2.4 ± 2.4 days vs. 2.6 ± 2.1, 4.5 ± 3.1, and 3.5 ± 2.6 days, shorter interval between the first consultation and treatment (10.1 ± 18.3 days vs. 31.0 ± 53.6, 31.2 ± 70.4, and 25.4 ± 37.6 days, and a higher successful treatment rate (92.6% vs. 65.2%, 63.9%, and 68.0%. Furthermore, after adjusting age and gender, the patients treated by the pulmonologists and treated at Chest Specialty Hospital had significantly more successful treatment rate, of which odds ratios were 1.74 and 4.58 respectively. Conclusion Differences in care quality exist among different types of healthcare institutions and among individual physicians

  11. Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study

    OpenAIRE

    Emery Jonathan D; Sanfilippo Frank M; Holman C D'Arcy J; Mai Qun; Preen David B

    2011-01-01

    Abstract Background Health care disparity is a public health challenge. We compared the prevalence of diabetes, quality of care and outcomes between mental health clients (MHCs) and non-MHCs. Methods This was a population-based longitudinal study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia (WA) from 1990 to 2006, using linked data of mental health registry, electoral roll registrations, hospital admissions, emergency department attendances, deaths, and Medicare and pharm...

  12. Estimating leptospirosis incidence using hospital-based surveillance and a population-based health care utilization survey in Tanzania.

    Directory of Open Access Journals (Sweden)

    Holly M Biggs

    Full Text Available BACKGROUND: The incidence of leptospirosis, a neglected zoonotic disease, is uncertain in Tanzania and much of sub-Saharan Africa, resulting in scarce data on which to prioritize resources for public health interventions and disease control. In this study, we estimate the incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a population-based household health care utilization survey in two districts in the Kilimanjaro Region of Tanzania and identified leptospirosis cases at two hospital-based fever sentinel surveillance sites in the Kilimanjaro Region. We used multipliers derived from the health care utilization survey and case numbers from hospital-based surveillance to calculate the incidence of leptospirosis. A total of 810 households were enrolled in the health care utilization survey and multipliers were derived based on responses to questions about health care seeking in the event of febrile illness. Of patients enrolled in fever surveillance over a 1 year period and residing in the 2 districts, 42 (7.14% of 588 met the case definition for confirmed or probable leptospirosis. After applying multipliers to account for hospital selection, test sensitivity, and study enrollment, we estimated the overall incidence of leptospirosis ranges from 75-102 cases per 100,000 persons annually. CONCLUSIONS/SIGNIFICANCE: We calculated a high incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania, where leptospirosis incidence was previously unknown. Multiplier methods, such as used in this study, may be a feasible method of improving availability of incidence estimates for neglected diseases, such as leptospirosis, in resource constrained settings.

  13. Population-based analysis of health care contacts among suicide decedents: identifying opportunities for more targeted suicide prevention strategies.

    Science.gov (United States)

    Schaffer, Ayal; Sinyor, Mark; Kurdyak, Paul; Vigod, Simone; Sareen, Jitender; Reis, Catherine; Green, Diane; Bolton, James; Rhodes, Anne; Grigoriadis, Sophie; Cairney, John; Cheung, Amy

    2016-06-01

    The objective of this study was to detail the nature and correlates of mental health and non-mental health care contacts prior to suicide death. We conducted a systematic extraction of data from records at the Office of the Chief Coroner of Ontario of each person who died by suicide in the city of Toronto from 1998 to 2011. Data on 2,835 suicide deaths were linked with provincial health administrative data to identify health care contacts during the 12 months prior to suicide. Sub-populations of suicide decedents based on the presence and type of mental health care contact were described and compared across socio-demographic, clinical and suicide-specific variables. Time periods from last mental health contact to date of death were calculated and a Cox proportional hazards model examined covariates. Among suicide decedents, 91.7% had some type of past-year health care contact prior to death, 66.4% had a mental health care contact, and 25.3% had only non-mental health contacts. The most common type of mental health contact was an outpatient primary care visit (54.0%), followed by an outpatient psychiatric visit (39.8%), an emergency department visit (31.1%), and a psychiatric hospitalization (21.0%). The median time from last mental health contact to death was 18 days (interquartile range 5-63). Mental health contact was significantly associated with female gender, age 25-64, absence of a psychosocial stressor, diagnosis of schizophrenia or bipolar disorder, past suicide attempt, self-poisoning method and absence of a suicide note. Significant differences between sub-populations of suicide decedents based on the presence and nature of their health care contacts suggest the need for targeting of community and clinical-based suicide prevention strategies. The predominance of ambulatory mental health care contacts, often close to the time of death, reinforce the importance of concentrating efforts on embedding risk assessment and care pathways into all routine primary

  14. Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study.

    Directory of Open Access Journals (Sweden)

    Thomas E Cowling

    Full Text Available BACKGROUND: The number of visits to hospital emergency departments (EDs in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS. Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. METHODS: A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001. Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.

  15. Constructing episodes of inpatient care: data infrastructure for population-based research

    Directory of Open Access Journals (Sweden)

    Fransoo Randy

    2012-09-01

    Full Text Available Abstract Background Databases used to study the care of patients in hospitals and Intensive Care Units (ICUs typically contain a separate entry for each segment of hospital or ICU care. However, it is not uncommon for patients to be transferred between hospitals and/or ICUs, and when transfers occur it is necessary to combine individual entries to accurately reconstruct the complete episodes of hospital and ICU care. Failure to do so can lead to erroneous lengths-of-stay, and rates of admissions, readmissions, and death. Methods This study used a clinical ICU database and administrative hospital abstracts for the adult population of Manitoba, Canada from 2000–2008. We compared five methods for identifying patient transfers and constructing hospital episodes, and the ICU episodes contained within them. Method 1 ignored transfers. Methods 2–5 considered the time gap between successive entries (≤1 day vs. ≤2 days, with or without use of data fields indicating inter-hospital transfer. For the five methods we compared the resulting number and lengths of hospital and ICU episodes. Results During the study period, 48,551 hospital abstracts contained 53,246 ICU records. For Method 1 these were also the number of hospital and ICU episodes, respectively. Methods 2–5 gave remarkably similar results, with transfers included in approximately 25% of ICU-containing hospital episodes, and 10% of ICU episodes. Comparison with Method 1 showed that failure to account for such transfers resulted in overestimating the number of episodes by 7-10%, and underestimating mean or median lengths-of-stay by 9-30%. Conclusions In Manitoba is it not uncommon for critically ill patients to be transferred between hospitals and between ICUs. Failure to account for transfers resulted in inaccurate assessment of parameters relevant to researchers, clinicians, and policy-makers. The details of the method used to identify transfers, at least among the variations tested

  16. Respiratory symptoms increase health care consumption and affect everyday life - a cross-sectional population-based study from Finland, Estonia, and Sweden

    OpenAIRE

    Axelsson, Malin; Lindberg, Anne; Kainu, Annette; Rönmark, Eva; Jansson, Sven-Arne

    2016-01-01

    Background: Even though respiratory symptoms are common in the adult population, there is limited research describing their impact on everyday life and association with health care consumption.Aim: The main objective of this population-based study was to estimate and compare the prevalence of respiratory symptoms among adults in Finland, Estonia, and Sweden in relation to health care consumption and to identify factors influencing health care consumption. A secondary aim was to assess to whic...

  17. The contribution of cultural competence to evidence-based care for ethnically diverse populations.

    Science.gov (United States)

    Huey, Stanley J; Tilley, Jacqueline Lee; Jones, Eduardo O; Smith, Caitlin A

    2014-01-01

    Despite compelling arguments for the dissemination of evidence-based treatments (EBTs), questions regarding their relevance to ethnically diverse populations remain. This review summarizes what is known about psychotherapy effects with ethnic minorities, with a particular focus on the role of cultural competence when implementing EBTs. Specifically, we address three questions: (a) does psychotherapy work with ethnic minorities, (b) do psychotherapy effects differ by ethnicity, and (c) does cultural tailoring enhance treatment effects? The evidence suggests that psychotherapy is generally effective with ethnic minorities, and treatment effects are fairly robust across cultural groups and problem areas. However, evidence for cultural competence is mixed. Ethnic minority-focused treatments frequently incorporate culturally tailored strategies, and these tailored treatments are mostly efficacious; yet support for cultural competence as a useful supplement to standard treatment remains equivocal at best. We also discuss research limitations, areas for future research, and clinical implications. PMID:24437436

  18. The communication of a secondary care diagnosis of autoimmune hepatitis to primary care practitioners:a population-based study

    OpenAIRE

    Varyani, Fumi; Card, Timothy; Kaye, Philip; Aithal, Guru P; West, Joe

    2013-01-01

    BACKGROUND: Autoimmune Hepatitis is a chronic liver disease which affects young people and can result in liver failure leading to death or transplantation yet there is a lack of information on the incidence and prevalence of this disease and its natural history in the UK. A means of obtaining this information is via the use of clinical databases formed of electronic primary care records. How reliably the diagnosis is coded in such records is however unknown. The aim of this study therefore wa...

  19. The communication of a secondary care diagnosis of autoimmune hepatitis to primary care practitioners: a population-based study

    OpenAIRE

    Varyani, Fumi; Card, Timothy; Kaye, Philip; Aithal, Guru P; West, Joe

    2013-01-01

    Background Autoimmune Hepatitis is a chronic liver disease which affects young people and can result in liver failure leading to death or transplantation yet there is a lack of information on the incidence and prevalence of this disease and its natural history in the UK. A means of obtaining this information is via the use of clinical databases formed of electronic primary care records. How reliably the diagnosis is coded in such records is however unknown. The aim of this study therefore ...

  20. Maternal Pregnancy Intention and Professional Antenatal Care Utilization in Bangladesh: A Nationwide Population-Based Survey

    Science.gov (United States)

    Rahman, Md. Mosfequr; Rahman, Md. Mizanur; Tareque, Md. Ismail; Ferdos, Jannatul; Jesmin, Syeda S.

    2016-01-01

    Objective To investigate the association between maternal pregnancy intention and professional antenatal and delivery care utilization. Methods Our data were derived from the 2011 nationally representative Bangladesh Demographic Health Survey. We included antenatal and delivery care utilization data of the most recent live births for women for the previous three years (n = 4672). We used multilevel logistic regression models to assess the relationship between pregnancy intention and use of professional antenatal and delivery care, with adjustment for potential confounding variables. Results Approximately 13% and 16% of children were reported by their mothers as unwanted and mistimed at the time of conception, respectively. Among the women, 55% received at least one professional antenatal care service; 21% received four or more professional antenatal services, while 32% were attended by professionals during deliveries. Mothers of children whose pregnancies had been unwanted had a greater risk for not seeking professional antenatal and professional delivery care than those whose pregnancies had been wanted [1≥ ANC from professionals: AOR: 0.66; 95% CI:0.51–0.93; 4≥ ANC from professionals: AOR:0.56; 95% CI:0.37–0.84; and delivery care from professionals: AOR: 0.70; 95% CI:0.50–0.97]. Women who were married after age 18, had secondary or higher level of education, and were from the wealthiest households were more likely to utilize antenatal and delivery care. Conclusion Unwanted pregnancy is significantly associated with lower utilization of professional antenatal and delivery care services in Bangladesh. Reducing unwanted births and promoting access to professional antenatal and delivery care are crucial for achieving the Sustainable Development Goals (SDGs) 3 in Bangladesh. PMID:27309727

  1. Non-enrollment for free community HIV care: findings from a population-based study in Rakai, Uganda

    OpenAIRE

    NAKIGOZI, GERTRUDE; Makumbi, Fredrick; Reynolds, Steven; Galiwango, Ronald; Kagaayi, Joseph; Nalugoda, Fred; Ssettuba, Absalom; Sekasanvu, Joseph; Musuuza, Jackson; Serwada, David; Gray, Ron; Wawer, Maria

    2011-01-01

    Improved understanding of HIV-related health-seeking behavior at a population level is important in informing the design of more effective HIV prevention and care strategies. We assessed the frequency and determinants of failure to seek free HIV care in Rakai, Uganda. HIV-positive participants in a community cohort who accepted VCT were referred for free HIV care (cotrimoxazole prophylaxis, CD4 monitoring, treatment of opportunistic infections, and, when indicated, antiretroviral therapy). We...

  2. Association of antenatal care with facility delivery and perinatal survival – a population-based study in Bangladesh

    Directory of Open Access Journals (Sweden)

    Pervin Jesmin

    2012-10-01

    Full Text Available Abstract Background Antenatal Care (ANC during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006 and after (2008–2009 implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR 1.91; 95% confidence intervals (CI: 1.50, 2.42 among women who received ≤1 ANC compared to women who received ≥3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78 to non-significance (OR 0.81; 95% CI: 0.65, 1.01, when comparing cohorts before

  3. Anaesthesia care for emergency endoscopy for peptic ulcer bleeding. A nationwide population-based cohort study

    DEFF Research Database (Denmark)

    Duch, Patricia; Haahr Raunkjær, Camilla; Møller, Morten Hylander;

    2016-01-01

    OBJECTIVE: Currently, no standard approach exists to the level of monitoring or presence of staff with anaesthetic expertise required during emergency esophago-gastro-duodenoscopy (EGD) for peptic ulcer bleeding (PUB). We assess the association between anaesthesia care and mortality. We further d...

  4. A population-based model for priority setting across the care continuum and across modalities

    Directory of Open Access Journals (Sweden)

    Mortimer Duncan

    2006-03-01

    Full Text Available Abstract Background The Health-sector Wide (HsW priority setting model is designed to shift the focus of priority setting away from 'program budgets' – that are typically defined by modality or disease-stage – and towards well-defined target populations with a particular disease/health problem. Methods The key features of the HsW model are i a disease/health problem framework, ii a sequential approach to covering the entire health sector, iii comprehensiveness of scope in identifying intervention options and iv the use of objective evidence. The HsW model redefines the unit of analysis over which priorities are set to include all mutually exclusive and complementary interventions for the prevention and treatment of each disease/health problem under consideration. The HsW model is therefore incompatible with the fragmented approach to priority setting across multiple program budgets that currently characterises allocation in many health systems. The HsW model employs standard cost-utility analyses and decision-rules with the aim of maximising QALYs contingent upon the global budget constraint for the set of diseases/health problems under consideration. It is recognised that the objective function may include non-health arguments that would imply a departure from simple QALY maximisation and that political constraints frequently limit degrees of freedom. In addressing these broader considerations, the HsW model can be modified to maximise value-weighted QALYs contingent upon the global budget constraint and any political constraints bearing upon allocation decisions. Results The HsW model has been applied in several contexts, recently to osteoarthritis, that has demonstrated both its practical application and its capacity to derive clear evidenced-based policy recommendations. Conclusion Comparisons with other approaches to priority setting, such as Programme Budgeting and Marginal Analysis (PBMA and modality-based cost

  5. Divorce, divorce rates, and professional care seeking for mental health problems in Europe: a cross-sectional population-based study

    OpenAIRE

    Symoens Sara AA; Colman Elien; Bracke Piet F; Van Praag Lore

    2010-01-01

    Abstract Background Little is known about differences in professional care seeking based on marital status. The few existing studies show more professional care seeking among the divorced or separated compared to the married or cohabiting. The aim of this study is to determine whether, in a sample of the European general population, the divorced or separated seek more professional mental health care than the married or cohabiting, regardless of self-reported mental health problems. Furthermor...

  6. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy

    Directory of Open Access Journals (Sweden)

    Forastiere Francesco

    2009-12-01

    Full Text Available Abstract Background A relationship between quality of primary health care and preventable hospitalizations has been described in the US, especially among the elderly. In Europe, there has been a recent increase in the evaluation of Ambulatory Care Sensitive Conditions (ACSC as an indicator of health care quality, but evidence is still limited. The aim of this study was to determine whether income level is associated with higher hospitalization rates for ACSC in adults in a country with universal health care coverage. Methods From the hospital registries in four Italian cities (Turin, Milan, Bologna, Rome, we identified 9384 hospital admissions for six chronic conditions (diabetes, hypertension, congestive heart failure, angina pectoris, chronic obstructive pulmonary disease, and asthma among 20-64 year-olds in 2000. Case definition was based on the ICD-9-CM coding algorithm suggested by the Agency for Health Research and Quality - Prevention Quality Indicators. An area-based (census block income index was used for each individual. All hospitalization rates were directly standardised for gender and age using the Italian population. Poisson regression analysis was performed to assess the relationship between income level (quintiles and hospitalization rates (RR, 95% CI separately for the selected conditions controlling for age, gender and city of residence. Results Overall, the ACSC age-standardized rate was 26.1 per 10.000 inhabitants. All conditions showed a statistically significant socioeconomic gradient, with low income people being more likely to be hospitalized than their well off counterparts. The association was particularly strong for chronic obstructive pulmonary disease (level V low income vs. level I high income RR = 4.23 95%CI 3.37-5.31 and for congestive heart failure (RR = 3.78, 95% CI = 3.09-4.62. With the exception of asthma, males were more vulnerable to ACSC hospitalizations than females. The risks were higher among 45-64 year

  7. Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study

    Directory of Open Access Journals (Sweden)

    Emery Jonathan D

    2011-11-01

    Full Text Available Abstract Background Health care disparity is a public health challenge. We compared the prevalence of diabetes, quality of care and outcomes between mental health clients (MHCs and non-MHCs. Methods This was a population-based longitudinal study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia (WA from 1990 to 2006, using linked data of mental health registry, electoral roll registrations, hospital admissions, emergency department attendances, deaths, and Medicare and pharmaceutical benefits claims. Diabetes was identified from hospital diagnoses, prescriptions and diabetes-specific primary care claims (17,045 MHCs, 26,626 non-MHCs. Both univariate and multivariate analyses adjusted for socio-demographic factors and case mix were performed to compare the outcome measures among MHCs, category of mental disorders and non-MHCs. Results The prevalence of diabetes was significantly higher in MHCs than in non-MHCs (crude age-sex-standardised point-prevalence of diabetes on 30 June 2006 in those aged ≥20 years, 9.3% vs 6.1%, respectively, P 1c, microalbuminuria, blood lipids was suboptimal in both groups, but was lower in MHCs (for all tests combined; adjusted OR 0.81, 95% CI 0.78 to 0.85, at one year; and adjusted rate ratio (RR 0.86, 95% CI 0.84 to 0.88, during the study period. MHCs also had increased risks of hospitalisation for diabetes complications (adjusted RR 1.20, 95% CI 1.17 to 1.24, diabetes-related mortality (1.43, 1.35 to 1.52 and all-cause mortality (1.47, 1.42 to 1.53. The disparities were most marked for alcohol/drug disorders, schizophrenia, affective disorders, other psychoses and personality disorders. Conclusions MHCs warrant special attention for primary and secondary prevention of diabetes, especially at the primary care level.

  8. Quality of care indicators and their related outcomes: A population-based study in prostate cancer patients treated with radiotherapy

    International Nuclear Information System (INIS)

    Background and purpose: We describe variations across the regional cancer centres in Ontario, Canada for five prostate cancer radiotherapy (RT) quality indicators: incomplete pre-treatment assessment, follow-up care, leg immobilization, bladder filling, and portal film target localization. Along with cancer centre volume, we examined each indicator’s association with relevant outcomes: long-term cause-specific survival, urinary incontinence, and gastrointestinal and genitourinary late morbidities. Materials and methods: We conducted a population-based retrospective cohort study of 924 prostate cancer patients diagnosed between 1990 and 1998 who received RT within 9 months of diagnosis. Data sources included treating charts and registry and administrative data. The associations between indicators and outcomes were analysed using regression techniques to control for potential confounders. Results: Practice patterns varied across the regional cancer centres for all indicators (p < 0.0001). Incomplete pre-treatment assessment was associated with worse cause-specific survival although this result was not significant when adjusted for confounding (adjusted RR = 1.78, 95% CI = 0.79–3.98). Treatment without leg immobilization (adjusted RR = 1.72, 95% CI = 1.16–2.56) and with an empty bladder (adjusted RR = 1.98, 95% CI = 1.08–3.63) was associated with genitourinary late morbidities. Treatment without leg immobilization was also associated with urinary incontinence (adjusted RR = 2.18, 95% CI = 1.23–3.87). Conclusions: We documented wide variations in practice patterns. We demonstrated that measures of quality of care can be shown to be associated with clinically relevant outcomes in a population-based sample of prostate cancer patients

  9. Skin care in ethnic populations.

    Science.gov (United States)

    Cole, Patrick D; Hatef, Daniel A; Taylor, Susan; Bullocks, Jamal M

    2009-08-01

    Use of over-the-counter cosmetics, approaches to hygiene, and many basic dermatologic principles differ between individuals with Caucasian skin and ethnic skin. Still, comparatively few publications highlight these variations or discuss appropriate management. Among many ethnic patients, issues related to skin hydration, restoration of even pigmentation, hair removal, and acne care remain problematic yet not fully addressed. As well, there are some dermatologic conditions that may be rare in Caucasian skin but are much more common in the ethnic patient. Here, we discuss various aspects of skin hydration, dyschromia, sunscreen use, and chemical depilatories in the ethnic population. PMID:20676310

  10. Involvement in emergency situations by primary care doctors on-call in Norway - a prospective population-based observational study

    Directory of Open Access Journals (Sweden)

    Hunskaar Steinar

    2010-03-01

    Full Text Available Abstract Background Primary care doctors on-call in the emergency primary health care services in Norway are, together with the ambulances, the primary resources for handling emergencies outside hospitals. There is a lack of reliable data for Norway on how often the primary care doctors are alerted and on their responses in the most urgent emergency cases. The aim of this study was to investigate how doctors on-call are involved in red responses (highest priority, using three different emergency medical communication centres (EMCC as catchment area for a prospective population-based study. Methods In the period from October to December 2007 three dispatch centres covering approximately 816 000 inhabitants prospectively recorded all acute emergency cases. Ambulance records, air ambulance records and records from the doctors on-call were collected. NACA score was used to define the severity of the emergencies. Results 5 105 cases were classified as red responses during the period. We have complete basic recordings (AMIS forms from all and resaved ambulance records, air ambulance records and records from doctors on-call in 89% of the cases. Ambulances were alerted in 96% and doctors on-call in 47% of the cases, but there were large differences between the three EMCCs. Doctors on-call responded with call-out in 42% of the alerted cases. 28% of all patients were taken to a casualty clinic, 46% were admitted to hospital by a doctor and 24% were taken directly to hospital by ambulances. In total, primary care doctors on-call took active part in 42% of all red response cases, and together with GPs' daytime activity the primary health care services were involved in 50% of the cases. 29% of the cases were classified as life-threatening. Call-out by doctors on-call were found to be more frequent in life-threatening situations compared with not life-threatening situations. Conclusion Doctors on-call and GPs on daytime were involved in half of all red

  11. Health Care Consumption during Pregnancy in relation to Maternal Body Mass Index : A Swedish Population Based Observational Study

    OpenAIRE

    Lindholm, Elisabeth S.; Daniel Altman; Margareta Norman; Marie Blomberg

    2015-01-01

    Objective. To assess whether antenatal health care consumption is associated with maternal body mass index (BMI). Design. A register based observational study. Methods. The Swedish Medical Birth Register, the Maternal Health Care Register, and the Inpatient Register were used to determine antenatal health care consumption according to BMI categories for primiparous women with singleton pregnancies, from 2006 to 2008, n = 71,638. Pairwise comparisons among BMI groups are obtained post hoc by T...

  12. Hospital care for children and young adults in the last year of life: a population-based study

    Directory of Open Access Journals (Sweden)

    DiGiuseppe David L

    2003-12-01

    Full Text Available Abstract Background To help design population-based pediatric palliative care services, we sought to describe the hospital care received in the last year of life by children and young adults who died. We also determined the proportion with complex chronic conditions (CCCs and tested whether the use of hospital services increased as the date of death drew nearer. Methods For all deaths occurring under 25 years of age from 1990 to 1996 in Washington State, USA, we linked death certificate information to hospital utilization records and analyzed the timing and duration of hospitalizations and the nature of hospital procedures during the year prior to death. Results Of the 8 893 deaths, 25 % had CCCs. Among infants with CCCs, 84 % were hospitalized at the time of death and 50 % had been mechanically ventilated during their terminal admission. Among the 458 CCC neonates dying under a week of age, 92% of all days of life were spent in the hospital; among the 172 CCC neonates dying during the second to fourth weeks of life, 85 % of all days of life were spent hospitalized; among the 286 CCC infants dying during the second to twelfth month of life, 41 % of all days of life were spent hospitalized. Among children and young adults with CCCs, 55 % were hospitalized at the time of death, and 19 % had been mechanically ventilated during their terminal admission. For these older patients, the median number of days spent in the hospital during the year preceding death was 18, yet less than a third of this group was hospitalized at any point in time until the last week of their lives. The rate of hospital use increased as death drew near. For subjects who had received hospital care, 44 % had governmental insurance as the source of primary payment. Conclusions Infants who died spent a substantial proportion of their lives in hospitals, whereas children and adolescents who died from CCCs predominantly lived outside of the hospital during the last year of life. To

  13. Care practices and traditional beliefs related to neonatal jaundice in northern Vietnam: a population-based, cross-sectional descriptive study

    OpenAIRE

    Le, Loc T; Partridge, John Colin; Tran, Bich H; Le, Vui T; Duong, Tuan K; Nguyen, Ha T.; Newman, Thomas B.

    2014-01-01

    Background The National Hospital of Pediatrics in Vietnam performed >200 exchange transfusions annually (2006–08), often on infants presenting encephalopathic from lower-level hospitals. As factors delaying care-seeking are not known, we sought to study care practices and traditional beliefs relating to neonatal jaundice in northern Vietnam. Methods We conducted a prospective, cross-sectional, population-based, descriptive study from November 2008 through February 2010. We prospectively ident...

  14. Population based study of noncardiac chest pain in southern Chinese:Prevalence, psychosocial factors and health care utilization

    Institute of Scientific and Technical Information of China (English)

    Wai Man Wong; Chi Kuen Chan; Annie O.O. Chan; Shiu Kum Lam; Benjamin Chun-Yu Wong; Kwok Fai Lam; Cecilia Cheng; Wai Mo Hui; Harry Hua-Xiang Xia; Kam Chuen Lai; Wayne H.C. Hu; Jia Qing Huang; Cindy L.K. Lam

    2004-01-01

    AIM: Population-based assessment of noncardiac chest pain (NCCP) is lacking. The aim of this study was to evaluate the prevalence, psychosocial factors and health seeking behaviour of NCCP in southern Chinese.METHODS: A total of 2 209 ethnic Hong Kong Chinese households were recruited to participate in a telephone survey to study the epidemiology of NCCP using the Rose angina questionnaire, a validated gastroesophageal reflux disease (GERD) questionnaire and the hospital anxietydepression scale. NCCP was defined as non-exertional chest pain according to the Rose angina questionnaire and had not been diagnosed as ischaemic heart diseases by a physician.RESULTS: Chest pain over the past year was present in 454 subjects (20.6%, 95% CI 19-22), while NCCP was present in 307 subjects (13.9%, 95% CI 13-15). GERD was present in 51% of subjects with NCCP and 34% had consulted a physician for chest pain. Subjects with NCCP had a significantly higher anxiety (P<0.001) and depression score (P=0.007), and required more days off (P=0.021) than subjects with no chest pain. By multiple logistic regression analysis, female gender (OR 1.9, 95% CI 1.1-3.2), presence of GERD (OR 2.8, 95% CI 1.6-4.8), and social life being affected by NCCP (OR 6.9, 95% CI 3.3-15.9) were independent factors associated with health seeking behaviour in southern Chinese with NCCP.CONCLUSION: NCCP is a common problem in southern Chinese and associated with anxiety and depression. Female gender, GERD and social life affected by chest pain were associated with health care utilization in subjects with NCCP.

  15. Perceptions of crisis care in populations who self-referred to a telephone-based mental health triage service.

    Science.gov (United States)

    Sands, Natisha; Elsom, Stephen; Keppich-Arnold, Sandra; Henderson, Kathryn; Thomas, Phillipa A

    2016-03-01

    Although psychiatric crises are very common in people with mental illness, little is known about consumer perceptions of mental health crisis care. Given the current emphasis on recovery-oriented approaches, shared decision-making, and partnering with consumers in planning and delivering care, this knowledge gap is significant. Since the late 1990s, access to Australian mental health services has been facilitated by 24/7 telephone-based mental health triage systems, which provide initial psychiatric assessment, referral, support, and advice. A significant proportion of consumers access telephone-based mental health triage services in a state of crisis, but to date, there has been no published studies that specifically report on consumer perceptions on the quality and effectiveness of the care provided by these services. This article reports on a study that investigated consumer perceptions of accessing telephone-based mental health triage services. Seventy-five mental health consumers participated in a telephone interview about their triage service use experience. An eight-item survey designed to measure the responsiveness of mental health services was used for data collection. The findings reported here focus on the qualitative data produced in the study. Consumer participants shared a range of perspectives on telephone-based mental health triage that provide invaluable insights into the needs, expectations, and service use experiences of consumers seeking assistance with a mental health problem. Consumer perceptions of crisis care have important implications for practice. Approaches and interventions identified as important to quality care can be used to inform educational and practice initiatives that promote person-centred, collaborative crisis care. PMID:26733103

  16. Use of a population-based survey to determine incidence of AIDS-defining opportunistic illnesses among HIV-positive persons receiving medical care in the United States

    Directory of Open Access Journals (Sweden)

    Sullivan Patrick S

    2007-09-01

    Full Text Available Abstract Background Diagnosis of an opportunistic illness (OI in a person with HIV infection is a sentinel event, indicating opportunities for improving diagnosis of HIV infection and secondary prevention efforts. In the past, rates of OIs in the United States have been calculated in observational cohorts, which may have limited representativeness. Methods We used data from a 1998 population-based survey of persons in care for HIV infection to demonstrate the utility of population-based survey data for the calculation of OI rates, with inference to populations in care for HIV infection in three geographic areas: King County Washington, selected health districts in Louisiana, and the state of Michigan. Results The overall OI rate was 13.8 per 100 persons with HIV infection in care during 1998 (95% CI, 10.2–17.3. In 1998, an estimated 11.3% of all persons with HIV in care in these areas had at least one OI diagnosis (CI, 8.8–13.9. The most commonly diagnosed OIs were Pneumocystis jiroveci pneumonia (PCP (annual incidence 2.4 per 100 persons, CI 1.0–3.8 and cytomegalovirus retinitis (annual incidence 2.4 per 100 persons, CI 1.0–3.7. OI diagnosis rates were higher in Michigan than in the other two geographic areas, and were different among patients who were white, black and of other races, but were not different by sex or history of injection drug use. Conclusion Data from population-based surveys – and, in the coming years, clinical outcomes surveillance systems in the United States – can be used to calculate OI rates with improved generalizability, and such rates should be used in the future as a meaningful indicator of clinical outcomes in persons with HIV infection in care.

  17. Three-year risk of cardiovascular disease among intensive care patients with acute kidney injury: a population-based cohort study

    OpenAIRE

    Gammelager, Henrik; Christiansen, Christian Fynbo; Johansen, Martin Berg; Tønnesen, Else; Jespersen, Bente; Sørensen, Henrik Toft

    2014-01-01

    Introduction Acute kidney injury (AKI) is common among intensive care unit (ICU) patients, but follow-up data on subsequent risk of cardiovascular disease remain sparse. We examined the impact of AKI on three-year risk of first-time heart failure, myocardial infarction (MI), and stroke among ICU patients surviving to hospital discharge, and whether this risk is modified by renal recovery before hospital discharge. Methods We used population-based medical registries to identify all adult patie...

  18. The role of palliative care in population management and accountable care organizations.

    Science.gov (United States)

    Smith, Grant; Bernacki, Rachelle; Block, Susan D

    2015-06-01

    By 2021, health care spending is projected to grow to 19.6% of the GDP, likely crowding out spending in other areas. The 2010 Affordable Care Act (ACA) attempts to curb health care spending by incentivizing high-value care through the creation of Accountable Care Organizations (ACOs), which assume financial risk for patient outcomes. With this financial risk, health systems creating ACOs will be motivated to pursue innovative care models that maximize the value of care. Palliative care, as an emerging field with a growing evidence base, is positioned to improve value in ACOs by increasing high-quality care and decreasing costs for the sickest patients. ACO leaders may find palliative care input valuable in optimizing high-quality patient-centered care in the accountable care environment; however, palliative care clinicians will need to adopt new models that extrapolate their direct patient care skills to population management strategies. We propose that palliative care specialists take on responsibilities for working with ACO leaders to broaden their mission for systemwide palliative care for appropriate patients by prospectively identifying patients with a high risk of death, high symptom burden, and/or significant psychosocial dysfunction, and developing targeted, "triggered" interventions to enhance patient-centered, goal-consistent, coordinated care. Developing these new population management competencies is a critical role for palliative care teams in the ACO environment. PMID:25723619

  19. Skin Care in Ethnic Populations

    OpenAIRE

    Cole, Patrick D.; Hatef, Daniel A.; Taylor, Susan; Bullocks, Jamal M.

    2009-01-01

    Use of over-the-counter cosmetics, approaches to hygiene, and many basic dermatologic principles differ between individuals with Caucasian skin and ethnic skin. Still, comparatively few publications highlight these variations or discuss appropriate management. Among many ethnic patients, issues related to skin hydration, restoration of even pigmentation, hair removal, and acne care remain problematic yet not fully addressed. As well, there are some dermatologic conditions that may be rare in ...

  20. The population-based oncological health care study OVIS – recruitment of the patients and analysis of the non-participants

    Directory of Open Access Journals (Sweden)

    Raspe Heiner

    2008-10-01

    Full Text Available Abstract Background The ageing of the population is expected to bring an enormous growth in demand for oncological health care. In order to anticipate and respond to future trends, cancer care needs to be critically evaluated. The present study explores the possibility of conducting representative and population-based research on cancer care on the basis of data drawn from the Cancer Registry. Methods A population-based state-wide cohort study (OVIS has been carried out in Schleswig-Holstein, Germany. All patients with malignant melanoma, breast, or prostate cancer were identified in the Cancer Registry. Epidemiological data were obtained for all the patients and screened for study eligibility. A postal questionnaire requesting information on diagnosis, therapy, QoL and aftercare was sent to eligible patients. Results A total of 11,489 persons diagnosed with the cancer types of interest in the period from January 2002 to July 2004 were registered in the Cancer Registry. Of the 5,354 (47% patients who gave consent for research, 4,285 (80% of consenters completed the questionnaire. In terms of relevant epidemiological variables, participants with melanoma were not found to be different from non-participants with the same diagnosis. However, participants with breast or prostate cancer were slightly younger and had smaller tumours than patients who did not participate in our study. Conclusion Population-based cancer registry data proved to be an invaluable resource for both patient recruitment and non-participant analysis. It can help improve our understanding of the strength and nature of differences between participants and non-respondents. Despite minor differences observed in breast and prostate cancer, the OVIS-sample seems to represent the source population adequately.

  1. “Burden of osteoporotic fractures in primary health care in Catalonia (Spain: a population-based study”

    Directory of Open Access Journals (Sweden)

    Pagès-Castellà Aina

    2012-05-01

    Full Text Available Abstract Background Knowledge on the epidemiology of non-hip fractures in Spain is limited and somewhat outdated. Using computerized primary care records from the SIDIAP database, we derived age and sex-specific fracture incidence rates for the region of Catalonia during the year 2009. Methods The SIDIAP database contains quality-checked clinical information from computerized medical records of a representative sample of >5,800,000 patients (80% of the population of Catalonia. We conducted a retrospective cohort study including all patients aged ≥50 years, and followed them from January 1 to December 31, 2009. Major osteoporotic fractures registered in SIDIAP were ascertained using ICD-10 codes and validated by comparing data to hospital admission and patient-reported fractures records. Incidence rates and 95% confidence intervals were calculated. Results In total, 2,011,430 subjects were studied (54.6% women. Overall fracture rates were 10.91/1,000 person-years (py [95%CI 10.89–10.92]: 15.18/1,000 py [15.15–15.21] in women and 5.78/1,000 py [5.76–5.79] in men. The most common fracture among women was wrist/forearm (3.86/1,000 py [3.74–3.98], while among men it was clinical spine (1.25/1,000 py [1.18–1.33]. All fracture rates increased with age, but varying patterns were observed: while most of the fractures (hip, proximal humerus, clinical spine and pelvis increased continuously with age, wrist and multiple rib fractures peaked at age 75–80 and then reached a plateau. Conclusions Our study provides local estimates of age, sex and site-specific fracture burden in primary health care, which will be helpful for health-care planning and delivery. A proportion of fractures are not reported in primary care records, leading to underestimation of fracture incidence rates in these data.

  2. Access to Adequate Outpatient Depression Care for Mothers in the US: A Nationally Representative Population-Based Study

    OpenAIRE

    Witt, Whitney P.; Keller, Abiola; Gottlieb, Carissa; Litzelman, Kristin; Hampton, John; Maguire, Jonathan; Hagen, Erika W.

    2009-01-01

    Maternal depression is often untreated, resulting in serious consequences for mothers and their children. Factors associated with receipt of adequate treatment for depression were examined in a population-based sample of 2,130 mothers in the USA with depression using data from the 1996-2005 Medical Expenditure Panel Survey. Chi-squared analyses were used to evaluate differences in sociodemographic and health characteristics by maternal depression treatment status (none, some, adequate). Multi...

  3. IMPaCT Back study protocol. Implementation of subgrouping for targeted treatment systems for low back pain patients in primary care: a prospective population-based sequential comparison

    Directory of Open Access Journals (Sweden)

    Foster Nadine E

    2010-08-01

    Full Text Available Abstract Background Prognostic assessment tools to identify subgroups of patients at risk of persistent low back pain who may benefit from targeted treatments have been developed and validated in primary care. The IMPaCT Back study is investigating the effects of introducing and supporting a subgrouping for targeted treatment system in primary care. Methods/Design A prospective, population-based, quality improvement study in one Primary Care Trust in England with a before and after design. Phases 1 and 3 collect data on current practice, attitudes and behaviour of health care practitioners, patients' outcomes and health care costs. Phase 2 introduces and supports the subgrouping for targeted treatment system, via a multi-component, quality improvement intervention that includes educational courses and outreach visits led by opinion leaders, audit/feedback, mentoring and organisational support to embed the subgrouping tools within IT and clinical management systems. We aim to recruit 1000 low back pain patients aged 18 years and over consulting 7 GP practices within one Primary Care Trust in England, UK. The study includes GPs in participating practices and physiotherapists in associated services. The primary objective is to determine the effect of the subgrouping for targeted treatment system on back pain related disability and catastrophising at 2 and 6 months, comparing data from phase 1 with phase 3. Key secondary objectives are to determine the impact on: a GPs' and physiotherapists' attitudes and behaviour regarding low back pain; b The process of care that patients receive; c The cost-effectiveness and sustainability of the new clinical system. Discussion This paper details the rationale, design, methods, planned analysis and operational aspects of the IMPaCT Back study. We aim to determine whether the new subgrouping for targeted treatment system is implemented and sustained in primary care, and evaluate its impact on clinical decision

  4. Measuring frailty in population-based healthcare databases: multi-dimensional prognostic indices for the improvement of geriatric care

    Directory of Open Access Journals (Sweden)

    Janet Sultana

    2016-04-01

    Full Text Available The prognostic evaluation of geriatric patients is critical in helping clinicians to weigh the risks versus the benefits of available therapeutic options. Frailty contributes significantly to the risk of mortality in older patients and is already known to have implications on the outcome of treatment in a clinical context. The multi-dimensional prognostic index (MPI is a prognostic tool based on a comprehensive geriatric assessment and includes detailed information on patient cognition, functionality, disease and drug burden. The value of the MPI in predicting mortality has already been shown in hospital and community settings but never in a population- based healthcare database setting. One of the aims of the ongoing EU-funded MPI_Age project is to improve our understanding of how geriatric frailty data can be identified in healthcare databases and whether this can be used to predict serious adverse events associated with pharmacotherapy. Our findings suggest that data on functionality in elderly patients is poorly registered in The Health Improvement Network (THIN, a UK nationwide general practice database, and only few of the functionality domains could be used in a population-based analysis. The most commonly registered functionality information was related to mobility, dressing, accommodation and cognition. Our results suggest that some of these functionality domains are predictive of short- and long-term mortality in community-dwelling patients. This may have implications in observational research where frailty is an unmeasured confounder.

  5. Emerging organisational models of primary healthcare and unmet needs for care: insights from a population-based survey in Quebec province

    Directory of Open Access Journals (Sweden)

    Levesque Jean-Frédéric

    2012-07-01

    Full Text Available Abstract Background Reform of primary healthcare (PHC organisations is underway in Canada. The capacity of various types of PHC organizations to respond to populations’ needs remains to be assessed. The main objective of this study was to evaluate the association of PHC affiliation with unmet needs for care. Methods Population-based survey of 9205 randomly selected adults in two regions of Quebec, Canada. Outcomes Self-reported unmet needs for care and identification of the usual source of PHC. Results Among eligible adults, 18 % reported unmet needs for care in the last six months. Reasons reported for unmet needs were: waiting times (59 % of cases; unavailability of usual doctor (42 %; impossibility to obtain an appointment (36 %; doctors not accepting new patients (31 %. Regression models showed that unmet needs were decreasing with age and was lower among males, the least educated, and unemployed or retired. Controlling for other factors, unmet needs were higher among the poor and those with worse health status. Having a family doctor was associated with fewer unmet needs. People reporting a usual source of care in the last two-years were more likely to report unmet need for care. There were no differences in unmet needs for care across types of PHC organisations when controlling for affiliation with a family physician. Conclusion Reform models of primary healthcare consistent with the medical home concept did not differ from other types of organisations in our study. Further research looking at primary healthcare reform models at other levels of implementation should be done.

  6. Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania: a prospective population-based study

    Directory of Open Access Journals (Sweden)

    Lengeler Christian

    2008-12-01

    Full Text Available Abstract Background Drug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management. Methods A population-based survey of 9254 persons aged 25–64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP ≥ 160/95 mmHg at the initial contact, 253 (47% had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval. Results Among the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both. Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance. Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care. Conclusion Low utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases.

  7. The association between continuity of care in the community and health outcomes: a population-based study

    Directory of Open Access Journals (Sweden)

    Dreiher Jacob

    2012-05-01

    Full Text Available Abstract Background The study goal was to assess indices of continuity of care in the primary care setting and their association with health outcomes and healthcare services utilization, given the reported importance of continuity regarding quality of care and healthcare utilization. Methods The study included a random sample of enrollees from Clalit Health Services 19 years-of-age or older who visited their primary care clinic at least three times in 2009. Indices of continuity of care were computed, including the Usual Provider Index (UPC, Modified Modified Continuity Index (MMCI, Continuity of Care Index (COC, and Sequential Continuity (SECON. Quality measures of preventive medicine and healthcare services utilization and their costs were assessed as outcomes. Results 1,713 randomly sampled patients were included in the study (mean age: 48.9 ± 19.2, 42% males. Continuity of care indices were: UPC: 0.75; MMCI: 0.81; COC: 0.67; SECON: 0.70. After controlling for patient characteristics in a multivariate analysis, a statistically significant association was found between higher values of UPC, COC, and SECON and a decrease in the number and cost of ED visits. Higher MMCI values were associated with a greater number and higher costs of medical consultation visits. Continuity of care indices were associated with BMI measurements, and inversely associated with blood pressure measurements. No association was found with other quality indicators, e.g., screening tests for cancer. Conclusions Several continuity of care indices were associated with decreased number and costs of ED visits. There were both positive and negative associations of continuity of care indices with different aspects of healthcare utilization. The relatively small effects of continuity might be due to the consistently high levels of continuity in Clalit Health Services.

  8. Patterns of Care in the Administration of Neo-adjuvant Chemotherapy for Breast Cancer. A Population-Based Study.

    Science.gov (United States)

    Vugts, Guusje; Maaskant-Braat, Adriana J G; Nieuwenhuijzen, Grard A P; Roumen, Rudi M H; Luiten, Ernest J T; Voogd, Adri C

    2016-05-01

    Neo-adjuvant chemotherapy (NAC) is used to facilitate radical surgery for initially irresectable or locally advanced breast cancer. The indication for NAC has been extended to clinically node negative (cN0) patients in whom adjuvant systemic therapy is foreseen. A population-based study was conducted to evaluate the increasing use of NAC, breast conserving surgery (BCS) after NAC and timing of the sentinel node biopsy (SNB). All female breast cancer patients, treated in 10 hospitals in the Eindhoven Cancer Registry area in the Netherlands between January 2003 and June 2012 were included (N = 18,427). In total, 1,402 patients (7.6%) received NAC. The administration increased from 2.5% in 2003 to 13.0% in 2011 (p Downsizing of the tumor and BCS are achieved increasingly. In 2011, in three hospitals NAC was administered in 20% (p < 0.001). Of the 1,402 patients with NAC, 495 patients underwent SNB, 91.5% of whom prior to NAC. In the Netherlands up to one in eight patients receive NAC. The administration of NAC and the percentage of BCS increased over the past decade, especially in cT2 tumors. Considerable hospital variation in the administration of NAC exists. PMID:26945566

  9. [Vulnerable populations and access to care].

    Science.gov (United States)

    Castello, Christine; Michard-Lenoir, Anne-Pascale; Allemand, Robert

    2012-01-01

    Precariousness is a very complex concept that brings together a diverse and fragmented population. The interest in comparing views and opinions is clear for understanding of this phenomenon. A physician in the paediatric emergency unit of a hospital and the head of a "Medecins du Monde" branch evoke the different faces of precariousness. A difficult and sometimes poignant reality, which health care providers must try to cope with. PMID:23074804

  10. Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.

    Directory of Open Access Journals (Sweden)

    Alessandra Buja

    Full Text Available BACKGROUND: Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF and coronary heart disease (CHD, by age group. METHODS: This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥ 16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level. RESULTS: The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16-44 year-olds, adults (45-64, and oldest old (+85 than for patients aged 65-74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16-44 y, adults (45-64 y, the very old (75-84 y and the oldest old (+85 y patients with CHD, CHF and diabetes are less likely than 65-74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old. CONCLUSION: Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly.

  11. Can an alert in primary care electronic medical records increase participation in a population-based screening programme for colorectal cancer? COLO-ALERT, a randomised clinical trial

    International Nuclear Information System (INIS)

    Colorectal cancer is an important public health problem in Spain. Over the last decade, several regions have carried out screening programmes, but population participation rates remain below recommended European goals. Reminders on electronic medical records have been identified as a low-cost and high-reach strategy to increase participation. Further knowledge is needed about their effect in a population-based screening programme. The main aim of this study is to evaluate the effectiveness of an electronic reminder to promote the participation in a population-based colorectal cancer screening programme. Secondary aims are to learn population’s reasons for refusing to take part in the screening programme and to find out the health professionals’ opinion about the official programme implementation and on the new computerised tool. This is a parallel randomised trial with a cross-sectional second stage. Participants: all the invited subjects to participate in the public colorectal cancer screening programme that includes men and women aged between 50–69, allocated to the eleven primary care centres of the study and all their health professionals. The randomisation unit will be the primary care physician. The intervention will consist of activating an electronic reminder, in the patient’s electronic medical record, in order to promote colorectal cancer screening, during a synchronous medical appointment, throughout the year that the intervention takes place. A comparison of the screening rates will then take place, using the faecal occult blood test of the patients from the control and the intervention groups. We will also take a questionnaire to know the opinions of the health professionals. The main outcome is the screening status at the end of the study. Data will be analysed with an intention-to-treat approach. We expect that the introduction of specific reminders in electronic medical records, as a tool to facilitate and encourage direct referral by

  12. Using a Web-Based Approach to Assess Test-Retest Reliability of the "Hypertension Self-Care Profile" Tool in an Asian Population: A Validation Study.

    Science.gov (United States)

    Koh, Yi Ling Eileen; Lua, Yi Hui Adela; Hong, Liyue; Bong, Huey Shin Shirley; Yeo, Ling Sui Jocelyn; Tsang, Li Ping Marianne; Ong, Kai Zhi; Wong, Sook Wai Samantha; Tan, Ngiap Chuan

    2016-03-01

    Essential hypertension often requires affected patients to self-manage their condition most of the time. Besides seeking regular medical review of their life-long condition to detect vascular complications, patients have to maintain healthy lifestyles in between physician consultations via diet and physical activity, and to take their medications according to their prescriptions. Their self-management ability is influenced by their self-efficacy capacity, which can be assessed using questionnaire-based tools. The "Hypertension Self-Care Profile" (HTN-SCP) is 1 such questionnaire assessing self-efficacy in the domains of "behavior," "motivation," and "self-efficacy." This study aims to determine the test-retest reliability of HTN-SCP in an English-literate Asian population using a web-based approach.Multiethnic Asian patients, aged 40 years and older, with essential hypertension were recruited from a typical public primary care clinic in Singapore. The investigators guided the patients to fill up the web-based 60-item HTN-SCP in English using a tablet or smartphone on the first visit and refilled the instrument 2 weeks later in the retest. Internal consistency and test-retest reliability were evaluated using Cronbach's Alpha and intraclass correlation coefficients (ICC), respectively. The t test was used to determine the relationship between the overall HTN-SCP scores of the patients and their self-reported self-management activities.A total of 160 patients completed the HTN-SCP during the initial test, from which 71 test-retest responses were completed. No floor or ceiling effect was found for the scores for the 3 subscales. Cronbach's Alpha coefficients were 0.857, 0.948, and 0.931 for "behavior," "motivation," and "self-efficacy" domains respectively, indicating high internal consistency. The item-total correlation ranges for the 3 scales were from 0.105 to 0.656 for Behavior, 0.401 to 0.808 for Motivation, 0.349 to 0.789 for Self-efficacy. The corresponding ICC

  13. Etiology of community-acquired pneumonia in a population-based study: Link between etiology and patients characteristics, process-of-care, clinical evolution and outcomes

    Directory of Open Access Journals (Sweden)

    Capelastegui Alberto

    2012-06-01

    Full Text Available Abstract Background The etiologic profile of community-acquired pneumonia (CAP for each age group could be similar among inpatients and outpatients. This fact brings up the link between etiology of CAP and its clinical evolution and outcome. Furthermore, the majority of pneumonia etiologic studies are based on hospitalized patients, whereas there have been no recent population-based studies encompassing both inpatients and outpatients. Methods To evaluate the etiology of CAP, and the relationship among the different pathogens of CAP to patients characteristics, process-of-care, clinical evolution and outcomes, a prospective population-based study was conducted in Spain from April 1, 2006, to June 30, 2007. Patients (age >18 with CAP were identified through the family physicians and the hospital area. Results A total of 700 patients with etiologic evaluation were included: 276 hospitalized and 424 ambulatory patients. We were able to define the aetiology of pneumonia in 55.7% (390/700. The most frequently isolated organism was S. pneumoniae (170/390, 43.6%, followed by C. burnetti (72/390, 18.5%, M. pneumoniae (62/390, 15.9%, virus as a group (56/390, 14.4%, Chlamydia species (39/390, 106%, and L. pneumophila (17/390, 4.4%. The atypical pathogens and the S. pneumoniae are present in pneumonias of a wide spectrum of severity and age. Patients infected by conventional bacteria were elderly, had a greater hospitalization rate, and higher mortality within 30 days. Conclusions Our study provides information about the etiology of CAP in the general population. The microbiology of CAP remains stable: infections by conventional bacteria result in higher severity, and the S. pneumoniae remains the most important pathogen. However, atypical pathogens could also infect patients in a wide spectrum of severity and age.

  14. Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy

    Directory of Open Access Journals (Sweden)

    Sacerdote Carlotta

    2013-01-01

    Full Text Available Abstract Background It has been documented that variations exist in breast cancer treatment despite wide dissemination of clinical practice guidelines. The aim of this population-based study was to evaluate the impact of regional guidelines (Piedmont guidelines, PGL for breast cancer diagnosis and treatment on quality-of-care indicators in the Northwestern Italian region of Piedmont. Methods We included two samples of women aged 50–69 years with incident breast cancer treated in Piedmont before and after the introduction of PGL: 600 in 2002 (pre-PGL and 621 in 2004 (post-PGL. Patients were randomly selected among all incident breast cancer cases identified through the hospital discharge records database. We extracted clinical data on breast cancer cases from medical charts and ascertained vital status through linkage with town offices. We assessed compliance with 14 quality-of-care indicators from PGL recommendations, before and after their introduction in clinical practice. Results Among patients with invasive lesions, 77.1% (N = 368 and 77.5% (N = 383 in the pre-PGL and post-PGL groups, respectively, received breast conservative surgery (BCS as a first-line treatment. Following BCS, 87.7% received radiotherapy in 2002, compared to 87.9% in 2004. Of all patients at medium-to-high risk of distant metastasis, 65.5% (N = 268 and 63.6% (N = 252 received chemotherapy in 2002 and in 2004, respectively. Among the 117 patients with invasive lesions and negative estrogen receptor status in 2002, hormonal therapy was prescribed in 23 of them (19.6%. The incorrect prescription of hormonal therapy decreased to 10.8% (N = 10 among the 92 estrogen receptor-negative patients in 2004 (p Compliance with PGL recommendations was already high in the pre-PGL group, although some quality-of-care indicators did not reach the standard. In the pre/post analysis, 8 out of 14 quality-of-care indicators showed an improvement from 2002 to 2004, but only 4 out of 14

  15. Intensive care for the adult population in Ireland: a multicentre study of intensive care population demographics

    OpenAIRE

    ,

    2008-01-01

    Introduction This prospective observational study was conducted to describe the nature of the intensive care population across Ireland, identify adherence to international benchmarks of practice, and describe patient outcomes in critically ill patients. Methods A prospective observational multicentre study of demographics and organ failure incidence was carried out over a 10-week period in 2006 across the intensive care units (ICUs) of 14 hospitals in both the Republic and Northern Ireland. R...

  16. Care needs and clinical outcomes of older people with dementia: a population-based propensity score-matched cohort study.

    Directory of Open Access Journals (Sweden)

    Fei-Yuan Hsiao

    Full Text Available To explore the healthcare resource utilization, psychotropic drug use and mortality of older people with dementia.A nationwide propensity score-matched cohort study.National Health Insurance Research database.A total of 32,649 elderly people with dementia and their propensity-score matched controls (n=32,649.Outpatient visits, inpatient care, psychotropic drug use, in-hospital mortality and all-cause mortality at 90 and 365 days.Compared to the non-dementia group, a higher proportion of patients with dementia used inpatient services (1 year after index date: 20.91% vs. 9.55%, and the dementia group had more outpatient visits (median [standard deviation]: 7.00 [8.87] vs. 3.00 [8.30]. Furthermore, dementia cases with acute admission had the highest psychotropic drug utilization both at baseline and at the post-index dates (difference-in-differences: all <0.001. Dementia was associated with an increased risk of all-cause mortality (90 days, Odds ratio (OR=1.85 [95%CI 1.67-2.05], p<0.001; 365 days, OR=1.59 [1.50-1.69], p<0.001 and in-hospital mortality (90 days, OR=1.97 [1.71-2.27], p<0.001; 365 days, OR=1.82 [1.61-2.05], p<0.001 compared to matched controls.When older people with dementia are admitted for acute illnesses, they may increase their use of psychotropic agents and their risk of death, particularly in-hospital mortality.

  17. Multi-centre evaluation of the Determine HIV Combo assay when used for point of care testing in a high risk clinic-based population.

    Directory of Open Access Journals (Sweden)

    Damian P Conway

    Full Text Available BACKGROUND: Determine HIV Combo (DHC is the first point of care assay designed to increase sensitivity in early infection by detecting both HIV antibody and antigen. We conducted a large multi-centre evaluation of DHC performance in Sydney sexual health clinics. METHODS: We compared DHC performance (overall, by test component and in early infection with conventional laboratory HIV serology (fourth generation screening immunoassay, supplementary HIV antibody, p24 antigen and Western blot tests when testing gay and bisexual men attending four clinic sites. Early infection was defined as either acute or recent HIV infection acquired within the last six months. RESULTS: Of 3,190 evaluation specimens, 39 were confirmed as HIV-positive (12 with early infection and 3,133 were HIV-negative by reference testing. DHC sensitivity was 87.2% overall and 94.4% and 0% for the antibody and antigen components, respectively. Sensitivity in early infection was 66.7% (all DHC antibody reactive and the DHC antigen component detected none of nine HIV p24 antigen positive specimens. Median HIV RNA was higher in false negative than true positive cases (238,025 vs. 37,591 copies/ml; p = 0.022. Specificity overall was 99.4% with the antigen component contributing to 33% of false positives. CONCLUSIONS: The DHC antibody component detected two thirds of those with early infection, while the DHC antigen component did not enhance performance during point of care HIV testing in a high risk clinic-based population.

  18. Multi-Centre Evaluation of the Determine HIV Combo Assay when Used for Point of Care Testing in a High Risk Clinic-Based Population

    Science.gov (United States)

    Conway, Damian P.; Holt, Martin; McNulty, Anna; Couldwell, Deborah L.; Smith, Don E.; Davies, Stephen C.; Cunningham, Philip; Keen, Phillip; Guy, Rebecca

    2014-01-01

    Background Determine HIV Combo (DHC) is the first point of care assay designed to increase sensitivity in early infection by detecting both HIV antibody and antigen. We conducted a large multi-centre evaluation of DHC performance in Sydney sexual health clinics. Methods We compared DHC performance (overall, by test component and in early infection) with conventional laboratory HIV serology (fourth generation screening immunoassay, supplementary HIV antibody, p24 antigen and Western blot tests) when testing gay and bisexual men attending four clinic sites. Early infection was defined as either acute or recent HIV infection acquired within the last six months. Results Of 3,190 evaluation specimens, 39 were confirmed as HIV-positive (12 with early infection) and 3,133 were HIV-negative by reference testing. DHC sensitivity was 87.2% overall and 94.4% and 0% for the antibody and antigen components, respectively. Sensitivity in early infection was 66.7% (all DHC antibody reactive) and the DHC antigen component detected none of nine HIV p24 antigen positive specimens. Median HIV RNA was higher in false negative than true positive cases (238,025 vs. 37,591 copies/ml; p = 0.022). Specificity overall was 99.4% with the antigen component contributing to 33% of false positives. Conclusions The DHC antibody component detected two thirds of those with early infection, while the DHC antigen component did not enhance performance during point of care HIV testing in a high risk clinic-based population. PMID:24714441

  19. Health-care-seeking patterns in the emerging private sector in Burkina Faso: a population-based study of urban adult residents in Ouagadougou.

    Directory of Open Access Journals (Sweden)

    Idrissa Beogo

    Full Text Available BACKGROUND: The private medical care sector is expanding in urban cities in Sub-Saharan Africa (SSA. However, people's health-care-seeking behaviors in this new landscape remain poorly understood; furthermore, distinguishing between public and private providers and among various types of private providers is critical in this investigation. This study assessed, by type, the healthcare providers urban residents in Burkina Faso visit, and their choice determinants. METHOD: We conducted a population-based survey of a representative sample of 1,600 households in Ouagadougou from July to November 2011, consisting of 5,820 adults. We assessed the types of providers people typically sought for severe and non-severe conditions. We applied generalized estimating equations in this study. RESULTS: Among those surveyed, 97.7% and 53.1% indicated that they seek a formal provider for treating severe and non-severe conditions, respectively. Among the formal provider seekers, 20.5% and 17.0% chose for-profit (FP providers for treating severe and non-severe conditions, respectively. Insurance coverage was held by 2.0% of those surveyed. Possessing insurance was the strongest predictor for seeking FP, for both severe (odds ratio [OR]  = 1.15, 95% confidence interval [CI] = 1.04-1.28, and non-severe conditions (OR = 1.22, 95% CI = 1.07-1.39. Other predictors included being a formal jobholder and holding a higher level education. By contrast, we observed no significant difference in predisposing, enabling, or need characteristics between not-for-profit (NFP provider seekers and public provider seekers. Proximity was the primary reason for choosing a provider. CONCLUSION: The results suggested that FP providers play a crucial role in the urban healthcare market in SSA. Socioeconomic status and insurance status are significant predictors of provider choice. The findings can serve as a crucial reference for policymakers in response to the emergence of FP providers

  20. Using a Web-Based Approach to Assess Test–Retest Reliability of the “Hypertension Self-Care Profile” Tool in an Asian Population

    Science.gov (United States)

    Koh, Yi Ling Eileen; Lua, Yi Hui Adela; Hong, Liyue; Bong, Huey Shin Shirley; Yeo, Ling Sui Jocelyn; Tsang, Li Ping Marianne; Ong, Kai Zhi; Wong, Sook Wai Samantha; Tan, Ngiap Chuan

    2016-01-01

    Abstract Essential hypertension often requires affected patients to self-manage their condition most of the time. Besides seeking regular medical review of their life-long condition to detect vascular complications, patients have to maintain healthy lifestyles in between physician consultations via diet and physical activity, and to take their medications according to their prescriptions. Their self-management ability is influenced by their self-efficacy capacity, which can be assessed using questionnaire-based tools. The “Hypertension Self-Care Profile” (HTN-SCP) is 1 such questionnaire assessing self-efficacy in the domains of “behavior,” “motivation,” and “self-efficacy.” This study aims to determine the test–retest reliability of HTN-SCP in an English-literate Asian population using a web-based approach. Multiethnic Asian patients, aged 40 years and older, with essential hypertension were recruited from a typical public primary care clinic in Singapore. The investigators guided the patients to fill up the web-based 60-item HTN-SCP in English using a tablet or smartphone on the first visit and refilled the instrument 2 weeks later in the retest. Internal consistency and test–retest reliability were evaluated using Cronbach's Alpha and intraclass correlation coefficients (ICC), respectively. The t test was used to determine the relationship between the overall HTN-SCP scores of the patients and their self-reported self-management activities. A total of 160 patients completed the HTN-SCP during the initial test, from which 71 test–retest responses were completed. No floor or ceiling effect was found for the scores for the 3 subscales. Cronbach's Alpha coefficients were 0.857, 0.948, and 0.931 for “behavior,” “motivation,” and “self-efficacy” domains respectively, indicating high internal consistency. The item-total correlation ranges for the 3 scales were from 0.105 to 0.656 for Behavior, 0.401 to 0.808 for Motivation, 0.349 to 0

  1. Community-Based Care

    Science.gov (United States)

    ... respite care, transportation, medication coverage, rehabilitation (including maintenance physical and occupational therapy ), hearing aids, eyeglasses, and a variety of other benefits. The program also has the flexibility to pay ...

  2. Incremental health care costs for chronic pain in Ontario, Canada: a population-based matched cohort study of adolescents and adults using administrative data.

    Science.gov (United States)

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

    2016-08-01

    Little is known about the economic burden of chronic pain and how chronic pain affects health care utilization. We aimed to estimate the annual per-person incremental medical cost and health care utilization for chronic pain in the Ontario population from the perspective of the public payer. We performed a retrospective cohort study using Ontario health care databases and the electronically linked Canadian Community Health Survey (CCHS) from 2000 to 2011. We identified subjects aged ≥12 years from the CCHS with chronic pain and closely matched them to individuals without pain using propensity score matching methods. We used linked data to determine mean 1-year per-person health care costs and utilization for each group and mean incremental cost for chronic pain. All costs are reported in 2014 Canadian dollars. After matching, we had 19,138 pairs of CCHS respondents with and without chronic pain. The average age was 55 years (SD = 18) and 61% were female. The incremental cost to manage chronic pain was $1742 per person (95% confidence interval [CI], $1488-$2020), 51% more than the control group. The largest contributor to the incremental cost was hospitalization ($514; 95% CI, $364-$683). Incremental costs were the highest in those with severe pain ($3960; 95% CI, $3186-$4680) and in those with most activity limitation ($4365; 95% CI, $3631-$5147). The per-person cost to manage chronic pain is substantial and more than 50% higher than a comparable patient without chronic pain. Costs are higher in people with more severe pain and activity limitations. PMID:26989805

  3. Carência de atenção à saúde ocular no setor público: um estudo de base populacional Shortage of ocular health care in the public system: a population-based study

    Directory of Open Access Journals (Sweden)

    Victor Delpizzo Castagno

    2009-10-01

    Full Text Available Este estudo transversal de base populacional investigou a prevalência de utilização de serviços de saúde ocular e sua associação com fatores sócio-demográficos, necessidades em saúde e forma de financiamento da consulta. Avaliaram-se 2.960 indivíduos de 20 anos ou mais. Nos últimos cinco anos, 46% dos entrevistados e 30% daqueles com 50 anos ou mais não consultaram para os olhos. Dos que consultaram, 18% foram em óticas, e apenas 17% foram no setor público. O principal motivo foi não enxergar bem (69,5%. Falta de dinheiro (29% e de tempo (24,6% foram os principais motivos para ter deixado de consultar. Idade, escolaridade e nível econômico estiveram diretamente associados com ter consultado nos últimos cinco anos. Ser mulher, ter catarata, glaucoma e usar correção, bem como consultar no setor privado também estiveram positivamente associados com o desfecho. É preciso não só aumentar a participação do setor público, integrando a saúde ocular a todos os níveis de atenção, ampliando a participação de outros profissionais de saúde, como também intensificar o rastreamento de problemas oculares e a sua prevenção.This cross-sectional population-based study investigated the prevalence of eye care services utilization and the association with socioeconomic and demographic factors, need for health care, and type of service payment. The study evaluated 2,960 adults aged 20 and older. In the previous 5 years, 46% of the sample and 30% of those aged 50 and older had not visited an eye care service. Among the persons who used a service, 18% went to an optical store and only 17% used the public health system. The main reason for using eye care services was poor vision (69.5%. Lack of money (29% and time (24.6% were the most frequently cited reasons for non-utilization. Age, education, and economic status were directly associated with the outcome. Female gender, cataract, glaucoma, prescription eyewear, and private

  4. Reforming health care financing in Bulgaria: the population perspective.

    Science.gov (United States)

    Balabanova, Dina; McKee, Martin

    2004-02-01

    Health financing reform in Bulgaria has been characterised by lack of political consensus on reform direction, economic shocks, and, since 1998, steps towards social insurance. As in other eastern European countries, the reform has been driven by an imperative to embrace new ideas modelled on systems elsewhere, but with little attention to whether these reflect popular values. This study explores underlying values, such as views on the role of the state and solidarity, attitudes to, and understanding of compulsory and voluntary insurance, and co-payments. The study identifies general principles (equity, transparency) considered important by the population and practical aspects of implementation of reform. Data were obtained from a representative survey (n=1547) and from 58 in-depth interviews and 6 focus groups with users and health professionals, conducted in 1997 before the actual reform of the health financing system in Bulgaria. A majority supports significant state involvement in health care financing, ranging from providing safety net for the poor, through co-subsidising or regulating the social insurance system, to providing state-financed universal free care (half of all respondents). Collectivist values in Bulgaria remain strong, with support for free access to services regardless of income, age, or health status and progressive funding. There is strong support (especially among the well off) for a social insurance system based on the principle of solidarity and accountability rather than the former tax-based model. The preferred health insurance fund was autonomous, state regulated, financing only health care, and offering optional membership. Voluntary insurance and, less so, co-payments were acceptable if limited to selected services and better off groups. In conclusion, a health financing system under public control that fits well with values and population preferences is likely to improve compliance and be more sustainable. Universal health insurance

  5. Interpersonal Processes of Care in Diverse Populations

    OpenAIRE

    Stewart, Anita L.; Nápoles-Springer, Anna; Pérez-Stable, Eliseo J.; Posner, Samuel F.; Bindman, Andrew B.; Pinderhughes, Howard L.; Washington, A. Eugene

    1999-01-01

    Persons of lower socioeconomic status and members of racial and ethnic minority groups experience poorer health and increased health risk factors. A framework of interpersonal processes of care specifies distinct components and incorporates the perspective of diverse racial and ethnic or socioeconomic groups. Its dimensions, each with several domains, are communication (general clarity, elicitation of and responsiveness to patient concerns, explanations, empowerment), decision making (respons...

  6. Montessori-based dementia care.

    Science.gov (United States)

    Cline, Janet

    2006-10-01

    Montessori-based Dementia Care is an approach used in Alzheimer's care that does not involve chemical or physical restraints. This program works by giving the elder with Alzheimer/Dementia a purpose by getting them involved. When staff/families care for a confused Alzheimer/Dementia patient, who is having behaviors, the Montessori program teaches them to look at what is causing the behavior. When assessing the elder to determine what is causing the behavior, the goal is to find the answer, but the answer cannot be dementia. The goal of the program is to bring meaning to the life of an Alzheimer/Dementia elder. PMID:17111647

  7. Making Our Health and Care Systems Fit for an Ageing Population: Considerations for Canada

    Science.gov (United States)

    Andrew, Melissa K.; Rockwood, Kenneth

    2014-01-01

    A report from the United Kingdom on making health and care systems fit for an ageing population proposes a range of interventions to make care better for older adults, especially those who are frail. Here, we discuss the proposed shift for the acute care hospital to other models of care. The key for these models of care requires a fundamental shift to care that addresses the full range of an individual’s needs, rather than being based around single diseases. How this might apply in the Canadian context is considered. We emphasize strategies to keep people out of hospital but still receive needed care, make acute hospital care less hazardous, and improve the interface between acute and long-term care. PMID:25452826

  8. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial) - design, intervention, and population

    DEFF Research Database (Denmark)

    Zwisler, A.D.O.; Schou, O.; Soja, A.M.B.;

    2005-01-01

    randomized clinical trial to clarify whether hospital-based comprehensive CR is superior to usual care for patients with congestive heart failure, ischemic heart disease, or high risk for ischemic heart disease. A combined primary outcome measure included total mortality, myocardial infarction, or...... management, and clinical assessment. Study Population Of 5060 discharged patients, 1614 (32%) were eligible for the trial and 770 patients were randomized (47% of those eligible). Participants were younger (P < .001) and had less comorbidity than nonparticipants (P < .03). Conclusion Our trial shows that a...

  9. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial)--design, intervention, and population

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Brønnum-Hansen, Henrik;

    2005-01-01

    randomized clinical trial to clarify whether hospital-based comprehensive CR is superior to usual care for patients with congestive heart failure, ischemic heart disease, or high risk for ischemic heart disease. A combined primary outcome measure included total mortality, myocardial infarction, or...... management, and clinical assessment. STUDY POPULATION: Of 5060 discharged patients, 1614 (32%) were eligible for the trial and 770 patients were randomized (47% of those eligible). Participants were younger (P < .001) and had less comorbidity than nonparticipants (P < .03). CONCLUSION: Our trial shows that a...

  10. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care.

    Science.gov (United States)

    McKee, Diane; Fletcher, Jason

    2006-11-01

    Adolescent girls face unique challenges in health care utilization, which can result in unmet needs. We sought to describe settings of usual care and primary care use, and to identify predictors of foregone care and experience of confidential care in a primarily racial/ethnic minority low-income sample. We conducted an anonymous computer-assisted self-administered survey of 9th-12th grade girls (n=819) in three Bronx public high schools, the majority of whom were Hispanic (69.8%) and Black (21.4%). Most (80%) reported having a usual source of care. Of these, 77.2% had a regular doctor. Those least likely to have a usual source of care were non-U.S. born girls (73.1% vs. 83.1%) and less acculturated girls. Predictors of foregone care in the last year include being sexually active, poor family social support, and low self esteem. Predictors of access to confidential care at last visit were age, self-efficacy for confidential care, having a regular doctor, setting of care, and having had a recent physical exam. Many urban adolescent girls, especially non-U.S. born girls, lack a usual source of care and regular health care provider. Continued attention to reducing both financial and non-financial barriers to care is required to ensure access to and quality of care for diverse populations. PMID:17242529

  11. Long term health care use and costs in patients with stable coronary artery disease:a population based cohort using linked electronic health records (CALIBER)

    OpenAIRE

    Walker, Simon Mark; Asaria, Miqdad; Manca, Andrea; Palmer, Stephen John; Gale, Christopher; Shah, Anoop D; Abrams, Keith; Crowther, Michael; Timmis, Adam; Hemingway, Harry; Sculpher, Mark

    2016-01-01

    Aims To examine long term health care utilisation and costs of patients with stable coronary artery disease (SCAD). Methods and results Linked cohort study of 94,966 patients with SCAD in England, 1st January 2001 to 31st March 2010, identified from primary care, secondary care, disease and death registries. Resource use and costs, and cost predictors by time and 5-year cardiovascular (CVD) risk profile were estimated using generalised linear models. Coronary heart disease hospitalisations we...

  12. Screening for depression in the primary care population.

    Science.gov (United States)

    Deneke, D Edward; Schultz, Heather E; Fluent, Thomas E

    2015-03-01

    Despite strong efforts, the diagnosis and treatment of depression bring many challenges in the primary care setting. Screening for depression has been shown to be effective only if reliable systems of care are in place to ensure appropriate treatment by clinicians and adherence by patients. New evidence-based models of care for depression exist, but spread has been slow because of inadequate funding structures and conflicts within current clinical culture. The Affordable Care Act introduces potential opportunities to reorganize funding structures, conceivably leading to increased adoption of these collaborative care models. Suicide screening remains controversial. PMID:25725567

  13. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.;

    2016-01-01

    Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients...... with type 2 diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by insurance data analysis. Intervention: We compared protocol-based care management including structured assessment, action...

  14. Impact of the pay-for-performance contract and the management of hypertension in Scottish primary care: a 6-year population-based repeated cross-sectional study.

    LENUS (Irish Health Repository)

    Simpson, Colin R

    2011-07-01

    The 2004 introduction of the pay-for-performance contract has increased the proportion of income that GPs are able to earn by targeting quality care to patients with chronic diseases such as hypertension.

  15. Living Will Interest and Preferred End-of-life Care and Death Locations among Japanese Adults 50 and over: A Population-based Survey

    OpenAIRE

    Nishie, Hiroyuki; Mizobuchi, Satoshi; Suzuki, Etsuji; Sato, Kenji; TODA, YUICHIRO; Matsuoka, Junji; Morimatsu, Hiroshi

    2014-01-01

    The main purpose of this study was to determine the relationships between Japanese individualsʼ interest in living wills and their preferred end-of-life care and death locations. Questionnaires were mailed to 1,000 individuals aged ァ50 to measure these 2 factors. We examined the associations between the respondentsʼ characteristics and their preferred care and death locations by using multinomial logistic regression models. The response rate was 74%. Home was the most frequently preferred pla...

  16. Associations in the continuum of care for maternal, newborn and child health: a population-based study of 12 sub-Saharan Africa countries

    OpenAIRE

    Owili, Patrick Opiyo; Muga, Miriam Adoyo; Chou, Yiing-Jenq; Hsu, Yi-Hsin Elsa; Huang, Nicole; Chien, Li-Yin

    2016-01-01

    Background Despite the progress in the Millennium Development Goals (MDGs) 4 and 5, inequity in the utilization of maternal, newborn and child health (MNCH) care services still remain high in sub-Saharan Africa (SSA). The continuum of care for MNCH that recognizes a tight inter-relationship between maternal, newborn and child health at different time periods and location is key towards reducing inequity in health. In this study, we explored the distributions in the utilization MNCH services i...

  17. Intensive care unit-acquired weakness in the burn population.

    Science.gov (United States)

    Cubitt, Jonathan J; Davies, Menna; Lye, George; Evans, Janine; Combellack, Tom; Dickson, William; Nguyen, Dai Q

    2016-05-01

    Intensive care unit-acquired weakness is an evolving problem in the burn population. As patients are surviving injuries that previously would have been fatal, the focus of treatment is shifting from survival to long-term outcome. The rehabilitation of burn patients can be challenging; however, a certain subgroup of patients have worse outcomes than others. These patients may suffer from intensive care unit-acquired weakness, and their treatment, physiotherapy and expectations need to be adjusted accordingly. This study investigates the condition of intensive care unit-acquired weakness in our burn centre. We conducted a retrospective analysis of all the admissions to our burn centre between 2008 and 2012 and identified 22 patients who suffered from intensive care unit-acquired weakness. These patients were significantly younger with significantly larger burns than those without intensive care unit-acquired weakness. The known risk factors for intensive care unit-acquired weakness are commonplace in the burn population. The recovery of these patients is significantly affected by their weakness. PMID:26975787

  18. Do homosexual persons use health care services more frequently than heterosexuals persons: findings from a Dutch population survey.

    NARCIS (Netherlands)

    Bakker, F.C.; Sandfort, T.G.M.; Vanwesenbeeck, I.; Lindert, H. van; Westert, G.P.

    2006-01-01

    Use of health care services has been suggested to be lower among homo- or bisexual persons than among heterosexual persons, due to a lack of trust in the health care system. However, population-based studies on differences in health care utilization according to sexual orientation are scarce. The pu

  19. Unique health care utilization patterns in a homeless population in Ghent

    Directory of Open Access Journals (Sweden)

    Verlinde Evelyn

    2010-08-01

    Full Text Available Abstract Background Existing studies concerning the health care use of homeless people describe higher utilisation rates for hospital-based care and emergency care, and lower rates for primary care by homeless people compared to the general population. Homeless people are importantly hindered and/or steered in their health care use by barriers directly related to the organisation of care. Our goal is to describe the accessibility of primary health care services, secondary care and emergency care for homeless people living in an area with a universal primary health care system and active guidance towards this unique system. Methods Observational, cross-sectional study design. Data from the Belgian National health survey were merged with comparable data collected by means of a face-to-face interview from homeless people in Ghent. 122 homeless people who made use of homeless centres and shelters in Ghent were interviewed using a reduced version of the Belgian National Health survey over a period of 5 months. 2-dimensional crosstabs were built in order to study the bivariate relationship between health care use (primary health care, secondary and emergency care and being homeless. To determine the independent association, a logistic model was constructed adjusting for age and sex. Results and Discussion Homeless people have a higher likelihood to consult a GP than the non-homeless people in Ghent, even after adjusting for age and sex. The same trend is demonstrated for secondary and emergency care. Conclusions Homeless people in Ghent do find the way to primary health care and make use of it. It seems that the universal primary health care system in Ghent with an active guidance by social workers contributes to easier GP access.

  20. Population-based incidence, mortality and quality of life in critically ill patients treated with renal replacement therapy: a nationwide retrospective cohort study in finnish intensive care units

    OpenAIRE

    Vaara, Suvi T; Pettilä, Ville; Reinikainen, Matti; Kaukonen, Kirsi-Maija

    2012-01-01

    Introduction Acute kidney injury (AKI) increases mortality and morbidity of critically ill patients. Mortality of patients treated with renal replacement therapy (RRT) is high. We aimed to evaluate the nationwide incidence of RRT-treated AKI in Finland, hospital and six-month mortality, and health-related quality of life (HRQoL) of these patients. Methods We performed a retrospective cohort study including all general intensive care unit (ICU) admissions in Finland in 2007 through 2008. We id...

  1. China’s Rapidly Aging Population Creates Policy Challenges In Shaping A Viable Long-Term Care System

    OpenAIRE

    Feng, Zhanlian; Liu, Chang; Guan, Xinping; Mor, Vincent

    2012-01-01

    In China, formal long-term care services for the large aging population have increased to meet escalating demands as demographic shifts and socioeconomic changes have eroded traditional elder care. We analyze China’s evolving long-term care landscape and trace major government policies and private-sector initiatives shaping it. Although home and community-based services remain spotty, institutional care is booming with little regulatory oversight. Chinese policy makers face mounting challenge...

  2. The impact of nationwide education program on clinical practice in sepsis care and mortality of severe sepsis: a population-based study in Taiwan.

    Directory of Open Access Journals (Sweden)

    Yu-Chun Chen

    Full Text Available OBJECTIVES: We investigated the effect of a nationwide educational program following surviving sepsis campaign (SSC guidelines. Physicians' clinical practice in sepsis care and patient mortality rate for severe sepsis were analyzed using a nationally representative cohort. METHODS: Hospitalizations for severe sepsis with organ failure from 1997 to 2008 were extracted from Taiwan's National Health Insurance Research Database (NHIRD, and trends in sepsis incidence and mortality rates were analyzed. A before-and-after study design was used to evaluate changes in the utilization rates of SSC items and changes in severe sepsis mortality rates occurred after a national education program conducted by the Joint Taiwan Critical Care Medicine Committee since 2004. A total of 39,706 hospitalizations were analyzed, which consisted of a pre-intervention cohort of 14,848 individuals (2000-2003 and a post-intervention cohort of 24,858 individuals (2005-2008. RESULTS: The incidence rate of severe sepsis increased from 1.88 per 1,000 individuals in 1997 to 5.07 per 1,000 individuals in 2008. The cumulative mortality rate decreased slightly from 48.2% for the pre-intervention cohort to 45.9% for the post-intervention cohort. The utilization rates of almost all SSC items changed significantly between the pre-intervention and post-intervention cohorts. These changes of utilization rates were found to be associated with mild reduction in mortality rate. CONCLUSION: The nationwide education program through a national professional society has a significant impact on physicians' clinical practice and resulted in a slight but significant reduction of severe sepsis mortality rate.

  3. Population-Based Inorganic Mercury Biomonitoring and the Identification of Skin Care Products as a Source of Exposure in New York City

    OpenAIRE

    McKelvey, Wendy; Jeffery, Nancy; Clark, Nancy; Kass, Daniel; Parsons, Patrick J.

    2010-01-01

    Background Mercury is a toxic metal that has been used for centuries as a constituent of medicines and other items. Objective We assessed exposure to inorganic mercury in the adult population of New York City (NYC). Methods We measured mercury concentrations in spot urine specimens from a representative sample of 1,840 adult New Yorkers in the 2004 NYC Health and Nutrition Examination Survey. Cases with urine concentrations ≥ 20 μg/L were followed up with a telephone or in-person interview th...

  4. A collaborative clinical and population-based curriculum for medical students to address primary care needs of the homeless in New York City shelters : Teaching homeless healthcare to medical students.

    Science.gov (United States)

    Asgary, Ramin; Naderi, Ramesh; Gaughran, Margaret; Sckell, Blanca

    2016-06-01

    Background Millions of Americans experience homelessness annually. Medical providers do not receive adequate training in primary care of the homeless.Methods Starting in 2012, a comprehensive curriculum was offered to medical students during their family medicine or ambulatory clerkship, covering clinical, social and advocacy, population-based, and policy aspects. Students were taught to: elicit specific social history, explore health expectations, and assess barriers to healthcare; evaluate clinical conditions specific to the homeless and develop plans for care tailored toward patients' medical and social needs; collaborate with shelter staff and community organizations to improve disease management and engage in advocacy efforts. A mixed methods design was used to evaluate students' knowledge, attitudes, and skills including pre- and post-curriculum surveys, debriefing sessions, and observed clinical skills.Results The mean age of the students (n = 30) was 26.5 years; 55 % were female. The overall scores improved significantly in knowledge, attitude, and self-efficacy domains using paired t‑test (p relationship and collaboration with community organizations were key elements. PMID:27277430

  5. The Health Care Institution, Population Health and Black Lives.

    Science.gov (United States)

    King, Christopher J; Redwood, Yanique

    2016-05-01

    The ongoing existence of institutionalized racism and discriminatory practices in various systems (education, criminal justice, housing, employment) serve as root causes of poor health in Blacks Lives. Furthermore, these unjust social structures and their complex interplay result in inefficient utilization of health services and reactive or futile interactions with medical providers. Collectively, these factors contribute to racial disparities in health and treatment represents a significant portion of the nation's health care expenditures. In order for health care systems to optimize population health goals, racism must be recognized as a determinant of health. As anchor institutions in their respective communities, we offer hospitals and health systems a conceptual framework to address the issue within internal and external constructs. PMID:27372475

  6. Managing cancer pain at the end of life with multiple strong opioids: a population-based retrospective cohort study in primary care.

    Directory of Open Access Journals (Sweden)

    Wei Gao

    Full Text Available BACKGROUND: End-of-life cancer patients commonly receive more than one type of strong opioid. The three-step analgesic ladder framework of the World Health Organisation (WHO provides no guidance on multiple opioid prescribing and there is little epidemiological data available to inform practice. This study aims to investigate the time trend of such cases and the associated factors. METHODS: Strong opioid prescribing in the last three months of life of cancer patients were extracted from the General Practice Research Database (GPRD. The outcome variable was the number of different types of prescribed non-rescue doses of opioids (1 vs 2-4, referred to as a complex case. Associated factors were evaluated using prevalence ratios (PR derived from multivariate log-binomial model, adjusting for clustering effects and potential confounding variables. RESULTS: Overall, 26.4% (95% CI: 25.6-27.1% of 13,427 cancer patients (lung 41.7%, colorectal 19.1%, breast 18.6%, prostate 15.5%, head and neck 5.0% were complex cases. Complex cases increased steadily over the study period (1.02% annually, 95%CI: 0.42-1.61%, p = 0.048 but with a small dip (7.5% reduction, 95%CI: -0.03 to 17.8% around the period of the Shipman case, a British primary care doctor who murdered his patients with opioids. The dip significantly affected the correlation of the complex cases with persistent increasing background opioid prescribing (weighted correlation coefficients pre-, post-Shipman periods: 0.98(95%CI: 0.67-1.00, p = 0.011; 0.14 (95%CI: -0.85 to 0.91, p = 0.85. Multivariate adjusted analysis showed that the complex cases were predominantly associated with year of death (PRs vs 2000: 1.05-1.65, not other demographic and clinical factors except colorectal cancer (PR vs lung cancer: 1.24, 95%CI: 1.12-1.37. CONCLUSION: These findings suggest that prescribing behaviour, rather than patient factors, plays an important role in multiple opioid prescribing at the end of life

  7. Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health.

    Science.gov (United States)

    Scales, Charles D; Tasian, Gregory E; Schwaderer, Andrew L; Goldfarb, David S; Star, Robert A; Kirkali, Ziya

    2016-07-01

    Expanding epidemiologic and physiologic data suggest that urinary stone disease is best conceptualized as a chronic metabolic condition punctuated by symptomatic, preventable stone events. These acute events herald substantial future chronic morbidity, including decreased bone mineral density, cardiovascular disease, and CKD. Urinary stone disease imposes a large and growing public health burden. In the United States, 1 in 11 individuals will experience a urinary stone in their lifetime. Given this high incidence and prevalence, urinary stone disease is one of the most expensive urologic conditions, with health care charges exceeding $10 billion annually. Patient care focuses on management of symptomatic stones rather than prevention; after three decades of innovation, procedural interventions are almost exclusively minimally invasive or noninvasive, and mortality is rare. Despite these advances, the prevalence of stone disease has nearly doubled over the past 15 years, likely secondary to dietary and health trends. The NIDDK recently convened a symposium to assess knowledge and treatment gaps to inform future urinary stone disease research. Reducing the public health burden of urinary stone disease will require key advances in understanding environmental, genetic, and other individual disease determinants; improving secondary prevention; and optimal population health strategies in an increasingly cost-conscious care environment. PMID:26964844

  8. Estimates of complications of medical care in the adult US population

    Directory of Open Access Journals (Sweden)

    Anderson Jeremy N

    2001-03-01

    Full Text Available Abstract Background Total US population estimates of complications of medical care have relied on extrapolations of state-specific estimates. Generalizability is suspect because findings are limited by geographical location or time. We describe the relationship between the annual prevalence of complications of medical care (CM and socio-demographic characteristics in the adult US population. Methods We used data from the National Health Interview Surveys, annual nationwide surveys of the resident, civilian, noninstitutionalized population of the United States. The main outcome of interest was self-reported conditions from CMs (ICD-9 996-999 and activity limitations that arise from such events. Univariate estimates and multivariably adjusted models accounting for selected socio-demographic characteristics and health status were derived. Results A total of 618,167 reports of conditions from 313,438 subjects 18 years and older from 1987 to 1994 were examined. In 1987, 830,386 adults reported complications of medical care, increasing by about 40% to 1,174,089 adults in 1994. Based on an extrapolation to the US adult population, rates increased by 25% from 558 to 678 per 100,000 during the same period. One-third reported onset a year prior to the interview; two-thirds visited a doctor six months prior; half experienced limitation in major activities; a quarter reported limitation in personal care activities. In the two weeks preceding the interview, complications of medical care caused an average of 1.72 days of restricted activity, 0.79 days spent in bed, and 0.58 days of work lost. Race modified the age-specific risk of these complications. Conclusions Complications of medical care impose heavier morbidity than previously considered with some indication that socio-demographic variables modify the risk for injuries.

  9. Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population.

    Science.gov (United States)

    Ouslander, Joseph G; Maslow, Katie

    2012-12-01

    Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. PMID:23194066

  10. Evidence-based health care in pediatrics.

    Science.gov (United States)

    Robertson-Malt, Suzanne

    2014-12-01

    This article examines current trends in the type and quality of systematic reviews underpinning the evidence base for pediatric health care. A case study is used to highlight the quality standards for the conduct and publication of systematic reviews and the processes being used to transition the evidence produced from systematic reviews into the everyday systems and processes of care. PMID:25458134

  11. Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care

    Science.gov (United States)

    Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care, a 2010 workshop sponsored by the Epidemiology and Genomics Research Program.

  12. A Web-Based Model for Diabetes Education and Decision Support for the Home Care Nurse

    OpenAIRE

    Hill, Michelle; Kirby, Judy

    1998-01-01

    Diabetes education for the home care population requires expert knowledge to be available at the point-of-care, the patient's home. This poster displays a model for Web-based diabetes education and decision support for the home care nurse. The system utilizes the line of reasoning (LOR) model to organize and represent expert decision-making thought processes.

  13. Community Partners in Care: Leveraging Community Diversity to Improve Depression Care for Underserved Populations

    OpenAIRE

    Khodyakov, Dmitry; Mendel, Peter; Dixon, Elizabeth; Jones, Andrea; Masongsong, Zoe; Wells, Kenneth

    2009-01-01

    Research suggests that the quality and outcomes of depression treatment for adults can be substantially improved through “collaborative care” programs. However, there is a lack of resources required to implement such programs in vulnerable communities. Our paper examines the planning phase of the Community Partners in Care (CPIC) initiative, which addresses this problem through a unique approach in which academic institutions partner directly with a wide range of community-based and service o...

  14. Cross-Sectional Study of Periodontal Care and Glycosylated Hemoglobin in an Insured Population

    Science.gov (United States)

    Spangler, Leslie; Reid, Robert J.; Inge, Ronald; Newton, Katherine M.; Hujoel, Philippe; Chaudhari, Monica; Genco, Robert J.; Barlow, William E.

    2010-01-01

    OBJECTIVE Compare GHb among people with diabetes who have and have not received periodontal care. RESEARCH DESIGN AND METHODS This cross-sectional study linked 5 years of electronic medical record and dental insurance data for dually insured patients with diabetes, ages 40–70 years (n = 5,103). We assessed the association between annual mean GHb (%) and periodontal care (a proxy for periodontitis) defined using claim codes. Among patients who received periodontal care, we assessed the association between GHb and periodontal treatment intensity. We determined associations using linear regression adjusted for potential confounders and tested for effect modification by age, sex, insulin use, diabetes severity, BMI, and smoking. RESULTS Mean GHb was 7.66%; 38% of participants received periodontal care during the 5 years. After multivariate adjustment, patients who received periodontal care had a GHb level 0.08 percentage points higher than patients who did not (P = 0.02). In stratified analyses, the association was present for women (0.18 percentage points higher GHb with periodontal care, P < 0.001) but not significant for men (0.008 percentage points lower, P = 0.86). In patients who received periodontal care, those with one, and with two or more, surgical treatments had GHb 0.25 (P = 0.04) and 0.36 (P = 0.002) percentage points lower, respectively, than patients without periodontal surgeries. CONCLUSIONS This population-based cross-sectional study showed small associations between periodontal care (a proxy for periodontitis) and higher GHb. Well-controlled longitudinal studies or clinical trials are needed to evaluate causality and temporal trends. Sub-analyses suggest that further investigation of this association among women, and by intensity of periodontal treatment, may be of interest. PMID:20504894

  15. Health Care of the Elderly in Medically Disadvantaged Populations.

    Science.gov (United States)

    German, Pearl S.; And Others

    1978-01-01

    This study of three disadvantaged urban areas reports on the relationship between available resources and ambulatory health care. Findings indicate a high proportion of elderly receiving care for serious conditions but a sharp drop in care for less serious but potentially disabling conditions. (Author)

  16. Informal and Formal Kinship Care Populations: A Study in Contrasts.

    Science.gov (United States)

    McLean, Beth; Thomas, Rebecca

    1996-01-01

    Contrasts a group of informal kinship care providers in Philadelphia (KIDS'n'KIN Program) with two "formal" kinship care groups in Baltimore and California, examining similarities and differences in child and caregiver demographies and service needs. Presents the program's response to the needs of informal kinship care providers. (Author/SD)

  17. Integrating Primary Care in Cancer Survivorship Programs: Models of Care for a Growing Patient Population

    OpenAIRE

    Nekhlyudov, Larissa

    2014-01-01

    The author describes the primary care physician’s role in caring for cancer survivors who are transitioning from oncology settings to primary care settings. Four scenarios are addressed and advantages and disadvantages of each are listed.

  18. Representativeness in population-based studies

    DEFF Research Database (Denmark)

    Drivsholm, Thomas Bo; Eplov, Lene Falgaard; Davidsen, Michael;

    2006-01-01

    Decreasing rates of participation in population-based studies increasingly challenge the interpretation of study results, in both analytic and descriptive epidemiology. Consequently, estimates of possible differences between participants and non-participants are increasingly important for the...... interpretation of study results and generalization to the background population....

  19. Population prevalence of personality disorder and associations with physical health comorbidities and health care service utilization: A review.

    Science.gov (United States)

    Quirk, Shae E; Berk, Michael; Chanen, Andrew M; Koivumaa-Honkanen, Heli; Brennan-Olsen, Sharon L; Pasco, Julie A; Williams, Lana J

    2016-04-01

    Personality disorder (PD), outcomes of diverse comorbid physical health conditions, and the associated burden on health service resources have seldom been studied at a population level. Consequently, there is limited evidence that might inform a public health approach to managing PD and associated mental and physical disability. A review was conducted of population-based studies examining the prevalence of PD and associations between physical comorbidities and service utilization. The prevalence of any PDs were common (4.4% -21.5%) among populations spanning England, Wales, Scotland, Western Europe, Norway, Australia, and the United States. Preliminary evidence supports associations between PDs from Clusters A and B and physical comorbidities, namely cardiovascular diseases and arthritis. PD appears to increase health care utilization, particularly in primary care. In order to facilitate rational population health planning, further population studies are required. (PsycINFO Database Record PMID:26461047

  20. Prevalence of self-reported multimorbidity in the general population and in primary care practices: a cross-sectional study

    OpenAIRE

    Mokraoui, Nadjib-Mohamed; Haggerty, Jeannie; Almirall, José; Fortin, Martin

    2016-01-01

    Background Settings affect estimation of multimorbidity prevalence. Multimorbidity prevalence was reported to be substantially higher among family practice-based patients than in the general population, but prevalence estimates were obtained with different methods and at different time periods. The aim of the present study was to compare estimates of the prevalence of multimorbidity in the general population and in primary care clinical practices, both measured simultaneously and with the sam...

  1. Using health information technology to manage a patient population in accountable care organizations.

    Science.gov (United States)

    Wu, Frances M; Rundall, Thomas G; Shortell, Stephen M; Bloom, Joan R

    2016-06-20

    Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications - Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications - ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value - Using new empirical data, this study increases understanding of the extent of ACOs' current and developing HIT capabilities to support ongoing care management. PMID:27296880

  2. Time based management in health care system: The chosen aspects

    Directory of Open Access Journals (Sweden)

    Joanna Kobza

    2014-08-01

    Full Text Available Time-based management (TBM is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms. Over the past two decades a systematic review of Polish literature (since 1990 and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011 have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary

  3. The HIV Care Continuum among Female Sex Workers: A Key Population in Lilongwe, Malawi.

    Directory of Open Access Journals (Sweden)

    Kathryn Elizabeth Lancaster

    Full Text Available The HIV care continuum among female sex workers (FSW, a key population, has not been well characterized, especially within the generalized epidemics of sub-Saharan Africa. This was the first study to characterize the HIV care continuum among FSW in Lilongwe, Malawi.From July through September 2014, we used venue-based sampling to enroll 200 adult FSW in Lilongwe, Malawi into a cross-sectional evaluation assessing HIV care continuum outcomes. Seropositive FSW, identified using HIV rapid testing, received rapid CD4 counts in addition to viral loads using dried blood spots. We calculated proportions of HIV-infected FSW who had history of care, were on ART, and had suppressed viral load and we used Poisson regression to estimate the associations of demographic characteristics and transmission risk behaviors with each outcome.HIV seroprevalence was 69% (n = 138. Among all FSW the median age was 24 years (IQR: 22-28. Among the 20% who were newly diagnosed and reported previously testing negative, the median time since last HIV test was 11 months (interquartile range: 3-17. The majority (69% of HIV-infected FSW had a history of HIV care, 52% reported current ART use, and 45% were virally suppressed. Of the FSW who reported current ART use, 86% were virally suppressed. Transmission risk behaviors were not associated with continuum outcomes.FSW in Lilongwe were predominately young and have a high HIV prevalence. Only half of HIV-infected FSW reported current ART use, but the majority of those on ART were virally suppressed. To reduce ongoing transmission and improve health outcomes, increased HIV testing, care engagement, and ART coverage is urgently needed among FSW. Universal testing and treatment strategies for all FSW in Malawi must be strongly considered.

  4. Effective population management practices in diabetes care - an observational study

    DEFF Research Database (Denmark)

    Frølich, Anne; Bellows, Jim; Nielsen, Bo Friis;

    2010-01-01

    Of fifteen diabetes care management practices, our data indicate that high performance is most associated with provider alerts and more weakly associated with action plans and with guideline distribution and training. Lack of convergence in the literature on effective care management practices...... suggests that factors contributing to high performance may be highly context-dependent or that the factors involved may be too numerous or their implementation too nuanced to be reliably identified in observational studies....

  5. Navigator Approach to Improve Quality of Care for Vulnerable Populations in Mexico.

    Science.gov (United States)

    Ramos, Rebeca; Ferreira-Pinto, João; Loza, Oralia

    2015-01-01

    For nearly 30 years, Programa Compañeros Inc (Compañeros) has worked in Ciudad Juarez, Chihuahua, Mexico, to ensure that vulnerable populations can exercise their rights to receive HIV and substance abuse prevention and treatment services. Compañeros staff has worked to ameliorate the negative results that limit access to care to the most vulnerable individuals: those who are poor, homeless, sex workers, addicted, and others whose life context put them at greater risk for being infected with HIV. With support from the MAC AIDS Foundation, Compañeros has expanded its capacity to deliver services to persons living with HIV/AIDS (PLWHA) and to HIV-vulnerable populations. This short communication describes findings from an internal evaluation conducted to investigate the effectiveness of the MAC AIDS-funded navigator-based program implemented at Compañeros. PMID:26242198

  6. HIV/aids related home based care practices among primary health care workers in Ogun state, Nigeria

    Directory of Open Access Journals (Sweden)

    E Amoran

    2012-05-01

    Full Text Available Abstract Background HIV/AIDS is fast becoming a chronic disease with the advent of antiretroviral drugs, therefore making home based care key in the management of chronically ill HIV/AIDS patient. The objective of this study was to determine the perception and practice of health care workers on HIV/AIDS related home based care in the health facilities in Ogun state, Nigeria. Methods This study is an analytical cross-sectional study. A multistage cluster sampling technique was used to obtain a representative sample of the primary health care workers in Ogun state. An interviewer administered structured questionnaire was administered by trained health workers to elicit the required information. Result A total of 350 health care workers were interviewed, 70% of the respondents could adequately describe the components of home based care. Only 38.7% were aware of the National guideline on home based care practices and 17.1% believe that home based care will not significantly improve the prognosis of PLWAs. Few 19.1% had ever been trained or ever involved 16.6% in home based care practices. Only 20 [5.7%] are involved on a weekly basis, 16 [4.6%] monthly and 22 [6.3%] quarterly. Reasons given for non implementation of home based care are inadequate number of healthcare workers 45%, lack of political will 24.4%, lack of implementation by facility managers 14% and inadequate funds 16.6%. Factors that were significantly associated with the practice of home based care were perception of its relevance in improving prognosis [OR = 54.21, C.I = 23.22-129.52] and presence of a support group in the facility [OR = 4.80, C.I = 2.40-9.57]. There was however no statistically significant relationship between adequate knowledge of home based care [OR = 0.78, C.I = 0.39-1.54] and previous training on home based care (OR = 1.43, C.I = 0.66-3.06]. Conclusion The practice of home based care for HIV/AIDS among the study population is low

  7. Provision of critical care services for the obstetric population.

    Science.gov (United States)

    Sultan, P; Arulkumaran, N; Rhodes, A

    2013-12-01

    Management of the peripartum patient is a challenging aspect of critical care that requires consideration of both the physiological changes associated with pregnancy as well as the well-being of the foetus. In the UK, for every maternal death, approximately 118 near-miss events or severe acute maternal morbidities (SAMMs) occur. While a dedicated anaesthetic cover is usually provided on larger labour wards in the UK and US, a close communication with intensive care and other medical specialties must still be maintained. Medical outreach teams and early warning scores may help facilitate the early identification of clinical deterioration and prompt treatment. Ultimately level of care is allocated according to the clinical need, not the location, which may be a designated room, a normal labour room or a recovery area. Specialist obstetric units that provide high-dependency care facilities show lower rates of maternal transfer to critical care units and improved continuity of care before and after labour. The benefits of obstetric high-dependency units (HDUs) are likely to be determined by a number of logistic aspects of the hospital organisation, including hospital size and available resources. There remains a striking contrast in the burden of maternal mortality and morbidity and intensive care unit (ICU) resources between high- and low-income countries. The countries with the highest maternal mortality rates have the lowest number of ICU beds per capita. In under-resourced countries, patients admitted to ICUs tend to have higher illness severity scores, suggesting delayed admission to the ICU. The appropriate training of midwives is essential for successful HDUs located within labour wards. PMID:23972289

  8. Clincal and population-based epidemiology of vertigo, migraine and migrainous vertigo

    OpenAIRE

    Neuhauser, Hannelore

    2010-01-01

    This cumulative habilitation thesis is based on studies on various aspects of the clinical and population-based epidemiology of vertigo, migraine and migrainous vertigo. A large study of the general population by validated neurotologic interviews shows that vertigo is a frequent and underdiagnosed symptom in the general population. Vertigo has considerable personal impact and leads to a high health care utilisation. Data on the epidemiology of migraine in Germany are presented based on a...

  9. Caring for an Ageing Population: Are Physiotherapy Graduates Adequately Prepared?

    Science.gov (United States)

    Ramklass, Serela S.; Butau, Anne; Ntinga, Nomusa; Cele, Nozipho

    2010-01-01

    In view of South African policy developments related to the care of older persons, it was necessary to examine the nature of the geriatrics content within physiotherapy curricula. A survey was conducted amongst final-year student physiotherapists at South African universities, together with content analysis of physiotherapy curricula. Very little…

  10. Access to general health care services by a New Zealand population with serious mental illness.

    Directory of Open Access Journals (Sweden)

    Wheeler A

    2014-03-01

    Full Text Available INTRODUCTION: Literature suggests that good quality health care access can have a positive impact on the health of people with serious mental illness (SMI, but literature relating to patterns of access by this group is equivocal. AIM: This study was designed to explore health care access patterns in a group of people with SMI and to compare them with a general New Zealand population group, in order for health providers to understand how they might contribute to positive health outcomes for this group. METHODS: The study surveyed 404 mental health consumers aged 18-65 years receiving care from one district health board in Auckland about their patterns of health care access. Results were compared with those from the New Zealand Health Survey of the general population. RESULTS: Findings suggest that the SMI consumer respondents had poorer physical health than the general population respondents, accessed health care services in more complex ways and were more particular about who they accessed for their care than the general population respondents. There was some concern from SMI consumers around discrimination from health care providers. The study also suggested that some proactive management with SMI consumers for conditions such as metabolic syndrome was occurring within the health care community. DISCUSSION: The first point of access for SMI consumers with general health problems is not always the family general practitioner and so other health professionals may sometimes need to consider the mental and physical health of such consumers in a wider context than their own specialism.

  11. Evaluation of the european heart failure self-care behaviour scale in a united kingdom population

    NARCIS (Netherlands)

    Shuldham, Caroline; Theaker, Chris; Jaarsma, Tiny; Cowie, Martin R.

    2007-01-01

    Title. Evaluation of the European Heart Failure Self-care Behaviour Scale in a United Kingdom population Aim. This paper is a report of a study to test the internal consistency, reliability and validity of the 12-item European Heart Failure Self-care Behaviour Scale in an English-speaking sample in

  12. Vehicle parameter identification using population based algorithms

    OpenAIRE

    GÖKDAĞ, Hakan

    2015-01-01

    This work deals with parameter identification of a vehicle using population based algorithms such as Particle Swarm Optimization (PSO), Artificial Bee Colony Optimization (ABC) and Genetic Algorithm (GA). Full vehicle model with seven degree of freedom (DoF) is employed, and two objective functions based on reference and computed responses are proposed. Solving the optimization problem vehicle mass, moments of inertia and vehicle center of gravity parameters, which are necessary for later app...

  13. National population-based biobanks for genetic research.

    Science.gov (United States)

    Swede, Helen; Stone, Carol L; Norwood, Alyssa R

    2007-03-01

    Clinical practice guidelines derived from genetic research using population-based biobanks could dramatically change the nature of personal and public health medicine. Centralized population-based biobanks have been established or proposed in at least nine countries to date, and many lessons have been learned from these landmark developments. Scientific and governmental leaders in the United States are currently contemplating pending federal legislation regarding the establishment of centralized and networked biobanks. Public health practitioners and clinical care providers may be called on to serve pronounced planning roles at the state level. Possible responsibilities include: formulating legislation, gathering public comment, reviewing research proposals, and developing procedures for informed consent, participant withdrawal, and confidentiality protection. State health agencies may also need to create and/or administer banking facilities. Proper planning may ensure that individual rights are protected while research benefits are maximized. PMID:17413418

  14. The utility of population-based surveys to describe the continuum of HIV services for key and general populations.

    Science.gov (United States)

    Hladik, Wolfgang; Benech, Irene; Bateganya, Moses; Hakim, Avi J

    2016-01-01

    Monitoring the cascade or continuum of HIV services - ranging from outreach services to anti-retroviral treatment - has become increasingly important as the focus in prevention moves toward biomedical interventions, in particular, 'Treatment as Prevention.' The HIV continuum typically utilises clinic-based care and treatment monitoring data and helps identify gaps and inform programme improvements. This paper discusses the merits of a population-based survey-informed continuum of services. Surveys provide individual-level, population-based data by sampling persons both in and outside the continuum, which facilitate the estimation of population fractions, such as the proportion of people living with HIV in care, as well as the examination of determinants for being in or outside the continuum. Survey-informed cascades of services may especially benefit key populations at increased risk for HIV infection for who social marginalisation, criminalisation, and stigma result in barriers to access and retention in services, a low social visibility, mobility, and outreach-based services can compromise clinic-based monitoring. Adding CD4+ T-cell count and viral load measurements to such surveys may provide population-level information on viral load suppression, stage of disease, treatment needs, and population-level transmission potential. While routine clinic-based reporting will remain the mainstay of monitoring, a survey-informed service cascade can address some of its limitations and offer additional insights. PMID:25907348

  15. Applying activity-based costing in long-term care.

    Science.gov (United States)

    Wodchis, W P

    1998-01-01

    As greater numbers of the elderly use health services, and as health care costs climb, effective financial tracking is essential. Cost management in health care can benefit if costs are linked to the care activities where they are incurred. Activity-based costing (ABC) provides a useful approach. The framework aligns costs (inputs), through activities (process), to outputs and outcomes. It allocates costs based on client care needs rather than management structure. The ABC framework was tested in a residential care facility and in supportive housing apartments. The results demonstrate the feasibility and advantages of ABC for long term care agencies, including community-based care. PMID:10339203

  16. Patient-Centered Care and Population Health: Establishing Their Role in the Orthopaedic Practice.

    Science.gov (United States)

    Harwood, Jared L; Butler, Craig A; Page, Alexandra E

    2016-05-18

    As health care increasingly emphasizes high value, the terms "population health" and "patient-centered care" have become common, but their application is less clear. Patient-centered care encourages using data to optimize care for an individual. Population health offers a framework to consider how to efficiently and effectively manage a condition for a population, how prevention affects large groups, and the specific distribution of a given disorder. Integrating both concepts into practice can facilitate required outcome-measure reporting and potentially improve patient outcomes. Clinical practice guidelines and appropriate use criteria are examples of reconciliation of these topics. By embracing attempts to decrease variation in treating musculoskeletal disorders while personalizing delivery to individual patients, surgeons may benefit from the improvement of both efficiency and patient experience. PMID:27194502

  17. Chronic care case management for the frail elderly population in the United States: normative, funding and organizational aspects

    Directory of Open Access Journals (Sweden)

    Antonio Giulio de Belvis

    2004-12-01

    Full Text Available

    In the most developed countries, it is necessary to bring about significant changes to health care delivery through the strengthening of prevention, rehabilitation and the integration of the social and healthcare dimensions.

    This means moving the policy focus from “treating” to “taking care” of the sick in a broader and more integrated way, one which is more closely linked to the World Health Organization’s definition of health as physical, psychological and social well-being. This change involves the delivery of care for the elderly. Developed countries are confronting this issue by using different community-based programs to integrate acute and long-term care services for frail elderly individuals with complex health needs.

    The objective of this health policy article is to give an overview of the most recent initiatives on long-term care management for the elderly including normative, funding and organizational issues in the USA, as their public health system largely differs from those of the Western European countries.

    Particular attention is given to the PACE (Program of All Inclusive Care for the Elderly, which applies a comprehensive approach to managing the care of the frail elderly population and would represent a new framework in geriatric care. By incorporating a central core care team to manage the needs of each elderly individual, this approach recognizes the contributing factors that non-traditional health related functions play in the overall health of the individual.

    Although there is a little knowledge of this program, as it covers a very small percentage of the eligible individuals, and it may be difficult to extrapolate to other sectors of the population, PACE offers many lessons that could be applied to more effective integration of care for individuals and lead to better health outcomes.

  18. Measuring improvement in populations: implementing and evaluating successful change in lung cancer care

    OpenAIRE

    Yu, Xinhua; Klesges, Lisa M; Smeltzer, Mathew P.; Osarogiagbon, Raymond U.

    2015-01-01

    Improving quality of care in lung cancer, the leading cause of cancer death worldwide and in the United States, is a major public health challenge. Such improvement requires accurate and meaningful measurement of quality of care. Preliminary indicators have been derived from clinical practice guidelines and expert opinions, but there are few standard sets of quality of care measures for lung cancer in the United States or elsewhere. Research to develop validated evidence-based quality of care...

  19. Hypomagnesaemia in paediatric population in an intensive care unit.

    Directory of Open Access Journals (Sweden)

    Deshmukh C

    2000-07-01

    Full Text Available AIMS: To determine incidence and risk factors for hypomagnesaemia in children admitted in Paediatric Intensive Care Unit, (PICU. SUBJECTS AND METHODS: Prospective study was carried out on 80 children admitted in PICU. The patients were clinically assessed for nutritional status, neurological status on Glasgow coma scale, congestive cardiac failure, etc. and relevant biochemical parameters including serum and red cell magnesium levels were done. 25 patients of the same age group admitted in general ward who were not in critical state were included as a control group. RESULTS: 70% of PICU patients had hypomagnesaemia, which was more common in patients on aminoglycosides and diuretics. CONCLUSION: In view of complications of magnesium depletion and benign nature of appropriate magnesium therapy critically ill children should have their magnesium level monitored.

  20. Integrated patient unit care in schizophrenia population vs a non-integrated patient unit care

    Directory of Open Access Journals (Sweden)

    Waago-Hansen C

    2013-01-01

    Full Text Available Background: Several studies have described the benefits of integrated care in chronic conditions. Keeping the patients out of hospital is considered to increase value to the patient and is also benefit to the society and the healthcare provider.As we have an increase in the treatment options, costs, age and demand, an optimized treatment model is required if we want to maintain or obtain a sustainable system. The objective of this study was to describe how costs of treatment and value to the patient, to the hospital and the society differs in a non integrated patient unit (IPU vs an IPU system.Methods: Contact data of schizophrenic patients (n=51 from the hospital's electronic medical records (EMRs was accessed (from October 2010 till March 2012 and analyzed. All financial data was obtained from the finance department. Time driven activity based costing (TDABC as used to calculate the costs.Results: The study examined 1,149 out-patient consultations and 4,386 days of occupancy. By adopting an IPU approach, the costs were significantly reduced compared to the non-IPU approach. Increased complexity benefitted significantly from IPU. These patients had a higher frequency of contact but lower degrees of admission, whilst the non-IPU had significantly higher admission rates and duration of stay.Conclusions: This study shows a striking difference in the resources used on patients treated with an IPU vs a non-IPU approach. In almost every aspect, the IPU approach is by far superior to the non-IPU approach.

  1. Provider communication on perinatal depression: a population-based study.

    Science.gov (United States)

    Farr, Sherry L; Ko, Jean Y; Burley, Kim; Gupta, Seema

    2016-02-01

    Women's lack of knowledge on symptoms of perinatal depression and treatment resources is a barrier to receiving care. We sought to estimate the prevalence and predictors of discussing depression with a prenatal care provider. We used the 2011 population-based data from 24 sites participating in the Pregnancy Risk Assessment Monitoring System (n = 32,827 women with recent live births) to examine associations between maternal characteristics and report that a prenatal care provider discussed with her what to do if feeling depressed during or after pregnancy. Overall, 71.9 % of women reported discussing perinatal depression with their prenatal care provider (range 60.7 % in New York City to 85.6 % in Maine). Women were more likely to report a discussion on perinatal depression with their provider if they they were 18-29 years of age than over 35 years of age compared to older (adjusted prevalence ratio [aPR] 18 to 19 y = 1.08, 20 to 24 y = 1.10, 25 to 29 y = 1.09), unmarried (aPR = 1.07) compared to married, had 12 years, and had no previous live births (aPR = 1.03) compared to ≥ 1 live births. Research is needed on effective ways to educate women about perinatal depression and whether increased knowledge on perinatal depression results in higher rates of treatment and shorter duration of symptoms. PMID:25578631

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

    Science.gov (United States)

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

    2013-01-01

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

  3. Individual based population inference using tagging data

    DEFF Research Database (Denmark)

    Pedersen, Martin Wæver; Thygesen, Uffe Høgsbro; Baktoft, Henrik;

    estimate and its uncertainty (Hessian) can be computed. The individual model used in this text is a hidden Markov model. A simulation study concerning a two-dimensional biased random walk is examined to verify the consistency of the hierarchical estimation framework. In addition, a study based on acoustic...... telemetry data from pike illustrates how the framework can identify individuals that deviate from the remaining population....

  4. [A Maternal Health Care System Based on Mobile Health Care].

    Science.gov (United States)

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals. PMID:27382731

  5. Implanted Cardiac Defibrillator Care in Radiation Oncology Patient Population

    International Nuclear Information System (INIS)

    Purpose: To review the experience of a large cancer center with radiotherapy (RT) patients bearing implantable cardiac defibrillators (ICDs) to propose some preliminary care guidelines as we learn more about the devices and their interaction with the therapeutic radiation environment. Methods and Materials: We collected data on patients with implanted ICDs treated with RT during a 2.5-year period at any of the five Memorial Sloan-Kettering clinical campuses. Information regarding the model, location, and dose detected from the device, as well as the treatment fields, fraction size, and treatment energy was collected. During this time, a new management policy for these patients had been implemented requiring treatment with low-energy beams (6 MV) and close surveillance of the patients in partnership with their electrophysiologist, as they received RT. Results: During the study period, 33 patients were treated with an ICD in place. One patient experienced a default of the device to its initial factory setting that was detected by the patient hearing an auditory signal from the device. This patient had initially been treated with a 15-MV beam. After this episode, his treatment was replanned to be completed with 6-MV photons, and he experienced no further events. Conclusion: Patients with ICDs and other implanted computer-controlled devices will be encountered more frequently in the RT department, and proper management is important. We present a policy for the safe treatment of these patients in the radiation oncology environment.

  6. Provider-Level and Other Health Systems Factors Influencing Engagement in HIV Care: A Qualitative Study of a Vulnerable Population.

    Science.gov (United States)

    Lam, Yukyan; Westergaard, Ryan; Kirk, Gregory; Ahmadi, Azal; Genz, Andrew; Keruly, Jeanne; Hutton, Heidi; Surkan, Pamela J

    2016-01-01

    Despite the existence of highly active antiretroviral therapy, HIV/AIDS morbidity and mortality continue to be public health burdens in the United States due to difficulties in engaging people living with HIV/AIDS (PLWHA) in continuous, effective care. In comparison to studies investigating patient-level characteristics associated with starting and remaining in care, there is relatively little research on how structural factors, such as those pertaining to healthcare providers and the infrastructure for delivery of health services, influence patients' engagement in HIV care. Our study, based in the city of Baltimore, Maryland, uses qualitative research methods with a population of predominantly African American PLWHA who have a history of drug abuse, to examine facilitators and barriers regarding adherence to antiretroviral therapy (ART) and HIV care appointment attendance. Data collection involved conducting one-on-one, in-depth interviews with 31 study participants, and data analysis entailed thematic coding of interview transcripts and writing analytic memos to develop ideas and concepts. Among other findings, factors described as influential by our study participants related to appointment reminders and scheduling, the attitudes and communication styles of HIV clinicians, and the disposition and availability of other healthcare workers on the care "team." Thus, improving quality of HIV care and means of delivering it may help mitigate the numerous points in the continuum of HIV care when a patient may disengage. PMID:27428012

  7. Provider-Level and Other Health Systems Factors Influencing Engagement in HIV Care: A Qualitative Study of a Vulnerable Population

    Science.gov (United States)

    Lam, Yukyan; Westergaard, Ryan; Kirk, Gregory; Ahmadi, Azal; Genz, Andrew; Keruly, Jeanne; Hutton, Heidi; Surkan, Pamela J.

    2016-01-01

    Despite the existence of highly active antiretroviral therapy, HIV/AIDS morbidity and mortality continue to be public health burdens in the United States due to difficulties in engaging people living with HIV/AIDS (PLWHA) in continuous, effective care. In comparison to studies investigating patient-level characteristics associated with starting and remaining in care, there is relatively little research on how structural factors, such as those pertaining to healthcare providers and the infrastructure for delivery of health services, influence patients’ engagement in HIV care. Our study, based in the city of Baltimore, Maryland, uses qualitative research methods with a population of predominantly African American PLWHA who have a history of drug abuse, to examine facilitators and barriers regarding adherence to antiretroviral therapy (ART) and HIV care appointment attendance. Data collection involved conducting one-on-one, in-depth interviews with 31 study participants, and data analysis entailed thematic coding of interview transcripts and writing analytic memos to develop ideas and concepts. Among other findings, factors described as influential by our study participants related to appointment reminders and scheduling, the attitudes and communication styles of HIV clinicians, and the disposition and availability of other healthcare workers on the care “team.” Thus, improving quality of HIV care and means of delivering it may help mitigate the numerous points in the continuum of HIV care when a patient may disengage. PMID:27428012

  8. Adaptation of the Critical Care Family Need Inventory to the Turkish population and its psychometric properties

    OpenAIRE

    Büyükçoban, Sibel; Çiçeklioğlu, Meltem; Demiral Yılmaz, Nilüfer; Civaner, M. Murat

    2015-01-01

    In the complex environment of intensive care units, needs of patients’ relatives might be seen as the lowest priority. On the other hand, because of their patients’ critical and often uncertain conditions, stress levels of relatives are quite high. This study aims to adapt the Critical Care Family Need Inventory, which assesses the needs of patients’ relatives, for use with the Turkish-speaking population and to assess psychometric properties of the resulting inventory. The study was conducte...

  9. Selection of depression measures for use among Vietnamese populations in primary care settings: a scoping review

    OpenAIRE

    Murphy, Jill; Elliot M. Goldner; Goldsmith, Charles H; Oanh, Pham Thi; Zhu, William; Corbett, Kitty K; Nguyen, Vu Cong

    2015-01-01

    Depression is an important and growing contributor to the burden of disease around the world and evidence suggests the experience of depression varies cross-culturally. Efforts to improve the integration of services for depression in primary care are increasing globally, meaning that culturally valid measures that are acceptable for use in primary care settings are needed. We conducted a scoping review of 27 studies that validated or used 10 measures of depression in Vietnamese populations. W...

  10. Dental Care Demand: Age-Specific Estimates for the Population 65 Years of Age and Over

    OpenAIRE

    Conrad, Douglas A

    1983-01-01

    This paper derives estimates of the demand for dental care among the U.S. population 65 years of age and over. The analysis is unique in that it focuses on a segment of the population with particular relevance to future policy regarding dental insurance coverage and distinguishes determinants of dental care demand by type of service. The empirical estimates suggest that the use of dental service by elderly persons does respond to price changes and that price-elasticity of demand varies signif...

  11. Comparisons of annual health care utilization, drug consumption, and medical expenditure between the elderly and general population in Taiwan

    Directory of Open Access Journals (Sweden)

    Wan-Hsuan Lu, MS

    2016-06-01

    Conclusion: Elderly people had higher medical utilization than the general population, which may contribute to a fragmented health care system. Strategies to integrate health care for older people would be considered a first priority task of policymakers and health professionals.

  12. Model of Independency Mother in Caring for Preterm Infant Based on Experiential Learning Care (ELC)

    Science.gov (United States)

    Saudah, Noer; Nursalam; Meriana; Sulistyono, Agus

    2015-01-01

    The role of parents has done less during the preterm infant care in hospitals caused dependence in caring for the baby. The objective of the research was to development a model of independence of the mother in the care of preterm infants with experiential learning approach based theory of goal attainment. Research's design used analytic…

  13. The utility of a health risk assessment in providing care for a rural free clinic population

    OpenAIRE

    Scariati, Paula D; Williams, Cyndy

    2007-01-01

    Abstract Background Free clinics are an important part of our country's health safety net, serving a working poor uninsured population. With limited resources and heavily dependent upon volunteer health care providers, these clinics have historically focused on stopgap, band-aid solutions to the population's health problems. Embracing a new paradigm, free clinics are now prioritizing resources for disease prevention and health promotion. Methods We initiated a Healthy Friday Clinic project in...

  14. Engagement in the HIV Care Continuum among Key Populations in Tijuana, Mexico.

    Science.gov (United States)

    Smith, Laramie R; Patterson, Thomas L; Magis-Rodriguez, Carlos; Ojeda, Victoria D; Burgos, Jose Luis; Rojas, Sarah A; Zúñiga, María Luisa; Strathdee, Steffanie A

    2016-05-01

    In Tijuana, Mexico, HIV is concentrated in sub-epidemics of key populations: persons who inject drugs (PWID), sex workers (SW), and men who have sex with men (MSM). To date, data on engagement in the HIV care continuum among these key populations, particularly in resource-constrained settings, are sparse. We pooled available epidemiological data from six studies (N = 3368) to examine HIV testing and treatment uptake in these key populations; finding an overall HIV prevalence of 5.7 %. Of the 191 identified HIV-positive persons, only 11.5 % knew their HIV-positive status and 3.7 % were on ART. Observed differences between these HIV-positive key populations suggest PWID (vs. non-PWID) were least likely to have previously tested or initiate HIV care. MSM (vs. non-MSM) were more likely to have previously tested but not more likely to know their HIV-positive status. Of persons aware of their HIV-positive status, SW (vs. non-SW) were more likely to initiate HIV care. Findings suggest engagement of key populations in HIV treatment is far below estimates observed for similarly resource-constrained generalized epidemics in sub-Saharan Africa. These data provide one of the first empirical-snapshots highlighting the extent of HIV treatment disparities in key populations. PMID:26354518

  15. A successful population-based smoking cessation program

    Directory of Open Access Journals (Sweden)

    Hovan-Somborac Jaroslava

    2003-01-01

    Full Text Available Introduction Our country is in the third place in Europe concerning tobacco smoking. Although strict law regulations regarding indoor smoking have been brought, the law banning all tobacco advertising, and the behaviour of our population are inadequate. Our objective was to persuade smokers for the 'Quit and Win' campaign and to establish the number of smokers in health personnel employed in health facilities. Material and methods This population-based smoking cessation campaign was coordinated by Federal Institute of Public Health, through a network of Public Health Institutes within the country with the support of national and local media. Results and discussion Quit and Win campaign was organized for the third time. The campaign was realized with the financial support and sponsorship at community level throughout the country. The Federal Ministry provided a national health award. The national and local media accompanied the campaign. The campaign included 3.178 smokers and 2.575 supporters, that is 0.1% of the population over 18 years of age. This is in accordance with participants in some other countries, who had a better support. More than 60% of health care facility employees are smokers. Conclusions Our tradition, habits in the society and overall situation encourage smoking habits to spread in general population. Our campaign has proved that people should be motivated to quit smoking, but they need to be informed. Actions taken in general population and based on a positive smoking cessation program in which smokers are willing to stop smoking have given unexpectedly good results.

  16. Population Of US Practicing Psychiatrists Declined, 2003-13, Which May Help Explain Poor Access To Mental Health Care.

    Science.gov (United States)

    Bishop, Tara F; Seirup, Joanna K; Pincus, Harold Alan; Ross, Joseph S

    2016-07-01

    A large proportion of the US population suffers from mental illness. Limited access to psychiatrists may be a contributor to the underuse of mental health services. We studied changes in the supply of psychiatrists from 2003 to 2013, compared to changes in the supply of primary care physicians and neurologists. During this period the number of practicing psychiatrists declined from 37,968 to 37,889, which represented a 10.2 percent reduction in the median number of psychiatrists per 100,000 residents in hospital referral regions. In contrast, the numbers of primary care physicians and neurologists grew during the study period. These findings may help explain why patients report poor access to mental health care. Future research should explore the impact of the declining psychiatrist supply on patients and investigate new models of care that seek to integrate mental health and primary care or use team-based care that combines the services of psychiatrists and nonphysician providers for individuals with severe mental illnesses. PMID:27385244

  17. Development and Implementation of an Electronic Decision Support to Manage the Health of a High-Risk Population: The enhanced Electronic Medical Record Aging Brain Care Software (eMR-ABC)

    OpenAIRE

    Frame, Amie; LaMantia, Michael; Reddy Bynagari, Bharath B.; Dexter, Paul; Boustani, Malaz

    2013-01-01

    Introduction: Health care systems in the United States are transitioning from volume-based purchasing models to value-based purchasing models that demand both delivery of personalized care for each patient and cost-effective population health management. The enhanced medical record for aging brain care (eMR-ABC) software is an electronic decision support system that facilitates the management of a high-risk population suffering from aging brain disorders such as dementia. Methods: Using the l...

  18. Problematising Home-based Care for Children with Cancer

    OpenAIRE

    Fletcher, Hannah Kate

    2013-01-01

    Background and Literature Review This study explores issues around home-based care for children with cancer. Current policy tends to promote home-based care for children with cancer; this project seeks to interrogate that approach further and to explore the evidence base for this policy direction. The literature review is structured around key themes and demonstrates the gap in the evidence from health care professionals‘ perspectives and UK based research Methodology I adopt a quali...

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

    Directory of Open Access Journals (Sweden)

    J Whitehead

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

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

    Science.gov (United States)

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

    2016-01-01

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

  1. Occupational Therapy in Primary Health Care: reflections on the populations assisted

    Directory of Open Access Journals (Sweden)

    Mariana Leme Gomes

    2012-12-01

    Full Text Available This work is the result of reflections of a group discussion among professionals, students and teachersheld during the First Symposium on Occupational Therapy in Primary Health Care (PHC in 2011, which aimedto reflect on issues related to the populations assisted by the occupational therapist in PHC. The discussionssuggested two areas of consideration: (1 the challenges in the composition of care lines as well as living conditionsof the population assisted by occupational therapy; (2 the general practice of occupational therapists and theirinclusion in interdisciplinary teams. Participants reported that, in PHC, they provide assistance to populationstraditionally accompanied by Occupational Therapy such as people under psychological distress, people with disabilities, children with developmental delay, among others. The discussion pointed out that the difficultyof access to services, the weakness in the constitution of the lines of comprehensive health care and neglectof services to a number of groups that are excluded from care, define the profile of the population monitoredand the potential of assistance. These factors are related to the formation of PHC and “SUS” (Brazilian HealthSystem in the country. On the other hand, the living conditions of the population assisted, marked by povertyand social exclusion, the fragmentation of PHC practices, and the need for the professional to have a generalistprofile, being able to act interdisciplinarily and intersectorally, were considered crucial for the construction ofnew working tolls, theoretical improvement, and greater theoretical basis of professional performance in PHC.

  2. The Value of a College Degree for Foster Care Alumni: Comparisons with General Population Samples

    Science.gov (United States)

    Salazar, Amy M.

    2013-01-01

    Higher education is associated with substantial adult life benefits, including higher income and improved quality of life, among others. The current study compared adult outcomes of 250 foster care alumni college graduates with two samples of general population graduates to explore the role higher education plays in these young adults' lives.…

  3. Rapid Point-of-Care Diagnostic Test for Syphilis in High-Risk Populations, Manaus, Brazil

    OpenAIRE

    Sabidó, Meritxell; Adele S Benzaken; de Andrade Rodrigues, Ệnio José; Mayaud, Philippe

    2009-01-01

    We assessed the acceptability and operational suitability of a rapid point-of-care syphilis test and identified barriers to testing among high-risk groups and healthcare professionals in a sexually transmitted infections clinic in Manaus, Brazil. Use of this test could considerably alleviate the impact of syphilis in hard-to-reach populations in the Amazon region of Brazil.

  4. Classification of a palliative care population in a comprehensive cancer centre

    DEFF Research Database (Denmark)

    Benthien, Kirstine Skov; Nordly, Mie; Videbæk, Katja; Kurita, Geana Paula; von der Maase, Hans; Timm, Helle; Simonsen, Mette Kildevæld; Johansen, Christoffer; Sjøgren, Per

    2016-01-01

    PURPOSE: The purposes of the present study were to classify the palliative care population (PCP) in a comprehensive cancer centre by using information on antineoplastic treatment options and to analyse associations between socio-demographic factors, cancer diagnoses, treatment characteristics and...... receiving specialist palliative care (SPC). METHODS: This is a cross-sectional screening study of patients with cancer in the Department of Oncology, Rigshospitalet, Copenhagen University Hospital for 6 months. Patients were assessed to be included in the DOMUS study: a randomised controlled trial of...... accelerated transition to SPC at home (NCT01885637). The PCP was classified as patients with incurable cancer and limited or no antineoplastic treatment options. Patients with performance status 2-4 were further classified as the essential palliative care population (EPCP). RESULTS: During the study period...

  5. Family reintegration of children and adolescents in foster care in Brazilian municipalities with different population sizes

    Directory of Open Access Journals (Sweden)

    Andrea M. Iannelli

    2015-01-01

    Full Text Available The scope of this article is to present and analyze data from Brazilian foster care services for children / adolescents from the perspective of family reintegration. It also seeks to support the implementation of public policies in order to provide effective reintegration in accordance with the differing local contexts. It uses data from 1,157 municipalities that have foster care services. The methodology takes into account the data collection of 2,624 Brazilian centers and 36,929 children and adolescents in care. The growing number of children/adolescents in care is in line with the increase in population size: 8.4 per small city; 60 per large city and 602.4 per metropolis. With respect to care residence in a different municipality there are varying indices: 12.4% in metropolises and 33.6% in small cities, revealing the absence of centers close to family units in the smaller communities. Regarding the activities promoted together with families, it was seen that there are still units that do not perform any activities, which runs contrary to Brazilian law. It is clear that policies for the child/adolescent in foster care centers need to consider the capacity of the municipality in accordance with population size to implement support actions for families to assist in family reintegration.

  6. [The present and future of community/home-based palliative care in Taiwan].

    Science.gov (United States)

    Ueng, Ruey-Shiuan; Hsu, Su-Hsuan; Shih, Chih-Yuan; Huang, Sheng-Jean

    2015-04-01

    In Taiwan, the Department of Health (DOH) has implemented regulations and policies related to hospice and palliative care since 1995. Taiwan is the first country in Asia to have a Natural Death Act, promulgated in 2000. Although recognition of the need for palliative care in non-cancer terminally ill patients is increasing, at present, the needs of these patients are often not met. Moreover, while a majority of the population prefers to die at home, the percentage of patients who die in the home setting remains small. The palliative care system should be adjusted to improve the accessibility and continuity of care based on the needs of patients. Therefore, the Jin-Shan Branch of the National Taiwan University Hospital has run a pilot community palliative care service model since 2012. National Health Insurance reimbursement was introduced in 2014 for community-based palliative care services. Establishing a formal system of community-based palliative care should be encouraged in order to improve the quality of care at the end of life and to allow more patients to receive end-of-life care and die in their own communities. This system will require that skilled nurses provide discharge planning, symptoms control, end-of-life communications, social-resources integration, and social-support networks in order to achieve a high quality of end-of-life care. PMID:25854944

  7. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study

    Science.gov (United States)

    Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.

    2015-01-01

    Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Methods Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through “Embrace,” an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Results Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes “Struggling with health,” “Increasing dependency,” “Decreasing social interaction,” “Loss of control,” and “Fears;” and 2) Experiences with Embrace, with the themes “Relationship with the case manager,” “Interactions,” and “Feeling in control, safe, and secure”. The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants’ ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. Conclusion The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging. PMID:26489096

  8. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Sophie L W Spoorenberg

    Full Text Available Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs.Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach.Responses of participants concerned two focus areas: 1 Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2 Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system.The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

  9. Health Care Use by Patients with Somatoform Disorders A Register-Based Follow-Up Study*

    DEFF Research Database (Denmark)

    Andersen, Nadia Lyhne Trærup; Eplov, Lene Falgaard; Andersen, Jon Trærup;

    2012-01-01

    OBJECTIVE: Studies have shown a greater use of medical than mental health services in patients with somatoform disorders. However, not many studies are based on structured interviews and include the entire somatoform spectrum of diagnoses. We conducted a register-based case-control study to...... background population. Data from the Danish National Registers were used to assess health care use in both primary and secondary care. RESULTS: Somatoform patients incurred 2.11 (2.09-2.12) times the primary care visits of controls. They had 3.12 (3.08-3.16) times as many somatic bed-days than controls and 3...

  10. Training teachers to teach mental health skills to staff in primary care settings in a vast, under-populated area.

    Science.gov (United States)

    Goldberg, D P; Gask, L; Zakroyeva, A; Proselkova, E; Ryzhkova, N; Williams, P

    2012-12-01

    Background The Arkhangelsk Oblast is an area the size of France with a sparsely distributed population. The existing primary care staff have had very little training in the management of mental health disorders, despite the frequency of these disorders in the population. They requested special teaching on depression, suicide, somatisation and alcohol problems. Methods An educational intervention was developed in partnership with mental health and primary care staff in Russia, to develop mental health skills using established, evidence-based methods. After a preliminary demonstration of teaching methods to be employed, a 5-day full-time teaching course was offered to trainers of general practitioners and feldshers. Results The findings are presented by providing details of improvements that occurred over a 3-month period in four areas, namely depression in primary care, somatic presentations of distress, dealing with suicidal patients, and alcohol problems. We present preliminary data on how the training has generalised since our visits to Archangelsk. Conclusions Teachers who are used to teaching by didactic lectures can be taught the value of short introductory talks that invite discussion, and mental health skills can be taught using role play. The content of such training should be driven by perceived local needs, and developed in conjunction with local leaders and teachers within primary care services. Further research will be needed to establish the impact on clinical outcomes. PMID:24294296

  11. Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland

    Directory of Open Access Journals (Sweden)

    Bailey Kerry A

    2010-08-01

    Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.

  12. Local environment but not genetic differentiation influences biparental care in ten plover populations.

    Directory of Open Access Journals (Sweden)

    Orsolya Vincze

    Full Text Available Social behaviours are highly variable between species, populations and individuals. However, it is contentious whether behavioural variations are primarily moulded by the environment, caused by genetic differences, or a combination of both. Here we establish that biparental care, a complex social behaviour that involves rearing of young by both parents, differs between closely related populations, and then test two potential sources of variation in parental behaviour between populations: ambient environment and genetic differentiation. We use 2904 hours behavioural data from 10 geographically distinct Kentish (Charadrius alexandrinus and snowy plover (C. nivosus populations in America, Europe, the Middle East and North Africa to test these two sources of behavioural variation. We show that local ambient temperature has a significant influence on parental care: with extreme heat (above 40 °C total incubation (i.e. % of time the male or female incubated the nest increased, and female share (% female share of incubation decreased. By contrast, neither genetic differences between populations, nor geographic distances predicted total incubation or female's share of incubation. These results suggest that the local environment has a stronger influence on a social behaviour than genetic differentiation, at least between populations of closely related species.

  13. The Primary Care-Population Medicine Program at The Warren Alpert Medical School of Brown University.

    Science.gov (United States)

    George, Paul; Tunkel, Allan R; Dollase, Richard; Gruppuso, Philip; Dumenco, Luba; Rapoza, Brenda; Borkan, Jeffrey

    2015-09-01

    The United States healthcare system has been in a period of rapid evolution over the past decade, a trend that is anticipated to continue for the foreseeable future. Physicians are increasingly responsible for the quality of care they provide, and are being held accountable not just for the patient in front of them, but also for the outcomes of their patient panels, communities, and populations. In response to these changes, as well as the projected shortage of primary care physicians, the Warren Alpert Medical School of Brown University (AMS) developed the Primary Care-Population Medicine (PC-PM) program, which builds upon the traditional curriculum with major integrated curricular innovations. The first is a Master of Science Degree in Population Medicine that requires students to take nine additional courses over four years, complete a thesis project focused on an area of Population Medicine, and take part in significant leadership training. Another significant innovative element is the development of a Longitudinal Integrated Clerkship (LIC) during the 3rd year of medical school in which the students complete a longitudinal outpatient experience with the same preceptors and patients. During the LIC students will follow a panel of patients wherever care is provided, while focusing on population health and healthcare delivery issues, in addition to medical topics throughout their clinical and didactic experiences. Though several of the innovative elements are being piloted, the inaugural PC-PM class of up to 24 students will only begin in August 2015. While the outcomes from this program will not be known for many years, the potential impact of the program is significant for AMS, medical education, and the future of healthcare delivery. PMID:26324970

  14. Hospitalisation Rates for Ambulatory Care Sensitive Conditions for Persons with and without an Intellectual Disability--A Population Perspective

    Science.gov (United States)

    Balogh, R.; Brownell, M.; Ouellette-Kuntz, H.; Colantonio, A.

    2010-01-01

    Background: There is evidence that persons with an intellectual disability (ID) face barriers to primary care; however, this has not been extensively studied at the population level. Rates of hospitalisation for ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. The objective of the study was…

  15. Impact of Population Stratification on Family-Based Association in an Admixed Population

    OpenAIRE

    Mersha, T. B.; Ding, L; He, H; Alexander, E. S.; Zhang, X.; B. G. Kurowski; Pilipenko, V.; Kottyan, L.; Martin, L. J.; Fardo, D. W.

    2015-01-01

    Population substructure is a well-known confounder in population-based case-control genetic studies, but its impact in family-based studies is unclear. We performed population substructure analysis using extended families of admixed population to evaluate power and Type I error in an association study framework. Our analysis shows that power was improved by 1.5% after principal components adjustment. Type I error was also reduced by 2.2% after adjusting for family substratification. The prese...

  16. Do Health and Demographic Surveillance Systems benefit local populations? Maternal care utilisation in Butajira HDSS, Ethiopia

    Directory of Open Access Journals (Sweden)

    Mesganaw Fantahun Afework

    2014-07-01

    Full Text Available Background: The benefits of Health and Demographic Surveillance sites for local populations have been the topic of discussion as countries such as Ethiopia take efforts to achieve their Millennium Development Goal targets, on which they lag behind. Ethiopia's maternal mortality ratio is very high, and in the 2011 Ethiopia Demographic and Health Survey (2011 EDHS it was estimated to be 676/100,000 live births. Recent Global Burden of Disease (GBD and estimates based on the United Nations model reported better, but still unacceptably high, figures of 497/100,000 and 420/100,000 live births for 2013. In the 2011 EDHS, antenatal care (ANC utilization was estimated at 34%, and delivery in health facilities was only 10%. Objectives: To compare maternal health service utilization among populations in a Health and Demographic Surveillance System (HDSS to non-HDSS populations in Butajira district, south central Ethiopia. Design: A community-based comparative cross-sectional study was conducted in January and February 2012 among women who had delivered in the 2 years before the survey. Results: A total of 2,296 women were included in the study. One thousand eight hundred and sixty two (81.1% had attended ANC at least once, and 37% of the women had attended ANC at least four times. A quarter of the women delivered their last child in a health facility. Of the women living outside the HDSS areas, 715 (75.3% attended ANC at least once compared to 85.1% of women living in the HDSS areas [adjusted odds ratio (AOR 0.59; 95% CI 0.46, 0.74]. Of the women living outside the HDSS areas, only 170 (17.9% delivered in health facilities and were assisted by skilled attendants during delivery, whereas 30.0% of those living in HDSS areas delivered in health facilities (AOR 0.66; 95% CI 0.48, 0.91. Conclusion: This paper provides possible evidence that living in an HDSS site has a positive influence on maternal health. In addition, there may be a positive influence on

  17. [Prevalence of home care and associated factors in the Brazilian elderly population].

    Science.gov (United States)

    Wachs, Louriele Soares; Nunes, Bruno Pereira; Soares, Mariangela Uhlmann; Facchini, Luiz Augusto; Thumé, Elaine

    2016-03-01

    The aim of this study was to evaluate the prevalence of home care for the Brazilian elderly population and associated factors, using a cross-sectional design with a sample of individuals 60 years or older living in the urban areas of 100 municipalities located in 23 states. A Poisson regression model was used for crude and adjusted analyses. A total of 6,624 elderly individuals were interviewed, and prevalence of home care was 11.7%. After adjustment, higher home care rates were associated with female gender, older old age, lower schooling and purchasing power, diagnosis of chronic illness, history of falls, previous hospitalization, and medical consultation in the previous three months. The results highlight more extensive use of home care by the most vulnerable elderly. This finding suggests a contribution from home care to the promotion of healthcare equity in Brazil, especially due to the expansion of the Family Health Strategy. The results can support the organization of the work process for primary care professionals and managers. PMID:27027455

  18. A Patient-Based Analysis of Drug Disorder Diagnoses in the Medicare Population

    OpenAIRE

    Cartwright, William S.; Ingster, Lillian M.

    1993-01-01

    This article utilizes the Part A Medicare provider analysis and review (MEDPAR) file for fiscal year (FY) 1987. The discharge records were organized into a patient-based record that included alcohol, drug, and mental (ADM) disorder diagnoses as well as measures of resource use. The authors find that there are substantially higher costs of health care incurred by the drug disorder diagnosed population. Those of the Medicare population diagnosed with drug disorders had longer lengths of stay (L...

  19. Age- and Gender-Based Populations

    Science.gov (United States)

    ... Response, and Recovery Health Care and Health Systems Integration Health Disparities Health Financing Health Information Technology HIV, AIDS, and Viral Hepatitis Homelessness and Housing Laws, Regulations, and Guidelines Mental and Substance Use Disorders Prescription Drug Misuse and ...

  20. Prevalence of Depression and Depression Care for Populations Registered in Primary Care in Two Remote Cities in the Brazilian Amazon

    Science.gov (United States)

    2016-01-01

    Background The prevalence of depression has been widely studied in high-income countries and in large cities of low-income countries; however, little is known about the prevalence and treatment gap of depression in remote areas of the Amazonian region in Brazil. Objectives The objectives of this study are to estimate the prevalence of depression in adults registered with the Family Health Strategy in two remote cities in the Brazilian Amazon and to investigate the proportion of individuals with depression that received mental health care. Methods This is a cross-sectional study of an adult population registered with primary care clinics in the cities of Coari and Tefé, State of Amazon, Brazil. Depression was defined as a score of ≥10 on the Patient Health Questionnaire-9. Depression care was evaluated by asking participants with depression if they received antidepressants and/or had been seen by a health professional at a community mental health center in the three months prior to the interview. Poisson regression was used to examine the unadjusted and adjusted associations between depression and exposure variables. Results The overall prevalence of depression was 19.1% (95% CI: 17.2–21.1), with 22.2% (95% CI: 19.3–25.0) among women and 16.0% (95% CI: 13.4–18.5) among men. The prevalence of depression in Coari and Tefé were 18.3% (CI 95% 15.7–21.0) and 19.9% (95% CI:17.2–22.7), respectively. Being a woman, lacking social support, increasing exposure to stressful life events and having a higher number medical comorbidities were consistently associated with depression. Lower educational attainment and income, tobacco use, and risky alcohol use were also associated with depression in the unadjusted analyses. Only 11.5% of those with depression were receiving antidepressants and/or visited the mental health care facility during the three months prior to the interview. Conclusion Approximately one in five adults in our sample had depression. A high

  1. A Population-Based Study of Preschoolers' Food Neophobia and Its Associations with Food Preferences

    Science.gov (United States)

    Russell, Catherine Georgina; Worsley, Anthony

    2008-01-01

    Objective: This cross-sectional study was designed to investigate the relationships between food preferences, food neophobia, and children's characteristics among a population-based sample of preschoolers. Design: A parent-report questionnaire. Setting: Child-care centers, kindergartens, playgroups, day nurseries, and swimming centers. Subjects:…

  2. Population-Based Placental Weight Ratio Distributions

    Directory of Open Access Journals (Sweden)

    Erin M. Macdonald

    2014-01-01

    Full Text Available The placental weight ratio (PWR is a health indicator that reflects the balance between fetal and placental growth. The PWR is defined as the placental weight divided by the birth weight, and it changes across gestation. Its ranges are not well established. We aimed to establish PWR distributions by gestational age and to investigate whether the PWR distributions vary by fetal growth adequacy, small, average, and large for gestational age (SGA, AGA, and LGA. The data came from a hospital based retrospective cohort, using all births at two London, Ontario hospitals in the past 10 years. All women who delivered a live singleton infant between 22 and 42 weeks of gestation were included (n=41441. Nonparametric quantile regression was used to fit the curves. The results demonstrate decreasing PWR and dispersion, with increasing gestational age. A higher proportion of SGA infants have extreme PWRs than AGA and LGA, especially at lower gestational ages. On average, SGA infants had higher PWRs than AGA and LGA infants. The overall curves offer population standards for use in research studies. The curves stratified by fetal growth adequacy are the first of their kind, and they demonstrate that PWR differs for SGA and LGA infants.

  3. Coagulase-Negative Staphylococcal Skin Carriage among Neonatal Intensive Care Unit Personnel: from Population to Infection▿

    OpenAIRE

    Hira, Vishal; Sluijter, Marcel; Goessens, Wil H.F.; Ott, Alewijn; Groot, Ronald; Hermans, Peter W. M.; Kornelisse, René F.

    2010-01-01

    Coagulase-negative staphylococci (CoNS) are a major cause of sepsis in neonatal intensive care units (NICU) worldwide. Infecting strains of these commensal bacteria may originate from NICU personnel. Therefore, we studied the characteristics of CoNS isolates from NICU personnel and compared them to those of isolates from the general population and from sepsis patients. Furthermore, we studied the epidemiological effect on CoNS carriage of NICU personnel after a period of absence. In our study...

  4. Chronic morbidity and health care seeking behaviour amongst elderly population in rural areas of Uttarakhand

    OpenAIRE

    Surekha Kishore; Mr. Kapil Sharma; Richa Singh; Bhanu Pratap Singh Gaur; Rachana R Satish; Yatish Bhaskar; Ritu Bhaskar

    2015-01-01

    Background: Ageing is a natural process, always associated with physiological and biological decline. Global population is ageing; the proportion of older persons has been rising steadily, from 7% in 1950 to 11% in 2007, with an expected rise to reach 22 % in 2050. With improving knowledge and awareness the health care seeking behavior has shown an increasingly positive trend. With increasing age, morbidity,   especially those arising from chronic diseases also increases. On the contrary, hea...

  5. A population-based study of birth defects in Malaysia.

    Science.gov (United States)

    Thong, M K; Ho, J J; Khatijah, N N

    2005-01-01

    Birth defects are one of the leading causes of paediatric disability and mortality in developed and developing countries. Data on birth defects from population-based studies originating from developing countries are lacking. One of the objectives of this study was to determine the epidemiology of major birth defects in births during the perinatal period in Kinta district, Perak, Malaysia over a 14-month period, using a population-based birth defect register. There were 253 babies with major birth defects in 17,720 births, giving an incidence of 14.3/1000 births, a birth prevalence of 1 in 70. There were 80 babies with multiple birth defects and 173 with isolated birth defects. The exact syndromic diagnosis of the babies with multiple birth defects could not be identified in 18 (22.5%) babies. The main organ systems involved in the isolated birth defects were cardiovascular (13.8%), cleft lip and palate (11.9%), clubfeet (9.1%), central nervous system (CNS) (including neural tube defects) (7.9%), musculoskeletal (5.5%) and gastrointestinal systems (4.7%), and hydrops fetalis (4.3%). The babies with major birth defects were associated with lower birth weights, premature deliveries, higher Caesarean section rates, prolonged hospitalization and increased specialist care. Among the cohort of babies with major birth defects, the mortality rate was 25.2% during the perinatal period. Mothers with affected babies were associated with advanced maternal age, birth defects themselves or their relatives but not in their other offspring, and significantly higher rates of previous abortions. The consanguinity rate of 2.4% was twice that of the control population. It is concluded that a birth defects register is needed to monitor these developments and future interventional trials are needed to reduce birth defects in Malaysia. PMID:16096215

  6. The importance of job characteristics in determining medical care-seeking in the Dutch working population, a longitudinal survey study

    OpenAIRE

    Steenbeek Romy

    2012-01-01

    Abstract Background The working population is ageing, which will increase the number of workers with chronic health complaints, and, as a consequence, the number of workers seeking health care. It is very important to understand factors that influence medical care-seeking in order to control the costs. I will investigate which work characteristics independently attribute to later care-seeking in order to find possibilities to prevent unnecessary or inefficient care-seeking. Methods Data were ...

  7. A public-private trauma center network in Florida harnesses data to improve care quality for an aging population.

    Science.gov (United States)

    DuVernay, Christina

    2013-12-01

    As the US population ages, trauma systems face new challenges in addition to the long-standing problem of access. Patients ages sixty-five and older are more likely than younger patients to fall and suffer serious injury or death as a result. This older patient population, when compared with younger cohorts, suffers higher mortality rates, has more comorbidities-diabetes, cancer, and heart conditions being the more serious among them-and takes more medications, which can complicate treatment. The University of South Florida (USF) Medical School and the HCA hospital system have partnered to create a network of five trauma centers in underserved areas of the state to increase access to trauma care for all Floridians while maintaining a special focus on geriatric trauma care. Collecting and analyzing data for improving care quality and undertaking research is a central aim of the partnership. Based on their research findings, trauma surgeons in the USF/HCA Trauma Network have identified best practices and codified them in standard operating procedures. PMID:24301397

  8. Dental care for aging populations in Denmark, Sweden, Norway, United kingdom, and Germany.

    Science.gov (United States)

    Holm-Pedersen, Poul; Vigild, Merete; Nitschke, Ina; Berkey, Douglas B

    2005-09-01

    This article reviews access to and financing of dental care for aging populations in selected nations in Europe. Old age per se does not seem to be a major factor in determining the use of dental services. Dentition status, on the other hand, is a major determinant of dental attendance. In addition to perceived need, a variety of social and behavioral factors as well as general health factors have been identified as determinants of dental service use. Frail and functionally dependent elderly have special difficulties in accessing dental care; private dental practitioners are hesitant to provide dental care to these patients. One reason may be that the fee for treating these patients is too low, considering high dental office expenses. Another reason may be problems related to management of medically compromised patients. This raises an important question: does inadequate training in geriatric dentistry discourage dentists from seeking opportunities to treat geriatric patients? Overall, the availability of dental services, the organization of the dental health care delivery system, and price subsidy for dental treatment are important factors influencing access to dental care among older people in Europe as well as in the United States. PMID:16141084

  9. Impact of Population Stratification on Family-Based Association in an Admixed Population

    Directory of Open Access Journals (Sweden)

    T. B. Mersha

    2015-01-01

    Full Text Available Population substructure is a well-known confounder in population-based case-control genetic studies, but its impact in family-based studies is unclear. We performed population substructure analysis using extended families of admixed population to evaluate power and Type I error in an association study framework. Our analysis shows that power was improved by 1.5% after principal components adjustment. Type I error was also reduced by 2.2% after adjusting for family substratification. The presence of population substructure was underscored by discriminant analysis, in which over 92% of individuals were correctly assigned to their actual family using only 100 principal components. This study demonstrates the importance of adjusting for population substructure in family-based studies of admixed populations.

  10. Impact of Population Stratification on Family-Based Association in an Admixed Population.

    Science.gov (United States)

    Mersha, T B; Ding, L; He, H; Alexander, E S; Zhang, X; Kurowski, B G; Pilipenko, V; Kottyan, L; Martin, L J; Fardo, D W

    2015-01-01

    Population substructure is a well-known confounder in population-based case-control genetic studies, but its impact in family-based studies is unclear. We performed population substructure analysis using extended families of admixed population to evaluate power and Type I error in an association study framework. Our analysis shows that power was improved by 1.5% after principal components adjustment. Type I error was also reduced by 2.2% after adjusting for family substratification. The presence of population substructure was underscored by discriminant analysis, in which over 92% of individuals were correctly assigned to their actual family using only 100 principal components. This study demonstrates the importance of adjusting for population substructure in family-based studies of admixed populations. PMID:26064873

  11. Violent offenders as a target population for Public Mental Health Care.

    Science.gov (United States)

    Fassaert, T; Segeren, M; Grimbergen, C; Tuinebreijer, W; de Wit, M

    2016-05-01

    The study sought to specify which part of a population of young adult violent offenders in Amsterdam (mean age 24.9 years, sd = 8.2) were eligible for Public Mental Health Care (PMHC). The results of a semi-structured clinical interview were used (N = 454), which included the Self-Sufficiency Matrix (SSM-D). Using the SSM-D and two distinct definitions of what constitutes a need for PMHC, the size of the PMHC target population was determined twice. Depending on which definition was used, 35.9% (mathematical algorithm which put weights to single SSM-D domains) and 34.8% (problematic levels of self-sufficiency on a selection of domains) appeared to be eligible for entering the PMHC system. The study confirms that a substantial proportion of vulnerable people are among the forensic population. PMID:27038096

  12. Time based management in health care system: The chosen aspects

    OpenAIRE

    Joanna Kobza; Magdalena Syrkiewicz-Świtała

    2014-01-01

    Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011) have be...

  13. 2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers.

    Science.gov (United States)

    Brush, John E; Handberg, Eileen M; Biga, Cathleen; Birtcher, Kim K; Bove, Alfred A; Casale, Paul N; Clark, Michael G; Garson, Arthur; Hines, Jerome L; Linderbaum, Jane A; Rodgers, George P; Shor, Robert A; Thourani, Vinod H; Wyman, Janet F

    2015-05-19

    The mission of the American College of Cardiology is "to transform cardiovascular care and improve heart health." Cardiovascular team-based care is a paradigm for practice that can transform care, improve heart health, and help meet the demands of the future. One strategic goal of the College is to help members successfully transition their clinical practices to the future, with all its complexity, challenges, and opportunities. The ACC's strategic plan is aligned with the triple aim of improved care, improved population health, and lower costs per capita. The traditional understanding of quality, access, and cost is that you cannot improve one component without diminishing the others. With cardiovascular team-based care, it is possible to achieve the triple aim of improving quality, access, and cost simultaneously to also improve cardiovascular health. Striving to serve the best interests of patients is the true north of our guiding principles. Cardiovascular team-based care is a model that can improve care coordination and communication and allow each team member to focus more on the quality of care. In addition, the cardiovascular team-based care model increases access to cardiovascular care and allows expansion of services to populations and geographic areas that are currently underserved. This document will increase awareness of the important components of cardiovascular team-based care and create an opportunity for more discussion about the most creative and effective means of implementing it. We hope that this document will stimulate further discussions and activities within the ACC and beyond about team-based care. We have identified areas that need improvement, specifically in APP education and state regulation. The document encourages the exploration of collaborative care models that should enable team members to optimize their education, training, experience, and talent. Improved team leadership, coordination, collaboration, engagement, and efficiency

  14. Population Scalability Analysis of Abstract Population-based Random Search: Spectral Radius

    CERN Document Server

    He, Jun

    2011-01-01

    Population-based Random Search (RS) algorithms, such as Evolutionary Algorithms (EAs), Ant Colony Optimization (ACO), Artificial Immune Systems (AIS) and Particle Swarm Optimization (PSO), have been widely applied to solving discrete optimization problems. A common belief in this area is that the performance of a population-based RS algorithm may improve if increasing its population size. The term of population scalability is used to describe the relationship between the performance of RS algorithms and their population size. Although understanding population scalability is important to design efficient RS algorithms, there exist few theoretical results about population scalability so far. Among those limited results, most of them belong to case studies, e.g. simple RS algorithms for simple problems. Different from them, the paper aims at providing a general study. A large family of RS algorithms, called ARS, has been investigated in the paper. The main contribution of this paper is to introduce a novel appro...

  15. Adjustment factors to per capita health-care indicators in countries with expatriate male-majority populations.

    Science.gov (United States)

    Hussin, A H

    2014-11-01

    From 2000 to 2010, the population in the Gulf Cooperation Council (GCC) countries underwent an increase of 53%, compared with an average global increase of 13%. The rates varied by country, ranging from 23% in Oman to 198% in Qatar. The main driving force for this sharp increase in population was the high demand for immigrant labour. The aim of this study was to adjust the population in the GCC countries in order to ensure that the comparisons of health-care key performance indicators with other countries account for the composition of the populations. The conclusion of the study was that adjusting the population in the GCC is instrumental for determining health spending and health outcomes, and that inaccurate forecasting would result in serious overestimation of the need for GCC countries to invest in the health-care sector. Policy-makers can utilize the population models in this study to accurately plan for health-care delivery. PMID:25601807

  16. Nanotechnology-Based Cosmetics for Hair Care

    OpenAIRE

    Jamie Rosen; Angelo Landriscina; Friedman, Adam J.

    2015-01-01

    Hair is a significant indicator of health and can have a major impact on an individual’s cosmetic appearance. Research within the cosmetics industry has revealed that when nanomaterials are engineered into hair care, they can enhance the benefits of active ingredients in order to improve hair cosmesis. Within the cosmetics arena, the unique size and intrinsic properties of nanoparticles can be tailored to target the hair follicle and shaft. This review aims to provide an overview of cosmetic ...

  17. Decision support for health care: the PROforma evidence base

    Directory of Open Access Journals (Sweden)

    John Fox

    2006-03-01

    Full Text Available Cancer Research UK has developed PROforma, a formal language for modelling clinical processes, along with associated tools for creating decision support, care planning, clinical workflow management and other applications. The PROforma method has been evaluated in a variety of settings: in primary health care (prescribing, referral of suspected cancer patients, genetic risk assessment and in specialist care of patients with breast cancer, leukaemia, HIV infection and other conditions. About nine years of experience have been gained with PROforma technologies. Seven trials of decision support applications have been published or are in preparation. Each of these has shown significant positive effects on a variety of measures of quality and/or outcomes of care. This paper reviews the evidence base for the clinical effectiveness of these PROforma applications, and previews the CREDO project _a multi-centre trial of a complex PROforma application for supporting integrated breast cancer care across primary and secondary care settings.

  18. Low documentation of chronic kidney disease among high-risk patients in a managed care population: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    McClellan William

    2009-09-01

    Full Text Available Abstract Background Early detection of chronic kidney disease (CKD is sub-optimal among the general population and among high risk patients. The prevalence and impact of major CKD risk factors, diabetes (DM and hypertension (HTN, on CKD documentation among managed care populations have not been previously reported. We examined this issue in a Kaiser Permanente Georgia (KPG CKD cohort. Methods KPG enrollees were included in the CKD cohort if they had eGFRs between 60 and 365 days apart that were 2. CKD documentation was defined as a presenting diagnosis of CKD by a primary care physician or nephrologist using ICD-9 event codes. The association between CKD documentation and DM and HTN were assessed with multivariate logistic regression models. Results Of the 50,438 subjects within the overall KPG CKD cohort, 20% (N = 10,266 were eligible for inclusion in the current analysis. Overall, CKD diagnosis documentation was low; only 14.4% of subjects had an event-based CKD diagnosis at baseline. Gender and types 2 diabetes interacted on CKD documentation. The prevalence of CKD documentation increased with the presence of hypertension and/or type 2 diabetes, but type 2 diabetes had a lower effect on CKD documentation. In multivariate analysis, significant predictors of CKD documentation were eGFR, hypertension, type 2 diabetes, congestive heart failure, peripheral artery disease, statin use, age and gender. CKD documentation was lower among women than similarly affected men. Conclusion Among patients with an eGFR 10-59, documentation of CKD diagnosis by primary and subspecialty providers is low within a managed care patient cohort. Gender disparities in CKD documentation observed in the general population were also present among KPG CKD enrollees.

  19. Population-based tobacco treatment: study design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Fu Steven S

    2012-03-01

    Full Text Available Abstract Background Most smokers do not receive comprehensive, evidence-based treatment for tobacco use that includes intensive behavioral counseling along with pharmacotherapy. Further, the use of proven, tobacco treatments is lower among minorities than among Whites. The primary objectives of this study are to: (1 Assess the effect of a proactive care intervention (PRO on population-level smoking abstinence rates (i.e., abstinence among all smokers including those who use and do not utilize treatment and on utilization of tobacco treatment compared to reactive/usual care (UC among a diverse population of smokers, (2 Compare the effect of PRO on population-level smoking abstinence rates and utilization of tobacco treatments between African American and White smokers, and (3 Determine the cost-effectiveness of the proactive care intervention. Methods/Design This prospective randomized controlled trial identifies a population-based sample of current smokers from the Department of Veterans Affairs (VA electronic medical record health factor dataset. The proactive care intervention combines: (1 proactive outreach and (2 offer of choice of smoking cessation services (telephone or face-to-face. Proactive outreach includes mailed invitation materials followed by an outreach call that encourages smokers to seek treatment with choice of services. Proactive care participants who choose telephone care receive VA telephone counseling and access to pharmacotherapy. Proactive care participants who choose face-to-face care are referred to their VA facility's smoking cessation clinic. Usual care participants have access to standard smoking cessation services from their VA facility (e.g., pharmacotherapy, smoking cessation clinic and from their state telephone quitline. Baseline data is collected from VA administrative databases and participant surveys. Outcomes from both groups are collected 12 months post-randomization from participant surveys and from VA

  20. Regression Discontinuity Designs Based on Population Thresholds

    DEFF Research Database (Denmark)

    Eggers, Andrew C.; Freier, Ronny; Grembi, Veronica;

    In many countries, important features of municipal government (such as the electoral system, mayors' salaries, and the number of councillors) depend on whether the municipality is above or below arbitrary population thresholds. Several papers have used a regression discontinuity design (RDD) to...

  1. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol

    Science.gov (United States)

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-01-01

    Introduction The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. Methods and analysis This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Ethics and dissemination Formal ethical approval is not required. Results The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. Review registration number CRD42014009685. PMID:27194315

  2. Nanotechnology-Based Cosmetics for Hair Care

    Directory of Open Access Journals (Sweden)

    Jamie Rosen

    2015-07-01

    Full Text Available Hair is a significant indicator of health and can have a major impact on an individual’s cosmetic appearance. Research within the cosmetics industry has revealed that when nanomaterials are engineered into hair care, they can enhance the benefits of active ingredients in order to improve hair cosmesis. Within the cosmetics arena, the unique size and intrinsic properties of nanoparticles can be tailored to target the hair follicle and shaft. This review aims to provide an overview of cosmetic nanocarriers that can be employed to improve the appearance of hair.

  3. Awareness and action for eliminating health care disparities in pain care: Web-based resources.

    Science.gov (United States)

    Fan, Ling; Thomas, Melissa; Deitrick, Ginna E; Polomano, Rosemary C

    2008-01-01

    Evidence shows that disparities in pain care exist, and this problem spans across all health care settings. Health care disparities are complex, and stem from the health system climate, limitations imposed by laws and regulations, and discriminatory practices that are deep seated in biases, stereotypes, and uncertainties surrounding communication and decision-making processes. A search of the Internet identified thousands of Web sites, documents, reports, and educational materials pertaining to health and pain disparities. Web sites for federal agencies, private foundations, and professional and consumer-oriented organizations provide useful information on disparities related to age, race, ethnicity, geography, socioeconomic status, and specific populations. The contents of 10 Web sites are examined for resources to assist health professionals and consumers in better understanding health and pain disparities and ways to overcome them in practice. PMID:19042858

  4. Group-based care: does it change problem behaviour?

    OpenAIRE

    van Weel, Chris

    1980-01-01

    As a result of disappointing experiences in managing problem behaviour presented by patients in general practice, a system of team or group-based care was developed at the Ommoord Health Centre in Rotterdam, the Netherlands.

  5. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Eva Helena; Kjaergaard, H; Schmiegelow, K;

    2012-01-01

    The study aims to describe the experiences of a hospital-based home care programme in the families of children with cancer. Fourteen parents, representing 10 families, were interviewed about their experiences of a hospital-based home care programme during a 4-month period in 2009 at a university...... decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. According to family members of children with cancer, hospital-based home care support enhanced their quality of life during the child's cancer trajectory...... hospital in Denmark. Five children participated in all or part of the interview. The interviews were transcribed verbatim and analysed using qualitative content analysis. The findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment, as it...

  6. Evidence-based care in Iran: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Morteza Ghojazadeh

    2014-08-01

    Conclusion: Weak knowledge, weak attitude, and time shortage .are among the most significant barriers of evidence-based care in Iran. These problems require more accurate planning and more favorable policies on the part of medical science authorities.

  7. Health care contact following a new incident neck or low back pain episode in the general population; the HUNT study

    OpenAIRE

    Woodhouse, Astrid; Pape, Kristine; Romundstad, Pål Richard; Vasseljen, Ottar

    2016-01-01

    Low back and neck pain are commonly reported in the general population and represent frequent causes for health care consultations. The main aim of this study was to describe the determinants of health care contact during a 1-year period in a general population with recent onset spinal pain. Methods: From 9056 participants in a general health survey in Norway we identified 219 persons reporting a recent onset (

  8. Health care contact following a new incident neck or low back pain episode in the general population; the HUNT study

    OpenAIRE

    Woodhouse, Astrid; Pape, Kristine; Pål R. Romundstad; Vasseljen, Ottar

    2016-01-01

    Background Low back and neck pain are commonly reported in the general population and represent frequent causes for health care consultations. The main aim of this study was to describe the determinants of health care contact during a 1-year period in a general population with recent onset spinal pain. Methods From 9056 participants in a general health survey in Norway we identified 219 persons reporting a recent onset (

  9. Analysis and strategies of pre-hospital emergency care for a community-based population in urban areas of Fuzhou city in 2010%福州市2010年中心城区社区人群的院前急救分析及策略

    Institute of Scientific and Technical Information of China (English)

    陈锋; 柯俊; 钱欣; 王晓萍; 陈敏; 陈兵; 何武兵; 林才经

    2013-01-01

    Objective To retrospectively analyze the epidemiological characteristics of pre-hospital emergency care for a community-based population in the urban areas of Fuzhou city and to propose strategies for improving pre-hospital emergency care and the prevention and treatment of common emergency conditions.Methods Data of different sorts of diseases,age,gender,monthly variation in number of cases,time required to response the emergency call and outcome of care were retrospectively analyzed in patients who received pre-hospital emergency care in the urban areas of Fuzhou city in 2010.Results A total of 2130 subjects had pre-hospital emergency care in the urban areas of Fuzhou city.Among them,trauma was the major cause,and was found mainly in youths and adults aged 31-40 years.Cardiovascular and cerebrovascular diseases were the second most common causes and were found mainly in patients aged >50 years (especially in those > 70) accounting for 50.57% in patients of that age cohort.More males than females received pre-hospital emergency care (1.57∶1).A total of 190 patients died during pre-hospital emergency care with trauma (n =69,36.32%),the leading cause of death.Cardiovascular and cerebrovascular diseases were the second leading cause of death and found mainly in patients aged > 50 (n =53) accounting for 81.54% of deaths in patients of this age cohort.Among patients with sudden death before admission,there was no one had cardiopulmonary resuscitation performed by witness before the emergency care given.Pre-hospital emergency care and pre-hospital deaths were more often occurred in the winter and spring seasons.The time required to response emergency call and the time elapsed to on-site emergency care were (10.0 ± 6.1) min and (11.8 ± 5.9) min,respectively,for patients receiving prehospital emergency care; and the time required to response the emergency call and the time elapsed to onsite emergency care were (11.2 ± 6.2) min and (29.0 ± 21.1) min

  10. Effect of interventions to improve health care services for ethnic minority populations

    Directory of Open Access Journals (Sweden)

    Louise Forsetlund

    2011-03-01

    available evidence for the other interventions was too low to draw reliable conclusions. We found no studies that only included young patients, but we suggest that interventions targeted at health personnel or health organisations may be applicable regardless of the age of the patient population. This review reveals that the evidence for interventions to improve health care for minorities is sparse and generally of low quality.

  11. MEDICO-SOCIAL CHARACTERISTICS OF POPULATION GROUPS SEEKING FOR DENTAL CARE IN POLYCLINICS SMOLENSK

    OpenAIRE

    Светлана Николаевна Дехнич; Вера Павловна Загороднова; Елена Александровна Торопина (Дмитриева); Ирина Михайловна Горбацевич (Романова)

    2013-01-01

    The research’s aim is to give health-social characteristic of contingents of the urban population, seeking for outpatient dental care, including a comparative estimation of stomatological index of life quality (SILQ) by doctors and patients.Novelty: Was installed the difference in the estimation of work sets SILQ by doctors and patients.Methodology of the research work. It was used an advantage «Card of studying the dental health» for holding the research, including the objective and subjecti...

  12. Principle-based concept analysis: Caring in nursing education

    Science.gov (United States)

    Salehian, Maryam; Heydari, Abbas; Aghebati, Nahid; Moonaghi, Hossein Karimi; Mazloom, Seyed Reza

    2016-01-01

    Introduction The aim of this principle-based concept analysis was to analyze caring in nursing education and to explain the current state of the science based on epistemologic, pragmatic, linguistic, and logical philosophical principles. Methods A principle-based concept analysis method was used to analyze the nursing literature. The dataset included 46 English language studies, published from 2005 to 2014, and they were retrieved through PROQUEST, MEDLINE, CINAHL, ERIC, SCOPUS, and SID scientific databases. The key dimensions of the data were collected using a validated data-extraction sheet. The four principles of assessing pragmatic utility were used to analyze the data. The data were managed by using MAXQDA 10 software. Results The scientific literature that deals with caring in nursing education relies on implied meaning. Caring in nursing education refers to student-teacher interactions that are formed on the basis of human values and focused on the unique needs of the students (epistemological principle). The result of student-teacher interactions is the development of both the students and the teachers. Numerous applications of the concept of caring in nursing education are available in the literature (pragmatic principle). There is consistency in the meaning of the concept, as a central value of the faculty-student interaction (linguistic principle). Compared with other related concepts, such as “caring pedagogy,” “value-based education,” and “teaching excellence,” caring in nursing education does not have exact and clear conceptual boundaries (logic principle). Conclusion Caring in nursing education was identified as an approach to teaching and learning, and it is formed based on teacher-student interactions and sustainable human values. A greater understanding of the conceptual basis of caring in nursing education will improve the caring behaviors of teachers, create teaching-learning environments, and help experts in curriculum development

  13. Population Distribution and Influencing Factors Based on ESDA

    Institute of Scientific and Technical Information of China (English)

    Lv Chen; Fan Jie; Sun Wei

    2012-01-01

    Based on the exploratory spatial data analysis (ESDA) technique and geographic information system (GIS) platform, with statistic data of counties in 2005, this paper confirms that there is a large population density gap between counties in 2005 because the Gini coefficient is 0.55. Population distribution does not change a lot during the past decades, and the southeast China is still much more densely populated than the northwest China. The global spa- tial autoeorrelation of population distribution is obvious because Moran's I scores 0.42 and local spatial autocorrelation is partly significant. Climate and elevation are still the main natural influ- encing factors. Meanwhile industrial structure and transportation significantly influence population distribution. Different combinations of natural factors have different effects on population distribution. For a long term, climate and terrain factor stability affect population distribution. But its influence will be weakened by progress of technology. Economic development is the main factor that changes population distribution for a short term.

  14. Technology-based interventions in health care.

    Science.gov (United States)

    Kane, J M

    2014-12-01

    There are several converging forces that create a particularly opportune time for technological solutions to enhance cost efficiency in healthcare. Health care costs are unsustainable, yet many patients do not have adequate access to state-of-the-art treatments or to ongoing disease management. Consumerism is an increasingly powerful force in healthcare and the emphasis on personalised medicine will help to define future research and clinical treatment strategies. At the same time, the phenomenal advances in internet utilisation and mobile device applications provide possibilities that have never before existed. We have reason to be very optimistic about these opportunities, but appropriate research will be required to develop scalable and sustainable methods as well as determine expected outcomes. PMID:25154596

  15. Epidemiology and resistance patterns in urinary pathogens from long-term care facilities and GP populations.

    LENUS (Irish Health Repository)

    Brabazon, E D

    2012-06-01

    Urinary tract infections (UTIs) are a major source of antimicrobial prescribing in the clinical setting and a potential reservoir for the emergence of resistant organisms. Although studies have been published on resistance rates for urinary pathogens from both hospital and general practitioner (GP) settings, there is little information from Long-Term Care Facilities (LTCFs) in Ireland. This study aimed to document the epidemiology and resistance rates in urinary isolates, in the LTCF and GP setting, from samples submitted to a typical microbiology laboratory. In 2010, there were 963 urinary isolates from LTCFs and 1,169 urinary isolates from GPs, identified from patients 65 years and over, with cytology suggestive of infection. E. coil was the most common causative organism identified. There were significantly higher levels of resistance to ampicillin, co-amoxiclav, ciprofloxacin, nitrofurantoin, trimethoprim, and piperacillin\\/tazobactam in the LTCF population compared to the GP population (e.g. for E. coli, 86%-v-69%; 30%-v- 21%; 58%-v-26%, 10%-v-3%, 68%-v-48%, 10%-v- 4% respectively). Isolates with resistance mechanisms to beta-lactams, were identified in both populations. Results presented in this paper demonstrate significant differences between resistance rates in LTCF and GP populations which suggest that there are implications for empiric antimicrobial prescribing for UTIs in the LTCF setting.

  16. Neonatal outcomes in obese mothers: a population-based analysis

    Directory of Open Access Journals (Sweden)

    Minsart Anne-Frederique

    2013-02-01

    Full Text Available Abstract Background If it is well known that obesity increases morbidity for both mother and fetus and is associated with a variety of adverse reproductive outcomes, then few studies have assessed the relation between obesity and neonatal outcomes. This is the aim of the present study after taking into account type of labor and delivery, as well as social, medical and hospital characteristics in a population-based analysis. Methods This study used 2009 data from the Belgian birth register data pertaining to the regions of Brussels and Wallonia and included 38,675 consecutive births. Odds ratio and 95% confidence intervals for admission to neonatal intensive care unit, Apgar score, and perinatal mortality were calculated by logistic regression analyses adjusting for medical, social and hospital characteristics using obesity as the primary independent variable. The impact of analyzing all delivery sites together was tested using mixed-effect analyses. Results The adjusted odds ratio for neonatal intensive care unit admission was higher for obese mothers by 38% compared to non-obese mothers (95% confidence interval (CI: 1.22-1.56, and by 45% (CI: 1.21-1.73 and 34% (CI: 1.10-1.63 after spontaneous and induced labour respectively. The adjusted odds ratio was 1.18 (CI: 0.86-1.63 after caesarean section. The adjusted odds ratio for 1 minute Apgar score inferior to 7 was higher for obese mothers by 31% compared to non-obese mothers (CI: 1.15-1.49 and by 26% (CI: 1.04-1.52 and 38% (CI: 1.12-1.69 after spontaneous and induced labour respectively. The adjusted odds ratio was 1.50 (CI: 0.96-2.36 after caesarean section. The adjusted odds ratio for perinatal mortality was 1.36 (CI: 0.75-2.45 for obese mothers compared to non-obese mothers. Conclusions Neonatal admission to intensive care and low Apgar scores were more likely to occur in infants from obese mothers, both after spontaneous and induced labor.

  17. [Health care based on cooperation between professionals and affected people].

    Science.gov (United States)

    Muriel-Fernández, Rafael; García-Domínguez, José-Miguel; Rodríguez-Gómez, Susana; Sagués-Amadó, Antonio

    2016-01-01

    The purpose of this article is to support the need for a change of care, based on cooperation between those who provide care and those who receive it. This article develops the decisive factors for change: the investee cooperation, the reference in case management, the concept of recovery and terminal care, the reduction of suffering and the value of change reflected in the 'win-win'. In each of them a questioning of the current situation, a methodological analysis and an input of tools and consequences of the change is made. To conclude, the article incorporates the 'itinerary of shared care' as a resource and one of the ways to bring these changes to the reality of day-to-day care. PMID:26553866

  18. A survey-based study of knowledge of Alzheimer’s disease among health care staff

    OpenAIRE

    Smyth Wendy; Fielding Elaine; Beattie Elizabeth; Gardner Anne; Moyle Wendy; Franklin Sara; Hines Sonia; MacAndrew Margaret

    2013-01-01

    Abstract Background Continued aging of the population is expected to be accompanied by substantial increases in the number of people with dementia and in the number of health care staff required to care for them. Adequate knowledge about dementia among health care staff is important to the quality of care delivered to this vulnerable population. The purpose of this study was to assess knowledge about dementia across a range of health care staff in a regional health service district. Methods K...

  19. The health care needs of the physically disabled patient in a home-based care environment: Implications for the training of ancillary health care workers

    Directory of Open Access Journals (Sweden)

    Monica Springe

    2010-03-01

    Full Text Available According to existing literature, ancillary health care workers (AHCWs often do not meet the health care needs of patients with physical disabilities (physically disabled patients in a homebased environment, because of inadequate training programmes. The purpose of this research study was to explore the health care needs of physically disabled patients in long-term, home-based care in the northern suburbs of Johannesburg and, based on results, to offer recommendations for the training of AHCWs. Qualitative, exploratory, descriptive and contextual means were employed in data collection and analysis. The population consisted of eight physically disabled participants who employed an AHCW to assist them with their long-term home care. Purposive sampling was used with subsequent snowballing to identify further participants for the study. Individual interviews were conducted, where participants had to answer the questions (1‘What are your health care needs?’ and(2 ‘How should these be met?’ Data saturation was ensured, after which Tesch’s method of data analysis was followed. Three categories of health care needs were identified (1 physical health care needs, (2 interpersonal relationship needs and (3 social needs, and 12 themes were derived from these categories. These categories of health care needs should be addressed in the training of AHCWs.From the themes, recommendations were described for the training of AHCWs on the health care needs of the home-based physically disabled patients. The AHCW should assist in the adaptation of the environment to the patient’s individual needs, and should use knowledge and critical thinking skills to ensure a patient-centred care setting.

    Opsomming

    Volgens die literatuur kan assistentgesondheidsorgwerkers (AGWs, as gevolg van ontoereikende opleiding, nie altyd aan die behoeftes van fisies gestremde pasiënte in 'n tuisopset voldoen nie.Die doel van hierdie navorsingstudie was

  20. The importance of job characteristics in determining medical care-seeking in the Dutch working population, a longitudinal survey study

    Directory of Open Access Journals (Sweden)

    Steenbeek Romy

    2012-08-01

    Full Text Available Abstract Background The working population is ageing, which will increase the number of workers with chronic health complaints, and, as a consequence, the number of workers seeking health care. It is very important to understand factors that influence medical care-seeking in order to control the costs. I will investigate which work characteristics independently attribute to later care-seeking in order to find possibilities to prevent unnecessary or inefficient care-seeking. Methods Data were collected in a longitudinal two-wave study (n = 2305 workers. The outcome measures were visits (yes/no and frequency to a general practitioner (GP, a physical therapist, a medical specialist and/or a mental health professional. Multivariate regression analyses were carried out separately for men and women for workers with health complaints. Results In the Dutch working population, personal, health, and work characteristics, but not sickness absence, were associated with later care-seeking. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. Women experience more health complaints and seek health care more often than men. For women, experiencing a work handicap (health complaints that impede work performance was the only work characteristic associated with more care-seeking (GP. For men, work characteristics that led to less care-seeking were social support by colleagues (GP frequency, high levels of decision latitude (GP frequency and high levels of social support by the supervisor (medical specialist. Other work characteristics led to more care-seeking: high levels of engagement (GP, full time work (GP frequency and experiencing a work handicap (physical therapist. Conclusions We can conclude that personal and health characteristics are most important when explaining medical care-seeking in the Dutch working population. Work characteristics independently attributed to

  1. Primary care practice-based care management for chronically ill patients (PraCMan: study protocol for a cluster randomized controlled trial [ISRCTN56104508

    Directory of Open Access Journals (Sweden)

    Baldauf Annika

    2011-06-01

    status and severity (PHQ-9, self-management capabilities and clinical parameters. Data collection will be performed at baseline, 12 and 24 months (12 months post-intervention. Discussion Practice-based care management for high risk individuals involving trained HCAs appears to be a promising approach to face the needs of an aging population with increasing care demands. Trial registration Current Controlled Trials ISRCTN56104508

  2. Nursing students' perceptions of instructor caring: an instrument based on Watson's Theory of Transpersonal Caring.

    Science.gov (United States)

    Wade, Gail Holland; Kasper, Natalie

    2006-05-01

    This study describes the development and testing of an instrument to measure nursing students' perceptions of instructor caring. Originally, 69 statements about instructors' caring behaviors, based on Watson's 10 carative factors, were created with Dr. Jean Watson. The Nursing Students' Perceptions of Instructor Caring (NSPIC) instrument uses a 6-point Likert scale for students' responses to the statements. After pretesting the instrument with a small group of nursing students, the NSPIC was tested with 133 baccalaureate nursing students. Based on item analysis, factor analysis, and student comments, the number of statements were reduced to 31. Psychometric testing revealed that the NSPIC is internally consistent (alpha = 0.97) and contains five subscales. Convergent validity was established between the NSPIC and a semantic differential scale of students' perceptions of instructor caring. Predictive validity was assessed with Coates Caring Efficacy Scale. Although the NSPIC is in its early stages of development, its psychometric properties indicate that it is a valid and reliable measure of nursing students' perceptions of instructor caring. PMID:16722498

  3. A population-based Habitable Zone perspective

    CERN Document Server

    Zsom, Andras

    2015-01-01

    What can we tell about exoplanet habitability if currently only the stellar properties, planet radius, and the incoming stellar flux are known? A planet is in the Habitable Zone (HZ) if it harbors liquid water on its surface. The HZ is traditionally conceived as a sharp region around stars because it is calculated for one planet with specific properties. Such an approach is limiting because the planets' atmospheric and geophysical properties, which influence the presence of liquid water on the surface, are currently unknown but expected to be diverse. A statistical HZ description is outlined which does not favor one planet type. Instead the stellar and planet properties are treated as random variables and a continuous range of planet scenarios are considered. Various probability density functions are assigned to each random variable, and a combination of Monte Carlo sampling and climate modeling is used to generate synthetic exoplanet populations with known surface climates. Then, the properties of the liquid...

  4. Community-based care coordination: practical applications for childhood asthma.

    Science.gov (United States)

    Findley, Sally; Rosenthal, Michael; Bryant-Stephens, Tyra; Damitz, Maureen; Lara, Marielena; Mansfield, Carol; Matiz, Adriana; Nourani, Vesall; Peretz, Patricia; Persky, Victoria W; Valencia, Gilberto Ramos; Uyeda, Kimberly; Viswanathan, Meera

    2011-11-01

    Care coordination programs have been used to address chronic illnesses, including childhood asthma, but primarily via practice-based models. An alternative approach employs community-based care coordinators who bridge gaps between families, health care providers, and support services. Merck Childhood Asthma Network, Inc. (MCAN) sites developed community-based care coordination approaches for childhood asthma. Using a community-based care coordination logic model, programs at each site are described along with program operational statistics. Four sites used three to four community health workers (CHWs) to provide care coordination, whereas one site used five school-based asthma nurses. This school-based site had the highest caseload (82.5 per year), but program duration was 3 months with 4 calls or visits. Other sites averaged fewer cases (35 to 61 per CHW per year), but families received more (7 to 17) calls or visits over a year. Retention was 43% to 93% at 6 months and 24% to 75% at 12 months. Pre-post cross-site data document changes in asthma management behaviors and outcomes. After program participation, 93% to 100% of caregivers had confidence in controlling their child's asthma, 85% to 92% had taken steps to reduce triggers, 69% to 100% had obtained an asthma action plan, and 46% to 100% of those with moderate to severe asthma reported appropriate use of controller medication. Emergency department visits for asthma decreased by 36% to 63%, and asthma-related hospitalizations declined by 26% to 78%. More than three fourths had fewer school absences. In conclusion, MCAN community-based care coordination programs improved management behaviors and decreased morbidity across all sites. PMID:22068360

  5. User Interface Requirements for Web-Based Integrated Care Pathways: Evidence from the Evaluation of an Online Care Pathway Investigation Tool.

    Science.gov (United States)

    Balatsoukas, Panos; Williams, Richard; Davies, Colin; Ainsworth, John; Buchan, Iain

    2015-11-01

    Integrated care pathways (ICPs) define a chronological sequence of steps, most commonly diagnostic or treatment, to be followed in providing care for patients. Care pathways help to ensure quality standards are met and to reduce variation in practice. Although research on the computerisation of ICP progresses, there is still little knowledge on what are the requirements for designing user-friendly and usable electronic care pathways, or how users (normally health care professionals) interact with interfaces that support design, analysis and visualisation of ICPs. The purpose of the study reported in this paper was to address this gap by evaluating the usability of a novel web-based tool called COCPIT (Collaborative Online Care Pathway Investigation Tool). COCPIT supports the design, analysis and visualisation of ICPs at the population level. In order to address the aim of this study, an evaluation methodology was designed based on heuristic evaluations and a mixed method usability test. The results showed that modular visualisation and direct manipulation of information related to the design and analysis of ICPs is useful for engaging and stimulating users. However, designers should pay attention to issues related to the visibility of the system status and the match between the system and the real world, especially in relation to the display of statistical information about care pathways and the editing of clinical information within a care pathway. The paper concludes with recommendations for interface design. PMID:26446014

  6. Nationwide and population-based prescription patterns in bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Vradi, Eleni; Andersen, Per Kragh

    2016-01-01

    OBJECTIVES: The aim of the present study was to describe prescription patterns and changes in these patterns over the last decade for patients diagnosed with bipolar disorder in mental healthcare, using population-based and nationwide data, and to relate the findings to recommendations from...... international guidelines. METHODS: A population-based, nationwide study was carried out. It included register-based longitudinal data on all patients with a first-ever contact with mental healthcare with a diagnosis of mania/bipolar disorder from the entire Danish population, and all prescription data for this...

  7. Terminal Versus Advanced Cancer: Do the General Population and Health Care Professionals Share a Common Language?

    OpenAIRE

    Kim, Sang Hyuck; Shin, Dong Wook; Kim, So Young; Yang, Hyung Kook; Nam, Eunjoo; Jho, Hyun Jung; Ahn, Eunmi; Cho, Be Long; Park, Keeho; Park, Jong-Hyock

    2015-01-01

    Purpose Many end-of-life care studies are based on the assumption that there is a shared definition of language concerning the stage of cancer. However, studies suggest that patients and their families often misperceive patients’ cancer stages and prognoses. Discrimination between advanced cancer and terminal cancer is important because the treatment goals are different. In this study, we evaluated the understanding of the definition of advanced versus terminal cancer of the general populatio...

  8. Population-based tobacco treatment: study design of a randomized controlled trial

    OpenAIRE

    Fu Steven S; van Ryn Michelle; Sherman Scott E; Burgess Diana J; Noorbaloochi Siamak; Clothier Barbara; Joseph Anne M

    2012-01-01

    Abstract Background Most smokers do not receive comprehensive, evidence-based treatment for tobacco use that includes intensive behavioral counseling along with pharmacotherapy. Further, the use of proven, tobacco treatments is lower among minorities than among Whites. The primary objectives of this study are to: (1) Assess the effect of a proactive care intervention (PRO) on population-level smoking abstinence rates (i.e., abstinence among all smokers including those who use and do not utili...

  9. Adolescent school absenteeism and service use in a population-based study

    OpenAIRE

    Askeland, Kristin Gärtner; Haugland, Siren; Stormark, Kjell Morten; Bøe, Tormod; Hysing, Mari

    2015-01-01

    Background School absenteeism is linked to a range of health concerns, health risk behaviors and school dropout. It is therefore important to evaluate the extent to which adolescents with absenteeism are in contact with health care and other services. The aim of the current study was to investigate service use of Norwegian adolescents with moderate and high absenteeism in comparison to students with lower rates of absence. Methods The study employs data from a population-based study from 2012...

  10. Children with hemodynamically significant congenital heart disease can be identified through population-based registers

    DEFF Research Database (Denmark)

    Bergman, Gunnar; Hærskjold, Ann; Stensballe, Lone Graff;

    2015-01-01

    BACKGROUND: Epidemiological research is facilitated in Sweden by a history of national health care registers, making large unselected national cohort studies possible. However, for complex clinical populations, such as children with congenital heart disease (CHD), register-based studies are...... challenged by registration limitations. For example, the diagnostic code system International Classification of Diseases, 10th version (ICD-10) does not indicate the clinical significance of abnormalities, therefore may be of limited use if used as the sole parameter in epidemiological research. Palivizumab...

  11. Benzodiazepine discontinuation among community-dwelling older people: a population-based cohort study

    OpenAIRE

    Bell, J Simon; Lavikainen, Piia; Korhonen, Mikko; Hartikainen, Sirpa

    2010-01-01

    Benzodiazepine discontinuation among community-dwelling older people: a population-based cohort study fax: +358-171-62424 (Bell, J. Simon) (Bell, J. Simon) Kuopio Research Centre of Geriatric Care, University of Eastern Finland - P.O. Box 1627 - 70211 - Kuopio - FINLAND (Bell, J. Simon) Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland - Kuopio - FINLAND (Bell, J. Simon) ...

  12. Newborn care practices and home-based postnatal newborn care programme – Mewat, Haryana, India, 2013

    Directory of Open Access Journals (Sweden)

    Latika Nath Sinha

    2014-09-01

    Full Text Available Background: In India, the Home Based Postnatal Newborn Care programme by Accredited Social Health Activists (ASHAs under the National Rural Health Mission was initiated in 2011 to reduce neonatal mortality rates (NMRs. ASHAs get cash incentives for six postnatal home visits for newborn care. We studied newborn care practices among mothers in Mewat, Haryana, having a high NMR and determined risk factors for unsafe practices and described the knowledge and skills of ASHAs during home visits. Methods: A cross-sectional survey was conducted among mothers who had delivered a child during the previous seven months using cluster sampling. We interviewed mothers and ASHAs in the selected subcentres using semi–structured questionnaires on the six safe newborn care practices, namely safe breastfeeding, keeping cord and eyes clean, wrapping baby, kangaroo care, delayed bathing and hand washing. Results: We interviewed 320 mothers, 61 ASHAs and observed 19 home visits. Overall, 60% of mothers adopted less than three safe practices. Wrapping newborns (96% and delayed bathing (64% were better adopted than cord care (49%, safe breastfeeding (48%, hand washing (30%, kangaroo care (20% and eye care (9%. Cultural beliefs and traditional birth attendants influenced the mother’s practices. The lack of supervision by auxiliary nurse midwives (ANM, delayed referral and transportation were the other challenges. Conclusion: Knowledge–practice gaps existed among mothers counselled by ASHAs. Poor utilization of reproductive and child health services decreased opportunities for ASHA–mother dialogue on safe practices. Recommendations included training ANMs, training TBAs as ASHAs, innovative communication strategies for ASHAs and improved referral system.

  13. Identifying elements of patient-centered care in underserved populations: a qualitative study of patient perspectives.

    Directory of Open Access Journals (Sweden)

    Sheela Raja

    Full Text Available Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes.

  14. Spironolactone use and renal toxicity: population based longitudinal analysis.

    OpenAIRE

    Wei, L; Struthers, A D; Fahey, T; Watson, A D; MacDonald, T. M.

    2010-01-01

    Objective To determine the safety of spironolactone prescribing in the setting of the UK National Health Service. Design Population based longitudinal analysis using a record linkage database. Setting Tayside, Scotland. Population All patients who received one or more dispensed prescriptions for spironolactone between 1994 and 2007. Main outcome measures Rates of prescribing for spironolactone, hospital admissions for hyperkalaemia, and hyperkalaemia and renal function without...

  15. Biosignal-based relaxation evaluation of head-care robot.

    Science.gov (United States)

    Ando, Takeshi; Takeda, Maki; Maruyama, Tomomi; Susuki, Yuto; Hirose, Toshinori; Fujioka, Soichiro; Mizuno, Osamu; Yamada, Kenji; Ohno, Yuko; Yukio, Honda

    2013-01-01

    Such popular head care procedures as shampooing and scalp massages provide physical and mental relaxation. However, they place a big burden such as chapped hands on beauticians and other practitioners. Based on our robot hand technology, we have been developing a head care robot. In this paper, we quantitatively evaluated its relaxation effect using the following biosignals: accelerated plethymography (SDNN, HF/TP, LF/HF), heart rate (HR), blood pressure, salivary amylase (sAA) and peripheral skin temperature (PST). We compared the relaxation of our developed head care robot with the head care provided by nurses. In our experimental result with 54 subjects, the activity of the autonomic nerve system changed before and after head care procedures performed by both a human nurse and our proposed robot. Especially, in the proposed robot, we confirmed significant differences with the procedure performed by our proposed head care robot in five indexes: HF/TP, LF/HF, HR, sAA, and PST. The activity of the sympathetic nerve system decreased, because the values of its indexes significantly decreased: LF/HF, HR, and sAA. On the other hand, the activity of the parasympathetic nerve system increased, because of the increase of its indexes value: HF/TP and PST. Our developed head care robot provided satisfactory relaxation in just five minutes of use. PMID:24111288

  16. Oncology Nursing Is Evidence-Based Care.

    Science.gov (United States)

    Kennedy Sheldon, Lisa; Brown, Carlton G

    2016-06-01

    This issue of the Clinical Journal of Oncology Nursing (CJON) will be the final time that you will see the Evidence-Based Practice (EBP) feature column. Why? Because we have seen oncology nursing evolve in the past 20 years and EBP is everywhere! We use it in our clinics and hospital units, incorporate it into decisions about symptom management, and use evidence to develop survivorship guidelines. We discuss EBP in journal clubs and use applications on mobile devices to find the best interventions for our patients. We have oncology nurses sitting on committees to develop guidelines based on the best evidence and expert opinion. We have come a long way and it is our belief that EBP is included in almost every article in CJON and, therefore, a need no longer exists for an individual column about EBP. 
. PMID:27206287

  17. Demand and Supply–Based Operating Modes—A Framework for Analyzing Health Care Service Production

    Science.gov (United States)

    Lillrank, Paul; Groop, P Johan; Malmström, Tomi J

    2010-01-01

    Context: The structure of organizations that provide services should reflect the possibilities of and constraints on production that arise from the market segments they serve. Organizational segmentation in health care is based on urgency and severity as well as disease type, bodily function, principal method, or population subgroup. The result is conflicting priorities, goals, and performance metrics. A managerial perspective is needed to identify activities with similar requirements for integration, coordination, and control. Methods: The arguments in this article apply new reasoning to the previous literature. Findings: The method used in this article to classify health care provision distinguishes different types of health problems that share generic constraints of production. Conclusions: The analysis leads to seven different demand-supply combinations, each with its own operational logic. These are labeled demand and supply–based operating modes (DSO modes), and constitute the managerial building blocks of health care organizations. The modes are Prevention, Emergency, One visit, Project, Elective, Cure, and Care. As analytical categories the DSO modes can be used to understand current problems. Several operating modes in one unit create managerial problems of conflicting priorities, goals, and performance metrics. The DSO modes are constructed as managerially homogeneous categories or care platforms responding to general types of demand, and supply constraints. The DSO modes bring methods of industrial management to bear on efforts to improve health care. PMID:21166870

  18. Factors affecting burden on caregivers of stroke survivors: Population-based study in Mumbai (India)

    OpenAIRE

    Bhattacharjee, Madhumita; Vairale, Jaee; Gawali, Kamal; Praful M Dalal

    2012-01-01

    Background: Caring for stroke patients leads to caregiver (CG) strain. The aims of this study are to identify factors related to increased CG burden in stroke survivors in a census-defined population and to assess the relationship between patient characteristics and CG stress. Materials and Methods: In a prospective population-based study, 223 first ever stroke (FES) were identified over a 1-year period. At 28 days, 127 (56.9%) were alive and 79 (35%) died, and 17 were lost to follow-up. One ...

  19. Is food allergy testing reliable in pediatric atopic dermatitis? A population-based study

    OpenAIRE

    Keck, Laura E.; Simpson, Eric L.; Berry, Trista M.; Hanifin, Jon M.

    2012-01-01

    We sought to assess the value and reliability of serologic testing for predicting clinical food allergy in a population-based cohort of infants with atopic dermatitis (AD). Infants 3–18 months of age, recruited from the general population, were followed quarterly for three years and carefully evaluated for evidence of immediate reactions to foods. Specific serum IgE levels for six foods were assayed at 3–5 years. Parents were interviewed at each visit regarding past and current immediate food...

  20. Home-based care, technology, and the maintenance of selves.

    Science.gov (United States)

    Parks, Jennifer A

    2015-06-01

    In this paper, I will argue that there is a deep connection between home-based care, technology, and the self. Providing the means for persons (especially older persons) to receive care at home is not merely a kindness that respects their preference to be at home: it is an important means of extending their selfhood and respecting the unique selves that they are. Home-based technologies like telemedicine and robotic care may certainly be useful tools in providing care for persons at home, but they also have important implications for sustaining selfhood in ways that are of value to individuals and those who care for them. I will argue, by appealing to Hilde Lindemann's notion of "holding" persons' identities in place, that technological interventions are not only useful tools for improving and sustaining health and good care at home, but that they may also help to extend our personal identities and relational capacities in ways that are practically and ethically good. Because of these important goods, I will claim that there is a prima facie moral duty to do this "holding" work and that it is best done by family members and loved ones who are well suited to the job because of their history and relationship with the individual that needs to be "held" in place. PMID:25787720

  1. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Eva Helena; Kjaergaard, Hanne; Johansen, Christoffer;

    2013-01-01

    BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety, and...... home-care group. No significant difference was found in the Family Impact Module. CONCLUSION: This study indicates that HBHC is a feasible alternative to hospital care for children with cancer, and is greatly preferred by parents. Specific aspects of children's HRQOL may be improved with HBHC and the...... cost. A controlled trial was conducted to assess children's health-related quality of life (HRQOL) using the parent-reported and self-reported PedsQL Generic Core Scale and PedsQL Cancer Module, and the psychosocial impact on the family by PedsQL Family Impact Module comprising a subsample of 28...

  2. The logic of tax-based financing for health care.

    Science.gov (United States)

    Bodenheimer, T; Sullivan, K

    1997-01-01

    Employment-based health insurance faces serious problems. For the first time, the number of Americans covered by such health insurance is falling. Employers strongly oppose the employer mandate approach to extending health insurance. Employment-based financing is regressive and complex. Serious debate is needed on an alternative solution to financing health care for all Americans. Taxation represents a clear alternative to employment-based health care financing. The major criterion for choosing a tax is equity, with simplicity a second criterion. An earmarked, progressive individual income tax is a fair and potentially simple tax with which to finance health care. The political feasibility of such a tax is greater than that of employer mandate legislation. PMID:9285274

  3. Model-based decision support in diabetes care.

    Science.gov (United States)

    Salzsieder, E; Vogt, L; Kohnert, K-D; Heinke, P; Augstein, P

    2011-05-01

    The model-based Karlsburg Diabetes Management System (KADIS®) has been developed as a patient-focused decision-support tool to provide evidence-based advice for physicians in their daily efforts to optimize metabolic control in diabetes care of their patients on an individualized basis. For this purpose, KADIS® was established in terms of a personalized, interactive in silico simulation procedure, implemented into a problem-related diabetes health care network and evaluated under different conditions by conducting open-label mono- and polycentric trials, and a case-control study, and last but not least, by application in routine diabetes outpatient care. The trial outcomes clearly show that the recommendations provided to the physicians by KADIS® lead to significant improvement of metabolic control. This model-based decision-support system provides an excellent tool to effectively guide physicians in personalized decision-making to achieve optimal metabolic control for their patients. PMID:20621384

  4. CLINICAL AND HISTOPATHOLOGICAL ANALYSIS OF CONJUNCTIVAL TUMOURS AT A TERTIARY CARE CENTRE IN INDIAN POPULATION

    Directory of Open Access Journals (Sweden)

    Hemalatha

    2014-10-01

    Full Text Available The broad spectrum of conjunctival tumors ranges from non-neoplastic benign tumors to very aggressive malignancies, such as melanoma or Kaposi’s sarcoma which threat visual function and life of the patient. There is a relative paucity of large published studies documenting conjunctival lesions. In the Indian population, reported 46% of epithelial origin (benign, premalignant, and malignant neoplasm, degenerative lesions (14%, chronic non-specific inflammation (12%, melanocytic tumors (12%, lymphoid tumors (6%. Squamous cell carcinoma (20%, miscellaneous (22%, pterygium (10%, squamous papilloma (8%, and OSSN (8%. A review of a large series of conjunctival biopsy specimens from an adult US population documented the following distribution: inflammatory/degenerative lesions (12%, benign epithelial (2%, pigmented (53%, premalignant and malignant epithelial (11%, lymphoid (8%, miscellaneous (12% and congenital lesions (2%. AIM: To study the clinical and histopathological features of conjunctival tumors at a tertiary care hospital in south Indian population. MATERIAL AND METHODS: In our study, 134 patients with conjunctival tumors followed between January 2009 and September 2010 were retrospectively reviewed. Clinical data were collected from medical records and analyzed. Of the 134 patients with conjunctival tumor, 80 were male (59.70% and 54 were female (40.29%. The mean age of the134 patients was 35 years (range1to 95 years. In our series, the most common diagnosis of 134 lesions were, nevus 18.66% (n=25, carcinoma in situ 10.44% (n=14, dysplasia 5.97%(n=8, squamous cell carcinoma(SCC 5.22% (n=7, haemangioma 3.73% (n=5, squamous papilloma 3.73%(n=5, limbal dermoid 2.98%(n=4, malignant melanoma 1.49% (n=2 and lymphoma 0.74 %(n=1. CONCLUSION: Nevus was found to be the most common conjunctival benign tumor. Even though squamous cell carcinoma is a rare conjunctival malignant tumor, it may be encountered in younger male population.

  5. Restless Legs Syndrome in an Appalachian Primary Care Population: Prevalence, Demographic and Lifestyle Correlates, and Burden

    Science.gov (United States)

    Innes, Kim E.; Flack, Kathryn L.; Selfe, Terry Kit; Kandati, Sahiti; Agarwal, Parul

    2013-01-01

    Background: Restless legs syndrome (RLS) is a common and distressing sensorimotor disorder of unknown etiology. While the epidemiology of RLS has been examined in several North American and European studies, research on RLS and RLS burden in poor, rural populations, including those residing in Appalachia, remains sparse. In this study, we investigated RLS prevalence in an Appalachian primary care population and examined the association of RLS to demographic factors, lifestyle characteristics, sleep quality, and mood disorders. Methods: Participants of this anonymous survey study were community-dwelling adults aged ≥ 18 years visiting one of 4 West Virginia primary care clinics. Data gathered included detailed information on sleep patterns, demographic characteristics, lifestyle factors, and health/medical history; the survey also included questions specific to RLS diagnosis and severity. Response rates were excellent, with 68% of eligible adults contacted returning completed surveys (N = 1,424/2,087). Pregnant women (N = 65) and those with missing data on key variables (N = 142) were excluded from the analyses. Results: Of the 1,217 participants included in the final analytic sample, 19.6% (18.2% with symptoms at least once/month) met the 4 IRLSSG diagnostic criteria in the absence of positional discomfort or leg cramps; 14.5% reported RLS symptoms at least once/week and 10.1% indicated symptoms ≥ 3×/week. Excluding respondents with diabetes, kidney disease, or anemia reduced these rates only slightly. Those with RLS were more likely to be older, female, lower income, unemployed, disabled, non-Hispanic white, and less likely to be college educated than those without RLS. Mood and sleep impairment were significantly elevated in those with RLS; after adjustment for demographic and lifestyle characteristics, health history, and other factors, those with RLS remained significantly more likely to indicate a history of depression (adjusted odds ratio [OR] = 1.9; 95

  6. Design of a population-based study of visual impairment in India : The Andhra Pradesh eye disease study

    OpenAIRE

    Dandona Rakhi; Dandona Lalit; Naduvilath Thomas; Nanda Ashok; McCarty Catherine

    1997-01-01

    Reliable population-based epidemiologic data regarding vision and ocular morbidity, as well as those about the perceptions of people regarding visual impairment and eye care, are lacking for the most part in the developing world including India. These data are the basis on which effective eye care services can be developed. To meet this need we designed the Andhra Pradesh Eye Disease Study, a population-based epidemiology study of 10,000 people in the Indian state of Andhra Pradesh. The desig...

  7. Vitamin status and cognitive function in a long-term care population

    Directory of Open Access Journals (Sweden)

    Meckling Kelly A

    2005-12-01

    Full Text Available Abstract Background Ageing can be associated with poor dietary intake, reduced nutrient absorption, and less efficient utilization of nutrients. Loss of memory and related cognitive function are also common among older persons. This study aimed to measure the prevalence of inadequate vitamin status among long-term care patients and determine if an association exists between vitamin status and each of three variables; cognitive function, vitamin supplementation, and medications which alter gastric acid levels. Methods Seventy-five patients in a long-term care hospital in Guelph, Ontario were recruited to a cross-sectional study. 47 were female and the mean age was 80.7 (+/-11.5 years, ranging from 48 to 100 years. Blood was used to measure levels of vitamins B12 (cobalamin, B6 (pyridoxal-5'-phosphate/PLP, erythrocyte folate, vitamin B3 (niacin and homocysteine (Hcy. The Standardized Mini-Mental State Examination (SMMSE was administered to measure cognitive function. A list of medications and vitamin supplementation for each patient was provided by the pharmacy. Results The prevalence of low vitamin (B12, B6, erythrocyte folate, niacin or high metabolite (homocysteine levels among 75 patients were as follows: B12 13.3 μmol/L in 31/75 (41.3%. There was no significant difference among residents grouped into marked (n = 44, mild (n = 14, or normal (n = 9 cognitive function when evaluating the effect of vitamin status. There were no significant differences in mean B12 and homocysteine levels between users and non-users of drug therapy (Losec, Zantac, or Axid. Compared to vitamin supplement non-users, supplemented residents had significantly higher mean B12 (p Conclusion Given the prevalence data on vitamin status in this sample population, the possible benefits of vitamin supplementation should be considered in clinical intervention studies using these populations of elderly.

  8. Morphinofobia: the situation among the general population and health care professionals in North-Eastern Portugal

    Directory of Open Access Journals (Sweden)

    Rapin Charles-Henri

    2010-06-01

    Full Text Available Abstract Background Morphinofobia among the general population (GP and among health care professionals (HP is not without danger for the patients: it may lead to the inappropriate management of debilitating pain. The aim of our study was to explore among GP and HP the representation and attitudes concerning the use of morphine in health care. Methods A cross-sectional study was done among 412 HP (physicians and nurses of the 4 hospitals and 10 community health centers of Beira Interior (Portugaland among 193 persons of the GP randomly selected in public places. Opinions were collected through a translated self-administered questionnaire. Results A significant difference of opinion exists among GP and HP about the use of morphine. The word morphine first suggests drug to GP (36,2% and analgesia to HP (32,9%.. The reasons for not using morphine most frequently cited are: for GP morphine use means advanced disease (56%, risk of addiction (50%, legal requirements (49,7%; for HP it means legal risks (56,3% and adverse side effects of morphine such as somnolence - sedation (30,5% The socio-demographic situation was correlated with the opinions about the use of morphine. Conclusions False beliefs about the use of morphine exist among the studied groups. There seems to be a need for developing information campaigns on pain management and the use of morphine targeting. Better training and more information of HP might also be needed.

  9. Sexually transmitted infections treatment and care available to high risk populations in Pakistan.

    Science.gov (United States)

    Rahimtoola, Minal; Hussain, Hamidah; Khowaja, Saira N; Khan, Aamir J

    2008-01-01

    Limited literature exists on the quality and availability of treatment and care of sexually transmitted infections (STIs) in Pakistan. This article aims to document existing services for the care and treatment of STIs available in Pakistan's public and private sectors to high risk groups (HRG), particularly the transgendered population. We conducted a cross-sectional survey to document STI services in Lahore, Karachi, Rawalpindi, Peshawar, and Quetta. Seventy-three interviews were administered with health service providers at the 3 largest public sector hospitals in each city, as well as with general physicians and traditional healers in the private sector. Twenty-five nongovernmental organizations (NGO) providing STI services were also interviewed. Fewer than 45% of private and public sector general practitioners had been trained in STI treatment after the completion of their medical curriculum, and none of the traditional healers had received any formal training or information on STIs. The World Health Organization (WHO) syndromic management guidelines were followed for STI management by 29% of public and private sector doctors and 5% of traditional healers. STI drugs were available at no cost at 44% of NGOs and at some public sector hospitals. Our findings show that although providers do treat HRGs for STIs, there are significant limitations in their ability to provide these services. These deterrents include, but are not limited to, a lack of STI training of service providers, privacy and adherence to recommended WHO syndromic management guidelines, and costly diagnostic and consultation fees. PMID:19856743

  10. MEDICO-SOCIAL CHARACTERISTICS OF POPULATION GROUPS SEEKING FOR DENTAL CARE IN POLYCLINICS SMOLENSK

    Directory of Open Access Journals (Sweden)

    Светлана Николаевна Дехнич

    2013-09-01

    Full Text Available The research’s aim is to give health-social characteristic of contingents of the urban population, seeking for outpatient dental care, including a comparative estimation of stomatological index of life quality (SILQ by doctors and patients.Novelty: Was installed the difference in the estimation of work sets SILQ by doctors and patients.Methodology of the research work. It was used an advantage «Card of studying the dental health» for holding the research, including the objective and subjective expert estimations of the dental patient’s status by doctors. This information was comparing with the subjective estimation of SILQ by patients. The sample volume was about 400 people out of number of people, seeking for outpatient dental care in state budget dental clinics during 2011-2012 years.Results. Was installed mostly very high level of prevalence of caries, the destruction of fabrics of parodont reaches 100 % with the age. The stomatological index of life quality among the patients, seeking for outpatient care is low. One of the reasons- a low population’s sanitary culture. A big part of patients seek in case of acute pain(40%. Out of three components of SILQ the criteria of social welfare got rather high estimation. The lowest estimation was given to moral psychological well-being criteria. In this case the moral psychological well-being criteria was given a higher estimation by doctors then by patients (in 1,8. The criteria of the physical and social well-being is lower compared with the patient’s (in 1,8 and 1,2 times respectively.Practical implication: Indicators SILQ may be the basis for planning activities of stomatological polyclinics, including the preventive dentists’ work.DOI: http://dx.doi.org/10.12731/2218-7405-2013-6-46

  11. Population-based programs for increasing colorectal cancer screening in the United States.

    Science.gov (United States)

    Verma, Manisha; Sarfaty, Mona; Brooks, Durado; Wender, Richard C

    2015-01-01

    Answer questions and earn CME/CNE Screening to detect polyps or cancer at an early stage has been shown to produce better outcomes in colorectal cancer (CRC). Programs with a population-based approach can reach a large majority of the eligible population and can offer cost-effective interventions with the potential benefit of maximizing early cancer detection and prevention using a complete follow-up plan. The purpose of this review was to summarize the key features of population-based programs to increase CRC screening in the United States. A search was conducted in the SCOPUS, OvidSP, and PubMed databases. The authors selected published reports of population-based programs that met at least 5 of the 6 International Agency for Research on Cancer (IARC) criteria for cancer prevention and were known to the National Colorectal Cancer Roundtable. Interventions at the level of individual practices were not included in this review. IARC cancer prevention criteria served as a framework to assess the effective processes and elements of a population-based program. Eight programs were included in this review. Half of the programs met all IARC criteria, and all programs led to improvements in screening rates. The rate of colonoscopy after a positive stool test was heterogeneous among programs. Different population-based strategies were used to promote these screening programs, including system-based, provider-based, patient-based, and media-based strategies. Treatment of identified cancer cases was not included explicitly in 4 programs but was offered through routine medical care. Evidence-based methods for promoting CRC screening at a population level can guide the development of future approaches in health care prevention. The key elements of a successful population-based approach include adherence to the 6 IARC criteria and 4 additional elements (an identified external funding source, a structured policy for positive fecal occult blood test results and confirmed cancer

  12. Recurrent Wheezing in Infants: A Population-Based Study.

    Science.gov (United States)

    Belhassen, Manon; De Blic, Jacques; Laforest, Laurent; Laigle, Valérie; Chanut-Vogel, Céline; Lamezec, Liliane; Brouard, Jacques; Fauroux, Brigitte; de Pouvourville, Gérard; Ginoux, Marine; Van Ganse, Eric

    2016-04-01

    Recurrent wheezing (RW) has a significant impact on infants, caregivers, and society, but morbidity and related medical resource utilization (MRU) have not been thoroughly explored. The burden of RW needs to be documented with population-based data. The objective was to assess the characteristics, medical management, and MRU of RW infants identified from national claims data.Infants aged from 6 to 24 months, receiving ≥2 dispensations of respiratory drugs within 3 months, and presenting a marker of poor control (index date), were selected. During the 6 months after index date, MRU was described in the cohort and among 3 subgroups with more severe RW, defined as ≥4 dispensations of respiratory drugs, ≥3 dispensations of oral corticosteroids (OCS), or ≥1 hospitalization for respiratory symptoms.A total of 115,489 infants had RW, corresponding to 8.2% of subjects in this age group. During follow-up, 68.7% of infants received inhaled corticosteroids, but only 1.8 U (unit) were dispensed over 6 months, suggesting discontinuous use. Control was mostly inadequate: 61.7% of subjects received OCS, 80.2% antibiotics, and 71.2% short-acting beta-agonists, and medical/paramedical visits were numerous, particularly for physiotherapy. Severe RW concerned 39.0% of the cohort; 32.8% and 11.7% of infants had repeated use of respiratory drugs and OCS, respectively, and 5.5% were hospitalized for respiratory symptoms.In this real-life nation-wide study, RW was common and infants had poor control and high MRU. Interventions are needed to support adequate use of controller therapy, and to improve medical care. PMID:27082618

  13. [THE ORGANIZATION OF REHABILITATION CARE OF POPULATION USING INNOVATIVE MEDICAL ORGANIZATIONAL TECHNOLOGIES AND PRINCIPLES OF PUBLIC PRIVATE PARTNERSHIP].

    Science.gov (United States)

    Totskaia, E G; Sheliakina, O W; Sadovoii, M A; Netchaev, V S

    2015-01-01

    The article considers actual problems of actual stage of development of health care related to using innovative approaches to organization and management of rehabilitation care ofpopulation. The rehabilitation is most important direction of medical sector supporting complex of services in closed cycle of rendering medical care to population and significant social economic effects. The capacity and extreme unprofitability of rehabilitation services determine necessity of searching alternative forms of organization of this type of care and financing including mechanisms of public-private partnership. The experience is presented related to involvement of resources of non-public medical organizations for implementing public commitments on rendering qualitative rehabilitation services to population using innovative medical organizational technologies. PMID:26987174

  14. Medical Researchers' Ancillary Care Obligations: The Relationship-Based Approach.

    Science.gov (United States)

    Olson, Nate W

    2016-06-01

    In this article, I provide a new account of the basis of medical researchers' ancillary care obligations. Ancillary care in medical research, or medical care that research participants need but that is not required for the validity or safety of a study or to redress research injuries, is a topic that has drawn increasing attention in research ethics over the last ten years. My view, the relationship-based approach, improves on the main existing theory, Richardson and Belsky's 'partial-entrustment model', by avoiding its problematic restriction on the scope of health needs for which researchers could be obligated to provide ancillary care. Instead, it grounds ancillary care obligations in a wide range of morally relevant features of the researcher-participant relationship, including the level of engagement between researchers and participants, and weighs these factors against each other. I argue that the level of engagement, that is, the duration and intensity of interactions, between researchers and participants matters for ancillary care because of its connection to the meaningfulness of a relationship, and I suggest that other morally relevant features can be grounded in researchers' role obligations. PMID:26424512

  15. Improving Blood Pressure Control in a Large Multiethnic California Population Through Changes in Health Care Delivery, 2004–2012

    OpenAIRE

    Shaw, Kate M.; Handler, Joel; Wall, Hilary K.; Kanter, Michael H

    2014-01-01

    The Kaiser Permanente Southern California (Kaiser) health care system succeeded in improving hypertension control in a multiethnic population by adopting a series of changes in health care delivery. Data from the Healthcare Effectiveness Data and Information Set (HEDIS) was used to assess blood pressure control from 2004 through 2012. Hypertension control increased overall from 54% to 86% during that period, and 80% or more in every subgroup, regardless of race/ethnicity, preferred language, ...

  16. Spectacle Coverage and Spectacles Use among Elderly Population in Residential Care in the South Indian State of Andhra Pradesh

    OpenAIRE

    Srinivas Marmamula; Mei Ying Boon; L. V. Chandra Sekhar Ravuri; Khanna, Rohit C

    2013-01-01

    Background. There is limited research conducted on uncorrected refractive errors, presbyopia, and spectacles use among the elderly population in residential care in developing countries such as India. We conducted a cross-sectional study among elderly in residential care to assess the spectacle coverage and spectacles usage in the south Indian state of Andhra Pradesh. Methods. All 524 residents in the 26 “homes for aged” institutions in the district were enumerated. Eye examination was perfor...

  17. [Priority health care finances and joint control by the population and the state (Pikine - Senegal) 1975-1981].

    Science.gov (United States)

    Jancloes, M; Seck, B; Vandevelden, L; Ndiaye, B

    1982-01-01

    Where the government cannot meet wide-ranging health needs of the population and when people are given the opportunity to manage their own affairs and to be involved in decision-making, they can become very efficient. This was demonstrated by an experiment in a senegalese town (450 000 inh.) between 1975 and 1981. A strategy for priority health care with the active participation of the local community was developed to provide a network of acceptable and accessible health services. This was with government support. --The government provides the basic structure of its health services to which the community contributes. It provides the medical staff, technical guidance and logistic support and helps the community volunteers to develop sound accounting procedures. --The community contributes financial and human resources to improve the coverage of the health units. Based on a self-financing system controlled by a health committee per each health unit, communities are in decision making concerning the utilization and management of the community's resources. Procedures to control the community's financial contribution are especially well detailed in the paper. In view of this successful experiment, the minister of public health with the agreement of the government, has recommended that community participation in financing health care services be extended to all regions of the country. PMID:7154912

  18. Adapting evidence-based, cognitive-behavioral interventions for anxiety for use with adults in integrated primary care settings.

    Science.gov (United States)

    Shepardson, Robyn L; Funderburk, Jennifer S; Weisberg, Risa B

    2016-06-01

    Evidence-based treatments for adult patients with anxiety are greatly needed within primary care settings. Psychotherapy protocols, including those for cognitive-behavioral therapy (CBT), are often disorder-specific and were developed for specialty mental health settings, rendering them infeasible in primary care. Behavioral health consultants (BHCs) integrated into primary care settings are uniquely positioned to provide anxiety treatment. However, due to the dearth of empirically supported brief treatments for anxiety, BHCs are tasked with adapting existing treatments for use in primary care, which is quite challenging due to the abbreviated format and population-based approach to care. CBT protocols are highly effective in the treatment of anxiety and fit well with the self-management emphasis of integrated primary care. We review the rationale and procedure for 6 evidence-based CBT intervention techniques (psycho-education, mindfulness and acceptance-based behavioral techniques, relaxation training, exposure, cognitive restructuring, and behavioral activation) that can be adapted for use in the brief format typical of integrated primary care. We offer tips based on our clinical experience, highlight resources (e.g., handouts, websites, apps), and discuss 2 case examples to aid BHCs in their everyday practice. Our goal is to provide BHCs with practical knowledge that will facilitate the use of evidence-based interventions to improve the treatment of anxiety in primary care settings. (PsycINFO Database Record PMID:27064434

  19. Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation

    Directory of Open Access Journals (Sweden)

    Van Herp Michel

    2009-10-01

    Full Text Available Abstract Background In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. Methods An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. Results Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. Conclusion The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty.

  20. Managing incidental findings in population based biobank research

    Directory of Open Access Journals (Sweden)

    Berge Solberg

    2012-04-01

    Full Text Available With the introduction of whole genome sequencing in medical research, the debate on how to handle incidental findings is becoming omnipresent. Much of the literature on the topic so far, seems to defend the researcher’s duty to inform, the participant’s right to know combined with a thorough informed consent in order to protect and secure high ethical standards in research. In this paper, we argue that this ethical response to incidental findings and whole genome sequencing is appropriate in a clinical context, in what we call therapeutic research. However, we further argue, that it is rather inappropriate in basic research, like the research going on in public health oriented population based biobanks. Our argument is based on two premises: First, in population based biobank research the duties and rights involved are radically different from a clinical based setting. Second, to introduce the ethical framework from the clinical setting into population based basic research, is not only wrong, but it may lead to unethical consequences. A Norwegian population based biobank and the research-ethical debate in Norway on the regulation of whole genome sequencing is used as an illustrative case to demonstrate the pitfalls when approaching the debate on incidental findings in population based biobank research.

  1. Cloud based emergency health care information service in India.

    Science.gov (United States)

    Karthikeyan, N; Sukanesh, R

    2012-12-01

    A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the

  2. [An intervention to promote team-based care: two focus groups--what promotes team-based care?].

    Science.gov (United States)

    Sano, Itsuki

    2014-01-01

    There has recently been interest in new models of care delivery that promote a team-based approach in psychiatric care. The aim of the study was to clarify the way in which to promote a team-based approach in psychiatric hospitals. Two focus groups were held to collect data from psychiatric hospital nurses who underwent the intervention to improve collaborative behavior. The results indicated the effectiveness of the program to encourage different professionals to meet and interact in learning to improve collaborative practice. We commented on the importance of conflict management and system change. The results are discussed in relation to previous research and practical implications. PMID:24864561

  3. Reality of evidence-based practice in palliative care.

    Science.gov (United States)

    Visser, Claire; Hadley, Gina; Wee, Bee

    2015-09-01

    There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by 'gold standard' randomised controlled trials (RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves considerations of the patient's physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This review uses examples of the management of cancer-related fatigue and death rattle (noisy breathing) to demonstrate the current state of EBM in palliative care. The future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a 'mixed methods approach' are likely to pose the correct clinical questions and derive evidence-based yet clinically relevant outcomes. PMID:26487964

  4. Reality of evidence-based practice in palliative care

    Institute of Scientific and Technical Information of China (English)

    Claire Visser; Gina Hadley; Bee Wee

    2015-01-01

    hTere has been a paradigm shitf in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically signiifcant beneifts may be marginal and may not be related to clinical meaningfulness. hTe typical treatmentvs. placebo comparison necessitated by ‘gold standard’ randomised controlled trials (RCTs) is not necessarily applicable. hTe complex multimorbidity of end of life care involves considerations of the patient’s physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be diffcult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. hTis review uses examples of the management of cancer-related fatigue and death rattle (noisy breathing) to demonstrate the current state of EBM in palliative care. hTe future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a ‘mixed methods approach’ are likely to pose the correct clinical questions and derive evidence-based yet clinically relevant outcomes.

  5. ATTEND: Toward a Mindfulness-Based Bereavement Care Model

    Science.gov (United States)

    Cacciatore, Joanne; Flint, Melissa

    2012-01-01

    Few, if any, mindfulness-based bereavement care models exist. The ATTEND (attunement, trust, touch, egalitarianism, nuance, and death education) model is an interdisciplinary paradigm for providers, including physicians, social workers, therapists, nursing staff, and others. Using a case example to enhance the breadth and depth of understanding,…

  6. Evidence Based Order Sets as a Nursing Care Planning System

    OpenAIRE

    LaCrosse, Lisa M.; Heermann, Judith; Azevedo, Karen; Sorrentino, Catherine; Straub, Dawn; O'Dowd, Gloria

    2002-01-01

    The process for developing the nursing care planning (NCP) function for integration into a clinical information system (CIS) will be described. This NCP system uses evidence based order sets or interventions that are specific to a problem with associated patient focused goals or outcomes. The problem, order set, goal framework will eventually be used by all disciplines in the patient focused record.

  7. Evaluating Comparative Effectiveness Research Priorities for Care Coordination in Chronic Obstructive Pulmonary Disease: A Community-Based eDelphi Study

    OpenAIRE

    Stellefson, Michael; Alber, Julia; Paige, Samantha; Castro, Daniela; Singh, Briana

    2015-01-01

    Background Despite research supporting the use of care coordination in chronic obstructive pulmonary disease (COPD), there is relatively little known about the comparative effectiveness of different strategies used to organize care for patients. To investigate the most important COPD care coordination strategies, community-based stakeholder input is needed, especially from medically underserved populations. Web-based platforms are electronic tools now being used to bring together individuals ...

  8. Leveraging The Affordable Care Act To Enroll Justice-Involved Populations In Medicaid: State And Local Efforts

    OpenAIRE

    Bandara, Sachini N.; Huskamp, Haiden A.; Riedel, Lauren E.; McGinty, Emma E.; Webster, Daniel; Toone, Robert E.; Barry, Colleen L

    2015-01-01

    The Affordable Care Act provides an unprecedented opportunity to enroll criminal justice–involved populations in health insurance, particularly Medicaid. As a result, many state and county corrections departments have launched programs that incorporate Medicaid enrollment in discharge planning. Our study characterizes the national landscape of programs enrolling criminal justice–involved populations in Medicaid as of January 2015. We provide an overview of sixty-four programs operating in jai...

  9. LGBT Demographics: Comparisons among population-based surveys

    OpenAIRE

    Gates, Gary J.

    2014-01-01

    This report uses four large, national, population-based surveys to consider the ways in which LGBT populations are demographically similar to or distinct from their non-LGBT counterparts in the United States. Comparisons of demographic characteristics are made among the surveys and, when possible, among sexual orientation identities to consider differences between those who identify as lesbian or gay and those who identify as bisexual (none of the surveys allow for separate identification of ...

  10. Choosing quality of care measures based on the expected impact of improved care on health.

    OpenAIRE

    Siu, A L; McGlynn, E A; Morgenstern, H; Beers, M H; Carlisle, D M; Keeler, E B; Beloff, J.; Curtin, K; Leaning, J; Perry, B C

    1992-01-01

    Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy o...

  11. Home-based Self-care: Understanding and Designing Pervasive Technology to Support Care Management Work at Home

    DEFF Research Database (Denmark)

    Verdezoto, Nervo

    -clinical settings. As such, sustaining daily care activities in the home (or other non-clinical settings) is challenging as they are becoming more and more intertwined into people’s everyday life. Thus, this dissertation is concerned about one major challenge in Pervasive Healthcare: the design of technology that......Demographic changes are challenging healthcare systems as well as societies around the world due to an increasing aging population and rapid propagation of chronic diseases. To deal with the consequences of these changes, more and more long-term care services are being implemented including home...... self-care management work at home. People need to know which care activities to perform, when to perform them, how to proceed and why these are important. While at home, an active lifestyle and comorbidity not only challenge self-care activities but also the use of self-care technologies in non...

  12. Cancer registries can provide evidence-based data to improve quality of care and prevent cancer deaths

    OpenAIRE

    Bouchardy Magnin, Christine; Rapiti Aylward, Elisabetta; Benhamou, Simone

    2014-01-01

    Today, many countries are increasing their efforts to ensure that all cancer patients receive the best possible care. Population-based cancer registries have adapted their registration to collect additional clinical variables to provide clinicians with unbiased population data on cancer treatment and survival. Taking several examples of epidemiological cancer research performed at the Geneva Cancer Registry, we aim to illustrate how cancer registries oversee the treatment and outcomes of canc...

  13. A population perspective to evidence based medicine: "evidence for population health"

    OpenAIRE

    Heller, R.; Page, J.

    2002-01-01

    We explore the notion that the public health community could learn lessons from the success of evidence based medicine (EBM) and develop a public health counterpart called "Evidence for Population Health". While EBM focuses on individual patients, its public health counterpart would aim to improve the health of communities effectively and efficiently.

  14. Hospital based palliative care in sub-Saharan Africa; a six month review from Malawi

    Directory of Open Access Journals (Sweden)

    Jane Bates M

    2011-07-01

    Full Text Available Abstract Background The World Health Organisation recognises the importance of palliative care in an African setting. Despite this services are often patchy and inconsistent, and many operate at health centre and/or community level. Few reports from hospital based palliative care services in sub-Saharan Africa exist in the current literature. As part of its activities Tiyanjane Clinic has been providing hospital based palliative care to patients at Queen Elizabeth Central Hospital, a large government tertiary referral institution, in the Southern region of Malawi since 2003, caring for patients with HIV, cancer and other non-malignant palliative diagnoses. Methods A retrospective review of case notes for all in-patients seen by Tiyanjane Clinic over a six month period (April-Sept 2009 was undertaken. Results A total of 177 patients were seen, for whom 137 case notes were available (77%. 58% of patients were male, 42% female. The average age of patients was 39.1 years (range 15-92 years. 54% of patients were HIV positive, with 34% on ARV drugs at the time of care. 42% of patients had HIV related diagnoses, including AIDS defining malignancies, 48% had (non AIDS related cancers and 9% had other palliative diagnoses. The mean age of patients with HIV related diagnoses was 34 years, for cancer patients it was 48 years. Pain was the most commonly reported symptom (74%, with 56% of patients requiring oral morphine. The mean daily dose of morphine was 30 mg/day (range 9-100 mg. 65% of patients were discharged home, 26% of patients died during admission. Conclusions The palliative care population in this setting is relatively young, especially among patients with HIV related diagnoses. HIV and cancer are the main diagnostic groups. Pain is the most commonly reported symptom, with oral morphine frequently required. Health workers require access to and knowledge of oral morphine in order to provide appropriate assistance to patients under their care.

  15. Projecting the Benefits of Antiretroviral Therapy for HIV Prevention: The Impact of Population Mobility and Linkage to Care

    OpenAIRE

    Andrews, Jason R.; Wood, Robin; Bekker, Linda-Gail; Middelkoop, Keren; Walensky, Rochelle P.

    2012-01-01

    Background. Recent mathematical models suggested that frequent human immunodeficiency virus (HIV) testing with immediate initiation of antiretroviral therapy (ART) to individuals with a positive test result could profoundly curb transmission. The debate about ART as prevention has focused largely on parameter values. We aimed to evaluate structural assumptions regarding linkage to care and population mobility, which have received less attention.

  16. Participation of primary health care personnel in the Stockholm Health of the Population Study--a preliminary report

    DEFF Research Database (Denmark)

    Romelsjö, A; Haglund, B J; Diderichsen, Finn; Hallqvist, J; Holland, S; Nordström, G; Svanström, L

    1988-01-01

    The 1984/85 Stockholm Health of the Population Study (HPS) was a cross sectional study including a questionnaire and a health examination. It was conducted through the ordinary health personnel of four Primary Health Care (PHC) districts in the Stockholm County. The main objective was to broaden...

  17. How and by whom care is delivered influences anti-inflammatory use in asthma : Results of a national population survey

    NARCIS (Netherlands)

    Adams, RJ; Weiss, ST; Fuhlbrigge, A

    2003-01-01

    Background: Studies examining the influence of provider behavior and patterns of care delivery on the use of antiinflammatory asthma therapy have been limited to selected populations or have been unable to assess the appropriateness of therapy for individuals. We have previously reported the influen

  18. Improving Access to Primary Care for a Growing Latino Population: The Role of Safety Net Providers in the Rural Midwest

    Science.gov (United States)

    Blewett, Lynn A.; Casey, Michelle; Call, Kathleen Thiede

    2004-01-01

    Many rural Midwestern communities are experiencing rapid growth in Latino populations with low rates of health insurance coverage, limited financial resources, language and cultural differences, and special health care needs. We report on 2-day site visits conducted in 2001 and 2002 in 3 communities (Marshalltown, Iowa; Great Bend, Kansas; and…

  19. Population Control for Multi-agent Based Topical Crawlers

    OpenAIRE

    Mouton, Alban; Marteau, Pierre-François

    2008-01-01

    International audience The use of multi-agent topical Web crawlers based on the endogenous fitness model raises the problem of controling the population of agents. We tackle this question through an energy based model to balance the reproduction/life expectency of agents. Our goal is to simplify the tuning of parameters and to optimize the use of ressources available for the crawling. We introduce an energy based model designed to control the number of agents according to the precision of ...

  20. Elder abuse and neglect in a population offering care by a primary health care center in Izmir, Turkey.

    Science.gov (United States)

    Kissal, Aygul; Beşer, Ayşe

    2011-01-01

    The objective of this study is to investigate the prevalence of abuse and neglect of the elderly aged 65 years and older, living with their relative in a primary health care center area and affecting factors. A descriptive study included 331 people aged 65 years. The most frequent type of abuse was psychological abuse and the least frequent was sexual abuse. Female gender, low education levels, living with spouses and children, and perception of familial relationships as average or below average significantly increased abuse. The nurses providing primary health care should be able to identify and observe the elderly at risk of abuse and conduct programs preventing abuse. PMID:21347984

  1. Accidental intoxication of the infant-juvenile population in households: profiles of emergency care

    Directory of Open Access Journals (Sweden)

    Jackeline Gonçalves Brito

    2015-06-01

    Full Text Available OBJECTIVE Analyzing profiles of intoxication and accidental poisoning of infant-juvenile population (0-24 years in the household, treated at a reference facility for Emergency and Primary Care, during the year 2013. METHOD A descriptive, cross-sectional study. Data were analyzed using Epi-Info, by way of simple and bivariate analyzes. The project was approved by the Research Ethics Committee (protocol 405.578. RESULTS There were 45 intoxications, with a prevalence of males (60.0%, aged 1-4 years (71.1%. Among children under one, there was a higher frequency of pesticide poisoning (66.6%, between the ages of 1-4 by cleaning products (34.4%, and between 5-9 years of age by pharmacological substances (66.6%. The primary assistance was provided only at health institutions, with hospital admissions in 24.4% of the cases. CONCLUSION The importance of prevention through legislation is evident, in order to ensure greater safety in packaging of various products, and community awareness to eliminate risks in the household environment.

  2. Caring for the forensic population: recognizing the educational needs of emergency department nurses and physicians.

    Science.gov (United States)

    Henderson, Elizabeth; Harada, Nahoko; Amar, Angela

    2012-12-01

    The Emergency Department (ED) is a point of contact for victims of violence after an act of criminal activity has occurred. Hence, ED clinicians are in a key position to have a significant impact on both the medical and legal outcomes of the forensic patient population. The purpose of this study was to describe and compare forensic knowledge, practice, and experiences of ED nurses and physicians. Specific aims were to (1) describe experiences of nurses and physicians related to forensic practice; (2) compare clinical forensic knowledge and experience between nurses and physicians; and (3) describe forensic learning needs. This descriptive, correlational study utilized a survey questionnaire completed by 134 ED nurses and physicians. Results of the survey revealed no significant differences in the education, knowledge, and confidence with forensic patients between ED nurses and physicians. However, just over half of the sample reported feeling confident in managing forensic patients indicating a need for increased forensic education. Practice implications indicate that forensic education is needed and desired among ED nurses and physicians within the clinical setting. Further studies must be done to gain a more in depth understanding of existing forensic practices and protocols to elevate the level of care received by forensic patients within the ED setting. PMID:23176357

  3. Geospatial Technology in Disease Mapping, E- Surveillance and Health Care for Rural Population in South India

    Science.gov (United States)

    Praveenkumar, B. A.; Suresh, K.; Nikhil, A.; Rohan, M.; Nikhila, B. S.; Rohit, C. K.; Srinivas, A.

    2014-11-01

    Providing Healthcare to rural population has been a challenge to the medical service providers especially in developing countries. For this to be effective, scalable and sustainable, certain strategic decisions have to be taken during the planning phase. Also, there is a big gap between the services available and the availability of doctors and medical resources in rural areas. Use of Information Technology can aid this deficiency to a good extent. In this paper, a mobile application has been developed to gather data from the field. A cloud based interface has been developed to store the data in the cloud for effective usage and management of the data. A decision tree based solution developed in this paper helps in diagnosing a patient based on his health parameters. Interactive geospatial maps have been developed to provide effective data visualization facility. This will help both the user community as well as decision makers to carry out long term strategy planning.

  4. A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP

    Directory of Open Access Journals (Sweden)

    Francis Rebecca

    2010-01-01

    Full Text Available Abstract Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT. Methods/Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. Trial registration The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR with number ACTRN12609000251224.

  5. The benefits of measurement-based care for primary care patients with depression.

    Science.gov (United States)

    Jackson, W Clay

    2016-03-01

    Follow the case of Mrs C, a primary care patient with depression who fails to respond to initial antidepressant treatment, and see how measurement-based care helps her clinician confirm her diagnosis, track symptom response, and assess her sense of well-being. Using rating scales such as the 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7), and Mood Disorder Questionnaire (MDQ) can help clinicians recognize suboptimal response and make treatment adjustments such as optimizing the medication dose, switching to another medication, or augmenting with medications, psychotherapy, or exercise. For Mrs C and other patients with depression, the goal of treatment must go beyond symptom remission to improve quality of life. PMID:27046318

  6. Protocol for a population-based Ankylosing Spondylitis (PAS cohort in Wales

    Directory of Open Access Journals (Sweden)

    Atkinson Mark D

    2010-09-01

    Full Text Available Abstract Background To develop a population-based cohort of people with ankylosing spondylitis (AS in Wales using (1 secondary care clinical datasets, (2 patient-derived questionnaire data and (3 routinely-collected information in order to examine disease history and the health economic cost of AS. Methods This data model will include and link (1 secondary care clinician datasets (i.e. electronic patient notes from the rheumatologist (2 patient completed questionnaires (giving information on disease activity, medication, function, quality of life, work limitations and health service utilisation and (3 a broad range of routinely collected data (including; GP records, in-patient hospital admission data, emergency department data, laboratory/pathology data and social services databases. The protocol involves the use of a unique and powerful data linkage system which allows datasets to be interlinked and to complement each other. Discussion This cohort can integrate patient supplied, primary and secondary care data into a unified data model. This can be used to study a range of issues such as; the true economic costs to the health care system and the patient, factors associated with the development of severe disease, long term adverse events of new and existing medication and to understand the disease history of this condition. It will benefit patients, clinicians and health care managers. This study forms a pilot project for the use of routine data/patient data linked cohorts for other chronic conditions.

  7. Female genital cutting: an evidence-based approach to clinical management for the primary care physician.

    Science.gov (United States)

    Hearst, Adelaide A; Molnar, Alexandra M

    2013-06-01

    The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue. PMID:23726401

  8. Evaluation of the integrated community based home care model

    Directory of Open Access Journals (Sweden)

    LR Uys

    2001-09-01

    Full Text Available In 1999-2000 the Integrated Community-Based Home Care model for the care of people with AIDS in communities were implemented in seven sites across the country. The post-implementation evaluation showed that most respondents felt that the model could be replicated if a functioning and informed network including all partners, and a strong management team were in place. The effects of the project were mainly positive for all stakeholders (hospice, clinic, hospital, PWA and their carers, professionals and other community members. Hospitals and community- based services became more aware of and involved in the needs of PWA and felt that the model enabled them to address these needs. PWA and their carers felt supported and respected.

  9. Clinical characteristics and preventable acute care spending among a high cost inpatient population

    OpenAIRE

    Ronksley, Paul E.; Kobewka, Daniel M.; McKay, Jennifer A.; Rothwell, Deanna M.; Mulpuru, Sunita; Forster, Alan J

    2016-01-01

    Background A small proportion of patients account for the majority of health care spending. The objectives of this study were to explore the clinical characteristics, patterns of health care use, and the proportion of acute care spending deemed potentially preventable among high cost inpatients within a Canadian acute-care hospital. Methods We identified all individuals within the Ottawa Hospital with one or more inpatient hospitalization between April 1, 2010 and March 31, 2011. Clinical cha...

  10. A region-based palliative care intervention trial using the mixed-method approach: Japan OPTIM study

    Directory of Open Access Journals (Sweden)

    Morita Tatsuya

    2012-01-01

    populations are a nearly representative sample of advanced cancer patients, bereaved family members, physicians, and nurses in the region. Qualitative process studies consist of 3 studies with each aim: 1 to describe the process in developing regional palliative care in each local context, 2 to understand how and why the regional palliative care program led to changes in the region and to propose a model for shaping regional palliative care, and 3 to systemically collect the barriers of palliative care at a regional level and potential resolutions. The study methodology is a case descriptive study, a grounded theory approach based on interviews, and a content analysis based on systemically collected data, respectively. Discussion This study is, to our knowledge, one of the most comprehensive evaluations of a region-based palliative care intervention program. This study has 3 unique aspects: 1 it measures a wide range of outcomes, including quality of care and quality of life measures specifically designed for palliative care populations, whether patients died where they actually preferred, the changes in physicians and nurses at a regional level; 2 adopts qualitative studies along with quantitative evaluations; and 3 the intervention is without a fundamental change in health care systems. A comprehensive understanding of the findings in this study will contribute to a deeper insight into how to develop community palliative care. Trial Registration UMIN Clinical Trials Registry (UMIN-CTR, Japan, UMIN000001274.

  11. Efficacy of a Morinda citrifolia Based Skin Care Regimen

    OpenAIRE

    West, Brett J.; Rachel A. Sabin

    2012-01-01

    A six week clinical trial of a Morinda citrifolia (noni) based skin care regimen was conducted with 49 women, ages 38 to 55 years. Daily application of three product formulations to the face and neck resulted in significant reductions in lateral canthal fine lines and wrinkles (crow’s feet), as measured by technician scoring and digital image analysis. Use of the regimen also improved skin elasticity and firmness Cutometer® measurements. No evidence of skin irritation was present in any parti...

  12. Teacher's Understanding, Perceptions, and Experiences of Students in Foster Care: A Forgotten Population

    Science.gov (United States)

    Watson-Davis, Darneika

    2010-01-01

    The purpose of this study is to examine elementary teacher's understanding, perceptions, and experiences of working with students in foster care. The researcher examined whether teachers are informed about students in foster care, determined teacher's understanding of the foster care system, and how their students are affected. The results…

  13. Cost Effectiveness of Facility-Based Care, Home-Based Care and Mobile Clinics for Provision of Antiretroviral Therapy in Uganda

    OpenAIRE

    Babigumira, Joseph B; Sethi, Ajay K.; Smyth, Kathleen A.; Singer, Mendel E.

    2009-01-01

    Background: Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money. Objective: To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda. Methods: Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical ...

  14. Arteriovenous fistula: An evidence based practice in nursing care

    Directory of Open Access Journals (Sweden)

    Evangelia Prevyzi

    2013-01-01

    Full Text Available The arteriovenous fistula (AVF is the most frequent form of vascular access for patients undergoing haemodialysis because it ensures good quality of dialysis and reduce haemodialysis mortality. For this reason, the nephrology nurse plays an important role in the appropriate care of fistula with a view to promoting the longevity and prevention of complications. Purpose: The purpose of this review was to investigate the role of Nephrology nurse in the appropriate care of fistula, promoting longevity and reducing complications, based on scientific data and international guidelines. Material-Method: The methodology followed in this review relied on literatures reviews and investigative studies, which were carried out during the period 2000-2012 and international (Medline, PubMed, Cinahl and Greek databases (Iatrotek on the care and management of fistula in people undergoing chronic haemodialysis. Key-words were used: Arteriovenous fistula, cannulation techniques fistula, guidelines, vascular access, role of nurse. Results: The arteriovenous fistula (AVF is the life line for patients undergoing haemodialysis. For this reason, the appropriate care of fistula and its maintenance in a good condition plays an important role for patient΄s life. Conclusions: Nephrology nurse has a major role in the proper management of the fistula and the education of the patient. Additionally, there is a need for cooperation between all the members of the multidisciplinary team, which includes dialysis nurse, nefrologist, access surgeon, and radiologist, for the broader assessment of fistula and the prevention and timely treatment of any complications.

  15. The Team Approach to Home-Based Primary Care: Restructuring Care to Meet Patient, Program, and System Needs

    Science.gov (United States)

    Reckrey, Jennifer M.; Soriano, Theresa A.; Hernandez, Cameron R.; DeCherrie, Linda V.; Chavez, Silvia; Zhang, Meng; Ornstein, Katherine

    2016-01-01

    Team-based models of care are an important way to meet the complex medical and psychosocial needs of the homebound. As part of a quality improvement project to address patient, program, and system needs, we restructured a portion of our large, physician-led academic home-based primary care practice into a team-based model. With support from an office-based nurse practitioner, a dedicated social worker, and a dedicated administrative assistant, physicians were able to care for a larger number of patients. Hospitalizations, readmissions, and patient satisfaction remained the same while physician panel size increased and physician satisfaction improved. Our Team Approach is an innovative way to improve interdisciplinary, team-based care though practice restructuring and serves as an example of how other practices can approach the complex task of caring for the homebound. PMID:25645568

  16. PRACTICAL APPLICATION OF POPULATION BASED ANT COLONY OPTIMIZATION ALGORITHM

    OpenAIRE

    Valeeva, A.; Goncharova, Yu

    2013-01-01

    In this paper we consider the Split Delivery Vehicle Routing Problem, which has a wide practical application. The SDVRP is NP-hard problem. We propose a population based ant colony optimization algorithm for solving the SDVRP. Computational experiments for developed algorithm are reported.

  17. Epilepsy in Children With ADHD: A Population-Based Study

    OpenAIRE

    Davis, Shanlee M.; Katusic, Slavica K.; Barbaresi, William J.; Killian, Jill; Weaver, Amy L.; Ottman, Ruth; Wirrell, Elaine C.

    2010-01-01

    Prior studies suggest a higher incidence of symptoms of attention-deficit/hyperactivity disorder in children with epilepsy, but few have investigated epilepsy in children with attention-deficit/hyperactivity disorder. Our objective was to compare the incidence and characteristics of epilepsy among population-based, research identified cohorts of children with (N=358) and without attention-deficit/hyperactivity disorder (N=728), based on medical record review to age 20. Data abstracted include...

  18. Cardiovascular outcomes associated with use of clarithromycin: population based study

    OpenAIRE

    Wong, AY; Root, A.; Douglas, IJ; Chui, CS; Chan, EW; Ghebremichael-Weldeselassie, Y.; Siu, CW; Smeeth, L; Wong, IC

    2016-01-01

    STUDY QUESTION:  What is the association between clarithromycin use and cardiovascular outcomes? METHODS:  In this population based study the authors compared cardiovascular outcomes in adults aged 18 or more receiving oral clarithromycin or amoxicillin during 2005-09 in Hong Kong. Based on age within five years, sex, and calendar year at use, each clarithromycin user was matched to one or two amoxicillin users. The cohort analysis included patients who received clarithromycin (n=108 988) or ...

  19. Anxiety disorders in young people: a population-based study

    OpenAIRE

    Thaíse Campos Mondin; Caroline Elizabeth Konradt; Taiane de Azevedo Cardoso; Luciana de Avila Quevedo; Karen Jansen; Luciano Dias de Mattos; Ricardo Tavares Pinheiro; Ricardo Azevedo da Silva

    2013-01-01

    Objective: To assess the prevalence of anxiety disorders and associated factors in young adults. Methods: Cross-sectional population-based study of individuals between the ages of 18 and 24 years randomly selected from 89 census-based sectors to ensure an adequate sample size. Household selection within the sectors was performed according to a systematic sampling process. Anxiety disorders were assessed using the Mini International Neuropsychiatric Interview (MINI). The final sample compris...

  20. Population uptake of antiretroviral treatment through primary care in rural South Africa

    Directory of Open Access Journals (Sweden)

    Bärnighausen Till W

    2010-09-01

    Full Text Available Abstract Background KwaZulu-Natal is the South African province worst affected by HIV and the focus of early modeling studies investigating strategies of antiretroviral treatment (ART delivery. The reality of antiretroviral roll-out through primary care has differed from that anticipated and real world data are needed to inform the planning of further scaling up of services. We investigated the factors associated with uptake of antiretroviral treatment through a primary healthcare system in rural South Africa. Methods Detailed demographic, HIV surveillance and geographic information system (GIS data were used to estimate the proportion of HIV positive adults accessing antiretroviral treatment within northern KwaZulu-Natal, South Africa in the period from initiation of antiretroviral roll-out until the end of 2008. Demographic, spatial and socioeconomic factors influencing the likelihood of individuals accessing antiretroviral treatment were explored using multivariable analysis. Results Mean uptake of ART among HIV positive resident adults was 21.0% (95%CI 20.1-21.9. Uptake among HIV positive men (19.2% was slightly lower than women (21.8%, P = 0.011. An individual's likelihood of accessing ART was not associated with level of education, household assets or urban/rural locale. ART uptake was strongly negatively associated with distance from the nearest primary healthcare facility (aOR = 0.728 per square-root transformed km, 95%CI 0.658-0.963, P = 0.002. Conclusions Despite concerns about the equitable nature of antiretroviral treatment rollout, we find very few differences in ART uptake across a range of socio-demographic variables in a rural South African population. However, even when socio-demographic factors were taken into account, individuals living further away from primary healthcare clinics were still significantly less likely to be accessing ART

  1. A retrospective population-based study of childhood hospital admissions with record linkage to a birth defects registry

    OpenAIRE

    Bower Carol; Colvin Lyn

    2009-01-01

    Abstract Background Using population-based linked records of births, deaths, birth defects and hospital admissions for children born 1980–1999 enables profiles of hospital morbidity to be created for each child. Methods This is an analysis of a state-based registry of birth defects linked to population-based hospital admission data. Transfers and readmissions within one day could be taken into account and treated as one episode of care for the purposes of analyses (N = 485,446 children; 742,8...

  2. Prediction of critical illness in elderly outpatients using elder risk assessment: a population-based study

    Science.gov (United States)

    Biehl, Michelle; Takahashi, Paul Y; Cha, Stephen S; Chaudhry, Rajeev; Gajic, Ognjen; Thorsteinsdottir, Bjorg

    2016-01-01

    Rationale Identifying patients at high risk of critical illness is necessary for the development and testing of strategies to prevent critical illness. The aim of this study was to determine the relationship between high elder risk assessment (ERA) score and critical illness requiring intensive care and to see if the ERA can be used as a prediction tool to identify elderly patients at the primary care visit who are at high risk of critical illness. Methods A population-based historical cohort study was conducted in elderly patients (age >65 years) identified at the time of primary care visit in Rochester, MN, USA. Predictors including age, previous hospital days, and comorbid health conditions were identified from routine administrative data available in the electronic medical record. The main outcome was critical illness, defined as sepsis, need for mechanical ventilation, or death within 2 years of initial visit. Patients with an ERA score of 16 were considered to be at high risk. The discrimination of the ERA score was assessed using area under the receiver operating characteristic curve. Results Of the 13,457 eligible patients, 9,872 gave consent for medical record review and had full information on intensive care unit utilization. The mean age was 75.8 years (standard deviation ±7.6 years), and 58% were female, 94% were Caucasian, 62% were married, and 13% were living in nursing homes. In the overall group, 417 patients (4.2%) suffered from critical illness. In the 1,134 patients with ERA >16, 154 (14%) suffered from critical illness. An ERA score ≥16 predicted critical illness (odds ratio 6.35; 95% confidence interval 3.51–11.48). The area under the receiver operating characteristic curve was 0.75, which indicated good discrimination. Conclusion A simple model based on easily obtainable administrative data predicted critical illness in the next 2 years in elderly outpatients with up to 14% of the highest risk population suffering from critical illness

  3. [Glocalization: the outlook for Taiwan evidence based health care].

    Science.gov (United States)

    Chen, Chiehfeng

    2014-12-01

    Public attention to evidence-based health care (EBHC) has increased significantly in recent years. Key problems related to applying EBHC in current healthcare practice include the timely update of up-to-date knowledge and skills and the methodology used to implement EBHC in clinical settings. EBHC has been introduced to the Taiwan healthcare system for the past two decades. The annual EBM (Evidence based medicine) National Competition is a unique and important EBHC activity in Taiwan. EBHC has been promoted widely in medicine, nursing, pharmacy, public health and other professions, and EBHC-related organizations such as the Taiwan Evidence Based Medicine Association (TEBMA), and Taiwan Evidence Based Nursing Association (TEBNA), have increased in number and grown in membership. In addition to domestic developments, Taiwan is also actively involved in global organizations, such as the Cochrane Collaboration, East Asian Cochrane Alliance (EACA), and the International Society for Evidence Based Health Care (ISEHC). In Taiwan, most medical professionals work cooperatively to promote EBHC, which facilitates the gradual improvement of healthcare quality. PMID:25464951

  4. Primary Health Care Software-A Computer Based Data Management System

    Directory of Open Access Journals (Sweden)

    Tuli K

    1990-01-01

    Full Text Available Realising the duplication and time consumption in the usual manual system of data collection necessitated experimentation with computer based management system for primary health care in the primary health centers. The details of the population as available in the existing manual system were used for computerizing the data. Software was designed for data entry and analysis. It was written in Dbase III plus language. It was so designed that a person with no knowledge about computer could use it, A cost analysis was done and the computer system was found more cost effective than the usual manual system.

  5. What matters most for end-of-life care? Perspectives from community-based palliative care providers and administrators

    OpenAIRE

    Mistry, Bina; Bainbridge, Daryl; Bryant, Deanna; Tan Toyofuku, Sue; Seow, Hsien

    2015-01-01

    Objectives There has been little research conducted to understand the essential meaning of quality, community-based, end-of-life (EOL) care, despite the expansion of these services. The purpose of this study was to define what matters most for EOL care from the perspective of a diverse range of palliative care providers in the community who have daily encounters with death and dying. Methods We used interviews to explore the perceptions of providers and administrators from 14 specialised pall...

  6. Measuring geographic access to health care: raster and network-based methods

    Directory of Open Access Journals (Sweden)

    Delamater Paul L

    2012-05-01

    Full Text Available Abstract Background Inequalities in geographic access to health care result from the configuration of facilities, population distribution, and the transportation infrastructure. In recent accessibility studies, the traditional distance measure (Euclidean has been replaced with more plausible measures such as travel distance or time. Both network and raster-based methods are often utilized for estimating travel time in a Geographic Information System. Therefore, exploring the differences in the underlying data models and associated methods and their impact on geographic accessibility estimates is warranted. Methods We examine the assumptions present in population-based travel time models. Conceptual and practical differences between raster and network data models are reviewed, along with methodological implications for service area estimates. Our case study investigates Limited Access Areas defined by Michigan’s Certificate of Need (CON Program. Geographic accessibility is calculated by identifying the number of people residing more than 30 minutes from an acute care hospital. Both network and raster-based methods are implemented and their results are compared. We also examine sensitivity to changes in travel speed settings and population assignment. Results In both methods, the areas identified as having limited accessibility were similar in their location, configuration, and shape. However, the number of people identified as having limited accessibility varied substantially between methods. Over all permutations, the raster-based method identified more area and people with limited accessibility. The raster-based method was more sensitive to travel speed settings, while the network-based method was more sensitive to the specific population assignment method employed in Michigan. Conclusions Differences between the underlying data models help to explain the variation in results between raster and network-based methods. Considering that the

  7. Health IT-enabled Care for Underserved Rural Populations: The Role of Nursing

    OpenAIRE

    Effken, Judith A.; Abbott, Patricia

    2009-01-01

    This white paper explains the strong roles that nursing can play in using information technology (IT) to improve healthcare delivery in rural areas. The authors describe current challenges to providing care in rural areas, and how technology innovations can help rural communities to improve their health and health care. To maximize benefits, rural stakeholders (as individuals and groups) must collaborate to effect change. Because nonphysician providers deliver much of the health care in rural...

  8. Population-Level Density Dependence Influences the Origin and Maintenance of Parental Care

    OpenAIRE

    Reyes, E.; Thrasher, P; Bonsall, MB; Klug, HM

    2016-01-01

    Parental care is a defining feature of animal breeding systems. We now know that both basic life-history characteristics and ecological factors influence the evolution of care. However, relatively little is known about how these factors interact to influence the origin and maintenance of care. Here, we expand upon previous work and explore the relationship between basic life-history characteristics (stage-specific rates of mortality and maturation) and the fitness benefits associated with the...

  9. Cross-Sectional Study of Periodontal Care and Glycosylated Hemoglobin in an Insured Population

    OpenAIRE

    Spangler, Leslie; Reid, Robert J.; Inge, Ronald; Newton, Katherine M.; Hujoel, Philippe; Chaudhari, Monica; Genco, Robert J.; Barlow, William E.

    2010-01-01

    OBJECTIVE Compare GHb among people with diabetes who have and have not received periodontal care. RESEARCH DESIGN AND METHODS This cross-sectional study linked 5 years of electronic medical record and dental insurance data for dually insured patients with diabetes, ages 40–70 years (n = 5,103). We assessed the association between annual mean GHb (%) and periodontal care (a proxy for periodontitis) defined using claim codes. Among patients who received periodontal care, we assessed the associa...

  10. Locational and population factors in health care-seeking behavior in Savannah, Georgia.

    OpenAIRE

    Gesler, W M; Meade, M S

    1988-01-01

    The use of regular sources of health care by a sample of residents of Chatham County, Georgia was examined through an analysis of the interactions among distance, sociodemographic, locational, and activity-space factors. Health care facilities were concentrated near downtown Savannah. Distance from home to regular source of care was a relatively more important factor for inner-city residents than for suburban or urban fringe residents. There were no clear differences by race, sex, age, occupa...

  11. Recommendations for improving the end-of-life care system for homeless populations: A qualitative study of the views of Canadian health and social services professionals

    Directory of Open Access Journals (Sweden)

    McNeil Ryan

    2012-09-01

    Full Text Available Abstract Background Homeless populations have complex and diverse end-of-life care needs. However, they typically die outside of the end-of-life care system. To date, few studies have explored barriers to the end-of-life care system for homeless populations. This qualitative study involving health and social services professionals from across Canada sought to identify barriers to the end-of-life care system for homeless populations and generate recommendations to improve their access to end-of-life care. Methods Semi-structured qualitative interviews were conducted with 54 health and social services professionals involved in end-of-life care services delivery to homeless persons in six Canadian cities (Halifax, Hamilton, Ottawa, Thunder Bay, Toronto and Winnipeg. Participants included health administrators, physicians, nurses, social workers, harm reduction specialists, and outreach workers. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Results Participants identified key barriers to end-of-life care services for homeless persons, including: (1 insufficient availability of end-of-life care services; (2 exclusionary operating procedures; and, (3 poor continuity of care. Participants identified recommendations that they felt had the potential to minimize these barriers, including: (1 adopting low-threshold strategies (e.g. flexible behavioural policies and harm reduction strategies; (2 linking with population-specific health and social care providers (e.g. emergency shelters; and, (3 strengthening population-specific training. Conclusions Homeless persons may be underserved by the end-of-life care system as a result of barriers that they face to accessing end-of-life care services. Changes in the rules and regulations that reflect the health needs and circumstances of homeless persons and measures to improve continuity of care have the potential to increase equity in the end-of-life care system for this

  12. Evidence-based Health Care via Multi-Criteria Decision Analytic decision

    DEFF Research Database (Denmark)

    Kjer Kaltoft, Mette; Dowie, Jack

    ’Evidence-based Health Care via Multi-Criteria Decision Analytic decision support: a Danish case study......’Evidence-based Health Care via Multi-Criteria Decision Analytic decision support: a Danish case study...

  13. Using Measurement-Based Care to Enhance Any Treatment

    Science.gov (United States)

    Scott, Kelli; Lewis, Cara C.

    2016-01-01

    Measurement-based care (MBC) can be defined as the practice of basing clinical care on client data collected throughout treatment. MBC is considered a core component of numerous evidence-based practices (e.g., Beck & Beck, 2011; Klerman, Weissman, Rounsaville, & Chevron, 1984) and has emerging empirical support as an evidence-based framework that can be added to any treatment (Lambert et al., 2003, Trivedi et al., 2007). The observed benefits of MBC are numerous. MBC provides insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration, and improves client outcomes (Lambert et al., 2005). Moreover, as a framework to guide treatment, MBC has transtheoretical and transdiagnostic relevance with broad reach across clinical settings. Although MBC has primarily focused on assessing symptoms (e.g., depression, anxiety), MBC can also be used to assess valuable information about (a) symptoms, (b) functioning and satisfaction with life, (c) putative mechanisms of change (e.g., readiness to change), and (d) the treatment process (e.g., session feedback, working alliance). This paper provides an overview of the benefits and challenges of MBC implementation when conceptualized as a transtheoretical and transdiagnostic framework for evaluating client therapy progress and outcomes across these four domains. The empirical support for MBC use is briefly reviewed, an adult case example is presented to serve as a guide for successful implementation of MBC in clinical practice, and future directions to maximize MBC utility are discussed.

  14. A Model for Community-Based Pediatric Oral Heath: Implementation of an Infant Oral Care Program

    OpenAIRE

    RAMOS-GOMEZ, FRANCISCO J.

    2014-01-01

    The Affordable Care Act (ACA) mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP) in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0–5 and their ca...

  15. Feminist Interruptions: Creating Care-ful and Collaborative Community-Based Research with Students

    Directory of Open Access Journals (Sweden)

    Kelly Concannon

    2014-05-01

    Full Text Available This article describes a feminist community-based research project involving faculty and student collaboration to evaluate a dating and domestic violence awareness initiative. Using a critical ethics of care that emphasizes relationships and allows for constant reflection about power dynamics, role, positionality, and emotions, the authors reflect on what was learned during the research process. Faculty and student researchers share their perspectives and offer suggestions for future feminist collaborative research projects. Significant lessons learned include ensuring that all are invested from the outset of the project, guaranteeing that student researchers understand why their role is so critical in community-based research, and acknowledging not just faculty power over students but student privilege as well.

  16. A randomized study of telephonic care support in populations at risk for musculoskeletal preference-sensitive surgeries

    Directory of Open Access Journals (Sweden)

    Veroff David R

    2013-02-01

    Full Text Available Abstract Background The rate of elective surgeries varies dramatically by geography in the United States. For many of these surgeries, there is not clear evidence of their relative merits over alternate treatment choices and there are significant tradeoffs in short- and long-term risks and benefits of selecting one treatment option over another. Conditions and symptoms for which there is this lack of a single clear evidence-based treatment choice present great opportunities for patient and provider collaboration on decision making; back pain and joint osteoarthritis are two such ailments. A number of decision aids are in active use to encourage this shared decision-making process. Decision aids have been assessed in formal studies that demonstrate increases in patient knowledge, increases in patient-provider engagement, and reduction in surgery rates. These studies have not widely demonstrated the added benefit of health coaching in support of shared decision making nor have they commonly provided strong evidence of cost reductions. In order to add to this evidence base, we undertook a comparative study testing the relative impact on health utilization and costs of active outreach through interactive voice response technology to encourage health coaching in support of shared decision making in comparison to mailed outreach or no outreach. This study focused on individuals with back pain or joint pain. Methods We conducted four waves of stratified randomized comparisons for individuals with risk for back, hip, or knee surgery who did not have claims-based evidence of one or more of five chronic conditions and were eligible for population care management services within three large regional health plans in the United States. An interactive voice response (IVR form of outreach that included the capability for individuals to directly connect with health coaches telephonically, known as AutoDialog®, was compared to a control (mailed outreach or

  17. Population-Level Density Dependence Influences the Origin and Maintenance of Parental Care

    Science.gov (United States)

    Reyes, Elijah; Thrasher, Patsy; Bonsall, Michael B.; Klug, Hope

    2016-01-01

    Parental care is a defining feature of animal breeding systems. We now know that both basic life-history characteristics and ecological factors influence the evolution of care. However, relatively little is known about how these factors interact to influence the origin and maintenance of care. Here, we expand upon previous work and explore the relationship between basic life-history characteristics (stage-specific rates of mortality and maturation) and the fitness benefits associated with the origin and the maintenance of parental care for two broad ecological scenarios: the scenario in which egg survival is density dependent and the case in which adult survival is density dependent. Our findings suggest that high offspring need is likely critical in driving the origin, but not the maintenance, of parental care regardless of whether density dependence acts on egg or adult survival. In general, parental care is more likely to result in greater fitness benefits when baseline adult mortality is low if 1) egg survival is density dependent or 2) adult mortality is density dependent and mutant density is relatively high. When density dependence acts on egg mortality, low rates of egg maturation and high egg densities are less likely to lead to strong fitness benefits of care. However, when density dependence acts on adult mortality, high levels of egg maturation and increasing adult densities are less likely to maintain care. Juvenile survival has relatively little, if any, effect on the origin and maintenance of egg-only care. More generally, our results suggest that the evolution of parental care will be influenced by an organism’s entire life history characteristics, the stage at which density dependence acts, and whether care is originating or being maintained. PMID:27093056

  18. Population-Level Density Dependence Influences the Origin and Maintenance of Parental Care.

    Science.gov (United States)

    Reyes, Elijah; Thrasher, Patsy; Bonsall, Michael B; Klug, Hope

    2016-01-01

    Parental care is a defining feature of animal breeding systems. We now know that both basic life-history characteristics and ecological factors influence the evolution of care. However, relatively little is known about how these factors interact to influence the origin and maintenance of care. Here, we expand upon previous work and explore the relationship between basic life-history characteristics (stage-specific rates of mortality and maturation) and the fitness benefits associated with the origin and the maintenance of parental care for two broad ecological scenarios: the scenario in which egg survival is density dependent and the case in which adult survival is density dependent. Our findings suggest that high offspring need is likely critical in driving the origin, but not the maintenance, of parental care regardless of whether density dependence acts on egg or adult survival. In general, parental care is more likely to result in greater fitness benefits when baseline adult mortality is low if 1) egg survival is density dependent or 2) adult mortality is density dependent and mutant density is relatively high. When density dependence acts on egg mortality, low rates of egg maturation and high egg densities are less likely to lead to strong fitness benefits of care. However, when density dependence acts on adult mortality, high levels of egg maturation and increasing adult densities are less likely to maintain care. Juvenile survival has relatively little, if any, effect on the origin and maintenance of egg-only care. More generally, our results suggest that the evolution of parental care will be influenced by an organism's entire life history characteristics, the stage at which density dependence acts, and whether care is originating or being maintained. PMID:27093056

  19. Importance of Health and Social Care Research into Gender and Sexual Minority Populations in Nepal.

    Science.gov (United States)

    Regmi, Pramod R; van Teijlingen, Edwin

    2015-11-01

    Despite progressive legislative developments and increased visibility of sexual and gender minority populations in the general population, mass media often report that this population face a wide range of discrimination and inequalities. LGBT (lesbian, gay, and bisexual, and transgender) populations have not been considered as priority research populations in Nepal. Research in other geographical settings has shown an increased risk of poor mental health, violence, and suicide and higher rates of smoking, as well as alcohol and drugs use among LGBT populations. They are also risk for lifestyle-related illness such as cancer, diabetes, and heart diseases. Currently, in Nepal, there is a lack of understanding of health and well-being, social exclusion, stigma, and discrimination as experienced by these populations. Good-quality public health research can help design and implement targeted interventions to the sexual and gender minority populations of Nepal. PMID:26543163

  20. Behavioral Economics, Wearable Devices, and Cooperative Games: Results From a Population-Based Intervention to Increase Physical Activity

    OpenAIRE

    van Mierlo, Trevor; Hyatt, Douglas; Andrew T. Ching; Fournier, Rachel; Dembo, Ron S

    2016-01-01

    Background Health care literature supports the development of accessible interventions that integrate behavioral economics, wearable devices, principles of evidence-based behavior change, and community support. However, there are limited real-world examples of large scale, population-based, member-driven reward platforms. Subsequently, a paucity of outcome data exists and health economic effects remain largely theoretical. To complicate matters, an emerging area of research is defining the ro...

  1. Implementing evidence-based interventions in health care: application of the replicating effective programs framework

    Directory of Open Access Journals (Sweden)

    Pincus Harold A

    2007-12-01

    Full Text Available Abstract Background We describe the use of a conceptual framework and implementation protocol to prepare effective health services interventions for implementation in community-based (i.e., non-academic-affiliated settings. Methods The framework is based on the experiences of the U.S. Centers for Disease Control and Prevention (CDC Replicating Effective Programs (REP project, which has been at the forefront of developing systematic and effective strategies to prepare HIV interventions for dissemination. This article describes the REP framework, and how it can be applied to implement clinical and health services interventions in community-based organizations. Results REP consists of four phases: pre-conditions (e.g., identifying need, target population, and suitable intervention, pre-implementation (e.g., intervention packaging and community input, implementation (e.g., package dissemination, training, technical assistance, and evaluation, and maintenance and evolution (e.g., preparing the intervention for sustainability. Key components of REP, including intervention packaging, training, technical assistance, and fidelity assessment are crucial to the implementation of effective interventions in health care. Conclusion REP is a well-suited framework for implementing health care interventions, as it specifies steps needed to maximize fidelity while allowing opportunities for flexibility (i.e., local customizing to maximize transferability. Strategies that foster the sustainability of REP as a tool to implement effective health care interventions need to be developed and tested.

  2. Comparisons of annual health care utilization, drug consumption, and medical expenditure between the elderly and general population in Taiwan

    OpenAIRE

    Wan-Hsuan Lu, MS; Wei-Ju Lee, MD, MS; Liang-Kung Chen, MD, PhD; Fei-Yuan Hsiao, PhD

    2016-01-01

    Background/Purpose: The aim of this study was to present an overview of health care utilization (outpatient, inpatient, and emergency visits), total medical expenditure, and drug consumption between the elderly and general population under Taiwan's National Health Insurance program. Methods: We conducted a cross-sectional analysis using the 2010 Taiwan's Longitudinal Health Insurance Database. Our analysis included 999,418 beneficiaries with eligible records under the National Health Insur...

  3. Eclampsia: maternal and perinatal outcome among tribal population of Bastar, Chhattisgarh, India in a tertiary care centre

    OpenAIRE

    Indu Sharma; Alpana Bansal

    2016-01-01

    Background: Eclampsia is one of the major causes of maternal and perinatal morbidity and mortality in India and other developing countries. This problem is continued in spite of challenging efforts to reviev each and every pregnant woman with eclampsia and to analyse the factors affecting the outcome. The aim of the research is to study the demographic profile, maternal as well as perinatal outcome of patients with eclampsia and factor affecting it in tertiary care centre of tribal population...

  4. Do the incentive payments in the new NHS contract for primary care reflect likely population health gains?

    OpenAIRE

    Robert Fleetcroft; Richard Cookson

    2005-01-01

    The new contract for primary care in the UK offers fee-for-service payments for a wide range of activities in a quality outcomes framework, with payments designed to reflect likely workload. This study aims to explore the link between these financial incentives and the likely population health gains. The study examines a subset of eight preventive interventions covering 38 of the 81 clinical indicators in the quality framework. The maximum payment for each service was calculated and compared ...

  5. Antibody screening & identification in the general patient population at a tertiary care hospital in New Delhi, India

    OpenAIRE

    Raj Nath Makroo; Aakanksha Bhatia; Vikas Hegde; Mohit Chowdhry; Uday Kumar Thakur; N L Rosamma

    2014-01-01

    Background & objectives: The development of alloantibodies can significantly complicate transfusion therapy and results in difficulties in cross-matching of blood. Most literature on alloimmunization is limited to multitransfused individuals, with very few studies on the general hospital patients. This study was aimed at assessing the frequency and type of unexpected red cell antibodies in the general patient population at a multispecialty tertiary care centre in New Delhi, India. Methods...

  6. Collaborative care in the addiction management of alcohol, illicit drugs and hypnotics and tranquilizers in the Belgian working population

    OpenAIRE

    Van Royen, Kathleen; Remmen, Roy; Vanmeerbeek, Marc; Peremans, Lieve

    2012-01-01

    Background: General practitioners (GPs) and occupational physicians (OPs) play an important role in detecting and managing substance abuse in the working population. Their collaboration is critical in coordinating care, facilitate a quicker rehabilitation and shorten sickleave. A systematic literature search was performed according to the ADAPTE-framework to explore if guidelines exist for collaboration between GPs and OPs in substance abuse management. Method: International guidelines reg...

  7. Populism

    OpenAIRE

    Abts, Koenraad; van Kessel, Stijn

    2015-01-01

    Populism is a concept applied to a wide range of political movements and actors across the globe. There is, at the same time, considerable confusion about the attributes and manifestation of populism, as well as its impact on democracy. This contribution identifies the defining elements of the populist ideology and discusses the varieties in which populism manifests itself, for instance as a component of certain party families. We finally discuss various normative interpretations of populism,...

  8. Dental care for aging populations in Denmark, Sweden, Norway, United kingdom, and Germany

    DEFF Research Database (Denmark)

    Holm-Pedersen, Poul; Vigild, Merete; Nitschke, Ina;

    2005-01-01

    dentistry discourage dentists from seeking opportunities to treat geriatric patients? Overall, the availability of dental services, the organization of the dental health care delivery system, and price subsidy for dental treatment are important factors influencing access to dental care among older people in...

  9. Integrating Compliance, Communication, and Culture: Delivering Health Care to an Aging Population

    Science.gov (United States)

    Langer, Nieli

    2008-01-01

    Older adults often get lost in the process of assessment, diagnosis and service brokering. If our concern as care providers is to enable older persons to remain independent or in the community for as long as possible, we must tap into their personal values, cultural identity and health beliefs in order to foster enhanced health care communication.…

  10. Pharmacy-based care for perimenopausal and postmenopausal women.

    Science.gov (United States)

    Shepherd, Janet E; Bopp, Janice

    2002-01-01

    Perimenopause and menopause represent a major physiologic and, often, psychosocial transition in the lives of women. During this time, women often experience disturbing new symptoms and develop an increased awareness of their risks for major chronic illnesses. Women in this stage of life are often highly motivated to improve their health and can benefit greatly from pharmacy-based preventive health care services. Although perimenopausal and menopausal women represent an important target market, some pharmacists may wish to offer more focused services within the broader arena of women's health. For example, a number of community pharmacies have developed niche services for these patients, such as osteoporosis screening, (46) breast cancer risk assessment, (50) or bioidentical HRT consulting and compounding. (59) Other pharmacy care services that may be targeted to women in midlife include smoking cessation, weight management, and dietary supplement consulting. Based on the experiences of the Mar-Main Pharmacy staff, a practical approach is to implement new services gradually, while focusing on providing high-quality, individualized service to a small number of patients. Using this strategy, Mar-Main Pharmacy has experienced tremendous growth in its bioidentical HRT services. This increase in demand for pharmacy services has arisen from word-of-mouth referrals from patients and physicians rather than formal marketing. Perimenopausal and menopausal women represent a growing and increasingly knowledgeable group of patients. Many of these women are seeking care that is individualized, responsive to their health beliefs, and designed to help them maintain a high quality of life. Providing pharmacy-based consulting services for these patients can be extremely rewarding, both professionally and personally. PMID:12269705

  11. Genetic diversity of Sardinian goat population based on microsatellites

    Directory of Open Access Journals (Sweden)

    A. Carta

    2010-01-01

    Full Text Available During the last century, the selection for production traits of the main livestock species has led to a reduction in number of local populations with consequent loss of genetic variability. In Sardinia, the genetic improvement strategy has been based on selection for the local pure breed in sheep, whereas in the other species (cattle, swine and goat, an often unplanned crossbreeding with improved breeds has been applied.

  12. Sleep and Multisystem Biological Risk: A Population-Based Study

    OpenAIRE

    Carroll, Judith E.; Irwin, Michael R.; Merkin, Sharon Stein; Seeman, Teresa E

    2015-01-01

    Background Short sleep and poor sleep quality are associated with risk of cardiovascular disease, diabetes, cancer, and mortality. This study examines the contribution of sleep duration and sleep quality on a multisystem biological risk index that is known to be associated with morbidity and mortality. Methods Analyses include a population-based sample from the Midlife Development in the United States survey recruited to the Biomarker substudy. A total of 1,023 participants aged 54.5 years (S...

  13. Encoding through patterns: regression tree-based neuronal population models.

    Science.gov (United States)

    Haslinger, Robert; Pipa, Gordon; Lewis, Laura D; Nikolić, Danko; Williams, Ziv; Brown, Emery

    2013-08-01

    Although the existence of correlated spiking between neurons in a population is well known, the role such correlations play in encoding stimuli is not. We address this question by constructing pattern-based encoding models that describe how time-varying stimulus drive modulates the expression probabilities of population-wide spike patterns. The challenge is that large populations may express an astronomical number of unique patterns, and so fitting a unique encoding model for each individual pattern is not feasible. We avoid this combinatorial problem using a dimensionality-reduction approach based on regression trees. Using the insight that some patterns may, from the perspective of encoding, be statistically indistinguishable, the tree divisively clusters the observed patterns into groups whose member patterns possess similar encoding properties. These groups, corresponding to the leaves of the tree, are much smaller in number than the original patterns, and the tree itself constitutes a tractable encoding model for each pattern. Our formalism can detect an extremely weak stimulus-driven pattern structure and is based on maximizing the data likelihood, not making a priori assumptions as to how patterns should be grouped. Most important, by comparing pattern encodings with independent neuron encodings, one can determine if neurons in the population are driven independently or collectively. We demonstrate this method using multiple unit recordings from area 17 of anesthetized cat in response to a sinusoidal grating and show that pattern-based encodings are superior to those of independent neuron models. The agnostic nature of our clustering approach allows us to investigate encoding by the collective statistics that are actually present rather than those (such as pairwise) that might be presumed. PMID:23607564

  14. Cyberbullying among Finnish adolescents – a population-based study

    OpenAIRE

    Lindfors Pirjo L; Kaltiala-Heino Riittakerttu; Rimpelä Arja H

    2012-01-01

    Abstract Background Cyberbullying, threatening or harassing another via the internet or mobile phones, does not cause physically harm and thus the consequences are less visible. Little research has been performed on the occurrence of cyberbullying among adolescents or the perception of its seriousness. Only a few population-based studies have been published, none of which included research on the witnessing of cyberbullying. Here, we examined exposure to cyberbullying during the last year, an...

  15. Screening and cervical cancer cure: population based cohort study

    OpenAIRE

    Andrae, B.; Andersson, T. M.-L.; Lambert, P C; Kemetli, L.; Silfverdal, L.; Strander, B.; Ryd, W; Dillner, J; Tornberg, S; Sparen, P

    2012-01-01

    Objective To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death. Design Nationwide population based cohort study. Setting Sweden. Participants All 1230 women with cervical cancer diagnosed during 1999-2001 in Sweden prospectively followed up for an average of 8.5 years. Main outcome measures Cure proportions and five year relative survival ratios, stratified by screening history, mode of detection, age...

  16. Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life

    OpenAIRE

    Christine Ritchie; Robin Andersen; Jessica Eng; Garrigues, Sarah K.; Gina Intinarelli; Helen Kao; Suzanne Kawahara; Kanan Patel; Lisa Sapiro; Anne Thibault; Erika Tunick; Barnes, Deborah E.

    2016-01-01

    Introduction The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers. Aims To describe adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center. Setting 152 high-risk patients (≥5 ED visits or ≥2 hosp...

  17. Arts-based and creative approaches to dementia care.

    Science.gov (United States)

    McGreevy, Jessica

    2016-02-01

    This article presents a review of arts-based and creative approaches to dementia care as an alternative to antipsychotic medications. While use of antipsychotics may be appropriate for some people, the literature highlights the success of creative approaches and the benefits of their lack of negative side effects associated with antipsychotics. The focus is the use of biographical approaches, music, dance and movement to improve wellbeing, enhance social networks, support inclusive practice and enable participation. Staff must be trained to use these approaches. A case study is presented to demonstrate how creative approaches can be implemented in practice and the outcomes that can be expected when used appropriately. PMID:26938607

  18. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Helena; Hallström, Inger; Kjaergaard, Hanne;

    2011-01-01

    Hospital-based home care (HBHC) is widely applied in Pediatric Oncology. We reviewed the potential effect of HBHC on children's physical health and risk of adverse events, parental and child satisfaction, quality of life of children and their parents, and costs. A search of PubMed, CINAHL......, and EMBASE led to identification of five studies that met the inclusion criteria. All sample sizes were small, and both the interventions and the outcome measures were diverse. Although burdened by these limitations, the studies indicate that HBHC is feasible and carries no crucial negative effects...

  19. Differences in primary health care delivery to Australia’s Indigenous population: a template for use in economic evaluations

    Directory of Open Access Journals (Sweden)

    Ong Katherine S

    2012-09-01

    Full Text Available Abstract Background Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia’s Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting. Methods The ‘Indigenous Health Service Delivery Template’ has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs, and mainstream general practitioner (GP practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS. Results The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly. Conclusions The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to

  20. Primary Care Providers’ experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle, Pharm.D.

    2012-01-01

    Full Text Available This study explored primary care providers’ (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 “MTM is just part of our team approach to the practice of medicine”: MTM as an integral part of PCPs’ practices; (2 “Frankly it’s education for the patient but it’s also education for me”: MTM services as a source of education; (3 “It’s not exactly just the pharmacist that passes out the medicines at the pharmacy”: The MTM practitioner is different from the dispensing pharmacist; (4 “So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved”: MTM services as preventative health care efforts; (5“I think that time is the big thing”: MTM pharmacists spend more time with patients; (6 “There’s an access piece, there’s an availability piece, there’s a finance piece”: MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge –medication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients

  1. Evidence-based models of care for people with epilepsy.

    LENUS (Irish Health Repository)

    Fitzsimons, Mary

    2012-02-01

    Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

  2. Chinese Health Care Products Industry's Future Strategic Positioning: Elderly Biotechnological Health Care Products Based on TCM

    OpenAIRE

    Yong Liu; Suzhen Zhang; Dazheng Wang

    2015-01-01

    In order to study future strategic positioning of elderly biotechnological health care products from biological extraction technology in Chinese health care products industries, we analyze that the development of high-quality elderly health care products is needed and still remains a challenge due to the rapid growth in biological extraction technology. In this study, with the improvement of people's living standards, health care products has become a major consumer products for elderly, Trad...

  3. The impact of market-based 'reform' on cultural values in health care.

    Science.gov (United States)

    Curtin, L L

    1999-12-01

    The many issues managed care poses for providers and health networks are crystallized in the moral problems occasioned by its shifting of the financial risks of care from insurer to provider. The issues occasioned by market-based reform include: the problems presented by clashes between public expectations and payer restrictions; the corporatization of health service delivery and the cultural shift from humanitarian endeavor to business enterprise the depersonalization of treatment as time and money constraints stretch resources, and the culture rewards efficient "business-like" behavior the underfunding of care for the poor and uninsured, even as these populations grow the restructuring of care and reengineering of healthcare roles as the emphasis shifts from quality of care to conservation of resources rapid mergers of both health plans and institutional providers with all the inherent turmoil as rules change, services are eliminated, and support services are minimized to save money the unhealthy competition inherent in market-based reform that posits profit taking and market share as the measures of successful performance the undermining of the professional ethic of advocacy the use of incentives that pander to greed and self-interest. The costs of sophisticated technologies and the ongoing care of increasingly fragile patients have pulled many other elements into what previously were considered "privileged" professional interactions. The fact that very few citizens indeed could pay out-of-pocket for the treatment and ongoing care they might need led to social involvement (few people remember that both widespread health insurance and public programs are relatively recent phenomena--only about 30 years old). However, whether in tax dollars or insurance premiums, other people's money is being spent on the patient's care. Clearly, those "other people" never intended to give either the patient or the professional open-ended access to their collective pocketbooks

  4. Health and Health Care Disparities: The Effect of Social and Environmental Factors on Individual and Population Health

    Directory of Open Access Journals (Sweden)

    Billy Thomas

    2014-07-01

    Full Text Available Recently the existence and prevalence of health and health care disparities has increased with accompanying research showing that minorities (African Americans, Hispanics/Latinos, Native Americans, and Pacific Islanders are disproportionately affected resulting in poorer health outcomes compared to non-minority populations (whites. This is due to multiple factors including and most importantly the social determinants of health which includes lower levels of education, overall lower socioeconomic status, inadequate and unsafe housing, and living in close proximity to environmental hazards; all contributing to poor health. Given the ever widening gap in health and health care disparities, the growing number of individuals living at or below the poverty level, the low number of college graduates and the growing shortage of health care professionals (especially minority the goals of this paper are to: (1 Define diversity and inclusion as interdependent entities. (2 Review the health care system as it relates to barriers/problems within the system resulting in the unequal distribution of quality health care. (3 Examine institutional and global benefits of increasing diversity in research. (4 Provide recommendations on institutional culture change and developing a diverse culturally competent healthcare workforce.

  5. Prediction of critical illness in elderly outpatients using elder risk assessment: a population-based study

    Directory of Open Access Journals (Sweden)

    Biehl M

    2016-06-01

    Full Text Available Michelle Biehl,1 Paul Y Takahashi,2 Stephen S Cha,3 Rajeev Chaudhry,2 Ognjen Gajic,1 Bjorg Thorsteinsdottir2 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, 2Division of Primary Care Internal Medicine, 3Health Sciences Research, Mayo Clinic, Rochester, MN, USA Rationale: Identifying patients at high risk of critical illness is necessary for the development and testing of strategies to prevent critical illness. The aim of this study was to determine the relationship between high elder risk assessment (ERA score and critical illness requiring intensive care and to see if the ERA can be used as a prediction tool to identify elderly patients at the primary care visit who are at high risk of critical illness. Methods: A population-based historical cohort study was conducted in elderly patients (age >65 years identified at the time of primary care visit in Rochester, MN, USA. Predictors including age, previous hospital days, and comorbid health conditions were identified from routine administrative data available in the electronic medical record. The main outcome was critical illness, defined as sepsis, need for mechanical ventilation, or death within 2 years of initial visit. Patients with an ERA score of 16 were considered to be at high risk. The discrimination of the ERA score was assessed using area under the receiver operating characteristic curve. Results: Of the 13,457 eligible patients, 9,872 gave consent for medical record review and had full information on intensive care unit utilization. The mean age was 75.8 years (standard deviation ±7.6 years, and 58% were female, 94% were Caucasian, 62% were married, and 13% were living in nursing homes. In the overall group, 417 patients (4.2% suffered from critical illness. In the 1,134 patients with ERA >16, 154 (14% suffered from critical illness. An ERA score ≥16 predicted critical illness (odds ratio 6.35; 95% confidence interval 3.51–11.48. The area under the

  6. Which European Model for Elderly Care? Equity and Cost-Effectiveness in Home Based Care in Three European Countries

    OpenAIRE

    Francesca Bettio; Giovanni Solinas

    2009-01-01

    Long term care for the elderly is growing apace in developed economies. As growth is forcing change in existing production and delivery systems of elderly care services, the question arises as to how different systems compare in terms of cost-effectiveness, equity or quality. Based on an in depth survey carried out in Denmark, Ireland and Italy – the GALCA survey – this articles compares prevailing arrangements of home based long-term care in these three countries, focussing on the overall co...

  7. HIV/aids related home based care practices among primary health care workers in Ogun state, Nigeria

    OpenAIRE

    E Amoran; O Ogunsola; O Salako; O Alausa

    2012-01-01

    Abstract Background HIV/AIDS is fast becoming a chronic disease with the advent of antiretroviral drugs, therefore making home based care key in the management of chronically ill HIV/AIDS patient. The objective of this study was to determine the perception and practice of health care workers on HIV/AIDS related home based care in the health facilities in Ogun state, Nigeria. Methods This study is an analytical cross-sectional study. A multistage cluster sampling technique was used to obtain a...

  8. Revisiting the symptom iceberg in today's primary care: results from a UK population survey

    Directory of Open Access Journals (Sweden)

    Hannaford Philip C

    2011-04-01

    Full Text Available Abstract Background Recent changes in UK primary care have increased the range of services and healthcare professionals available for advice. Furthermore, the UK government has promoted greater use of both self-care and the wider primary care team for managing symptoms indicative of self-limiting illness. We do not know how the public has been responding to these strategies. The aim of this study was to describe the current use of different management strategies in the UK for a range of symptoms and identify the demographic, socio-economic and symptom characteristics associated with these different approaches. Methods An age and sex stratified random sample of 8,000 adults (aged 18-60, drawn from twenty general practices across the UK, were sent a postal questionnaire. The questionnaire collected detailed information on 25 physical and psychological symptoms ranging from those usually indicative of minor illness to those which could be indicative of serious conditions. Information on symptom characteristics, actions taken to manage the symptoms and demographic/socio-economic details were also collected. Results Just under half of all symptoms reported resulted in respondents doing nothing at all. Lay-care was used for 35% of symptoms and primary care health professionals were consulted for 12% of symptoms. OTC medicine use was the most common lay-care strategy (used for 25% of all symptom episodes. The GP was the most common health professional consulted (consulted for 8% of all symptom episodes while use of other primary care health professionals was very small (each consulted for less than 2% of symptom episodes. The actions taken for individual symptoms varied substantially although some broad patterns emerged. Symptom characteristics (in particular severity, duration and interference with daily life were more commonly associated with actions taken than demographic or socio-economic characteristics. Conclusion While the use of lay-care was

  9. Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa

    Directory of Open Access Journals (Sweden)

    Benjamin Clark

    2013-01-01

    Full Text Available Background: South Africa is experiencing a demographic and epidemiological transition with an increase in population aged 50 years and older and rising prevalence of non-communicable diseases. This, coupled with high HIV and tuberculosis prevalence, puts an already weak health service under greater strain. Objective: To measure self-reported chronic health conditions and chronic disease risk factors, including smoking and alcohol use, and to establish their association with health care use in a rural South African population aged 50 years or older. Methods: The Study on Global Ageing and Adult Health (SAGE, in collaboration with the INDEPTH Network and the World Health Organization, was implemented in the Agincourt sub-district in rural northeast South Africa where there is a long-standing health and socio-demographic surveillance system. Household-based interviews were conducted in a random sample of people aged 50 years and older. The interview included questions on self-reported health and health care use, and some physical measurements, including blood pressure and anthropometry. Results: Four hundred and twenty-five individuals aged 50 years or older participated in the study. Musculoskeletal pain was the most prevalent self-reported condition (41.7%; 95% Confidence Interval [CI] 37.0–46.6 followed by hypertension (31.2%; 95% CI 26.8–35.9 and diabetes (6.1%; 95% CI 4.1–8.9. All self-reported conditions were significantly associated with low self-reported functionality and quality of life, 57% of participants had hypertension, including 44% of those who reported normal blood pressure. A large waist circumference and current alcohol consumption were associated with high risk of hypertension in men, whereas in women, old age, high waist–hip ratio, and less than 6 years of formal education were associated with high risk of hypertension. Only 45% of all participants reported accessing health care in the last 12 months. Those who reported

  10. Workplace-based assessment in a primary-care setting.

    Science.gov (United States)

    Hecker, Kent G; Norris, Jill; Coe, Jason B

    2012-01-01

    Workplace-based assessment (WBA) is the process of directly observing students' work within a clinical setting, assessing their performance, and providing specific, goal oriented feedback. Assessment methods used for workplace-based assessment include tools developed for clinical interaction (e.g., the mini clinical evaluation exercise [mini-CEX]), for procedural or technical skills (e.g., the direct observation of procedural skills [DOPS]), and multi-source feedback tools to assess interpersonal and technical skills. While several of these assessment methods are being adopted by veterinary schools to evaluate students' progress through their clinical rotations, there is little reported at this time about their utility and effectiveness within the veterinary context. This article provides an introduction to the use of these tools and offers guidance in selecting appropriate methods for assessment in the primary health care setting. PMID:22951458

  11. Immigrant mothers and access to prenatal care: evidence from a regional population study in Italy

    OpenAIRE

    Chiavarini, Manuela; Lanari, Donatella; Minelli, Liliana; Pieroni, Luca; Salmasi, Luca

    2016-01-01

    Objectives We addressed the question of whether use of adequate prenatal care differs between foreign-born and Italian mothers and estimated the extent to which unobservable characteristics bias results. Setting This study is on primary care and especially on adequate access to prenatal healthcare services by immigrant mothers. Participants Approximately 37 000 mothers of both Italian and foreign nationality were studied. Data were obtained from the Standard Certificate of Live Birth between ...

  12. Evaluation of Demands and Needs For Dental Care in a Sample of the Turkish Population

    OpenAIRE

    Pekiner, Filiz; Gumru, Birsay; Borahan, Mehmet Oguz; Aytugar, Emre

    2010-01-01

    Objectives: To evaluate the demands and needs for dental care and to identify the level of dental and periodontal status in patients of different age groups visiting the Faculty of Dentistry, Marmara University, Istanbul, Turkey. Methods: A total of 1000 first-visit patients (517 female and 483 male) were examined and questioned. The main complaint of each patient was recorded and considered to be a measure of demand for dental care. The World Health Organization’s (WHO) basic methods were us...

  13. Studies of Health and Long-Term Care Expenditure Growth in Aging Populations

    OpenAIRE

    de Meijer, Claudine

    2012-01-01

    textabstractIn recent decades, elderly populations in most developed countries have increased considerably, both in absolute and relative terms. This growth of the elderly share of the population is mainly attributable to two demographic transitions: the (simultaneous) increase in longevity and decrease in fertility. Additionally, for some European countries a third cause of population aging can be distinguished: the aging of the baby boom generation. The extent to which this third demographi...

  14. Chinese Health Care Products Industry's Future Strategic Positioning: Elderly Biotechnological Health Care Products Based on TCM

    Directory of Open Access Journals (Sweden)

    Yong Liu

    2015-02-01

    Full Text Available In order to study future strategic positioning of elderly biotechnological health care products from biological extraction technology in Chinese health care products industries, we analyze that the development of high-quality elderly health care products is needed and still remains a challenge due to the rapid growth in biological extraction technology. In this study, with the improvement of people's living standards, health care products has become a major consumer products for elderly, Traditional Chinese Medicine (TCM as a traditional medicine health and health culture, is health care products developed an important theoretical basis and effective material source, development with biological extraction technology can promote future strategic positioning of elderly biotechnological health care products in Chinese health care products industry.

  15. Confidentiality or continuity? Family caregivers' experiences with care for HIV/AIDS patients in home-based care in Lesotho.

    Science.gov (United States)

    Makoae, Mokhantso G; Jubber, Ken

    2008-04-01

    In the context of poor access to antiretroviral therapies in sub-Saharan Africa, the minimum treatment package intended to treat opportunistic infections common with HIV infection is inadequate but appealing, since it presumes universal coverage of medical care for patients living with HIV and AIDS. The overall objective of this study was to analyse the challenges which family caregivers encountered in home-based care when they tried to access medical treatment for home-based AIDS patients in the context of confidentiality and limited medical care. A qualitative study using in-depth interviews with a sample of 21 family caregivers -16 females and 5 males aged between 23 and 85 years was conducted with the assistance of health personnel in two hospitals in Lesotho. Using the concept of continuity of care, this article discusses the experiences of family caregivers about home care, including their experiences of adherence to confidentiality by health care professionals and non-disclosure of AIDS as the context of illness, the circumstances under which the caregivers initiated caregiving and sought medical care, and how these factors could be stressors in caregiving. There was continuity of care where the caregivers obtained hospital support. However, when confidentiality was adhered to the caregivers were frustrated by lack of information, disrupted treatment, exclusion of their perspectives in medical care, failure to secure hospitalisation, ambiguous goals and non-responsiveness, so that continuity of care was jeopardised. Thus it can be concluded that professional-assisted disclosure benefited the patients because it facilitated continuity of care through the caregivers. PMID:18496618

  16. Is accessing dental care becoming more difficult? Evidence from Canada's middle-income population.

    Directory of Open Access Journals (Sweden)

    Chantel Ramraj

    Full Text Available OBJECTIVE: To explore trends in access to dental care among middle-income Canadians. METHODS: A secondary data analysis of six Canadian surveys that collected information on dental insurance coverage, cost-barriers to dental care, and out-of-pocket expenditures for dental care was conducted for select years from 1978 to 2009. Descriptive analyses were used to outline and compare trends among middle-income Canadians with other levels of income as well as national averages. RESULTS: By 2009, middle-income Canadians had the lowest levels of dental insurance coverage (48.7% compared to all other income groups. They reported the greatest increase in cost-barriers to dental care, from 12.6% in 1996 to 34.1% by 2009. Middle-income Canadians had the largest rise in out-of-pocket expenditures for dental care since 1978. CONCLUSIONS: This study suggests that affordability issues in accessing dental care are no longer just a problem for the lowest income groups in Canada, but are now impacting middle-income earners as a consequence of their lack of, or decreased access to, comprehensive dental insurance.

  17. Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines

    Directory of Open Access Journals (Sweden)

    Baade Peter

    2009-05-01

    Full Text Available Abstract Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Results Only 8 (3% of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost. A further 119 (49% could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status. Another 88 (36% required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases and 28 (11.5% required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. Conclusion The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.

  18. Do symptom-based questions help screen COPD among Chinese populations?

    Science.gov (United States)

    Zhang, Qun; Wang, Min; Li, Xiaona; Wang, Hong; Wang, Jianming

    2016-01-01

    Spirometry is required to confirm a chronic obstructive pulmonary disease (COPD) diagnosis, but it is difficult to perform in resource-limited settings. This study aimed to evaluate symptom-based questions for screening of individuals with COPD among Chinese populations. We recruited 3969 adult subjects from the First Affiliated Hospital of Nanjing Medical University. Spirometric measurements of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were collected to confirm the COPD diagnosis. A symptom-based questionnaire was administered to collect data related to COPD. The sensitivity and specificity together with the area under the curve (AUC) were calculated. The traditional IPAG eight-item questionnaire yielded an AUC of 0.80(95% CI: 0.78-0.82), with a sensitivity of 67.8% and specificity of 76.8%. After removing and adding questions, a revised eleven-item questionnaire exhibited a significantly increased diagnostic accuracy, with an AUC of 0.85(95% CI: 0.84-0.87). At the inflection point of the curve, it demonstrated a sensitivity of 82.5% and specificity of 72.9%. We showed that the revised symptom-based questionnaire could be used to screen individuals with a high likelihood of COPD among Chinese populations. Further validation is required before we claim it is a useful diagnostic for primary care populations. PMID:27456860

  19. Costs and prospects for home based Long Term Care in Northern Italy: the Galca survey

    OpenAIRE

    Bettio, Francesca; Mazzotta, Fernanda; Solinas, Giovanni

    2007-01-01

    An important issue in the design of sustainable Long Term Care policies is the relative social cost of community or home based care versus institutional care. Here we undertake this cost comparison making use of the findings from the GALCA surveys on Long Term Care in Denmark, Ireland and Italy but confining attention to Italy. The survey for Italy was conducted in the municipality of Modena that may be considered broadly representative of Long Term Care conditions in the North of the country...

  20. Cost Analysis of Prenatal Care Using the Activity-Based Costing Model: A Pilot Study

    OpenAIRE

    Gesse, Theresa; Golembeski, Susan; Potter, Jonell

    1999-01-01

    The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.

  1. Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

    Directory of Open Access Journals (Sweden)

    Nishikitani Mariko

    2010-06-01

    Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.

  2. Preventive Care Use among the Belgian Elderly Population: Does Socio-Economic Status Matter?

    Directory of Open Access Journals (Sweden)

    Sarah Hoeck

    2013-12-01

    Full Text Available Objective: To analyze the association between influenza and pneumococcus vaccination and blood cholesterol and blood sugar measurement by Belgian elderly respondents (≥65 years and socio-demographic characteristics, risk factors, health status and socio-economic status (SES. Methods: A cross-sectional study based on 4,544 non-institutionalized elderly participants of the Belgian Health Interview Surveys 2004 and 2008. Multivariate logistic regression models were constructed to examine the independent effect of socio-demographic characteristics, risk factors, health status and SES on the four preventive services. Results: After adjustment for age, sex, region, survey year, living situation, risk factors (body mass index, smoking status, physical activity and health status (self-assessed health and longstanding illness lower educated elderly were significantly less likely to report a blood cholesterol and blood sugar measurement. For instance, elderly participants with no degree or only primary education were less likely to have had a cholesterol and blood sugar measurement compared with those with higher education. Pneumococcus vaccination was not related to educational level, but lower income groups were more likely to have had a pneumococcus immunization. Influenza vaccination was not significantly related to SES. Conclusion: The results highlight the need to promote cholesterol and blood sugar measurement for lower SE groups, and pneumococcus immunization for the entire elderly population. Influenza immunization seems to be equally spread among different SE groups.

  3. Genomic-based nursing care for women with Turner Syndrome: genomic-based nursing care Atención de enfermería basada en genómica para las mujeres con Síndrome de Turner Cuidado de enfermagem baseado em genômica para mulheres com Síndrome de Turner

    OpenAIRE

    Milena Flória-Santos; Ester Silveira Ramos

    2006-01-01

    Biologic and technologic advances generated from The Human Genome Project are having a dramatic impact on the expanding role of nurses in current health care practice. New genetic research needs to be transformed rapidly into clinical protocols with recommendations for delivering care to targeted populations. Nurses can contribute significantly, as part of an interdisciplinary approach, to translate genome-based knowledge into benefits for health care and society. In this context, we describe...

  4. 76 FR 21372 - Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions...

    Science.gov (United States)

    2011-04-15

    ... the Medicare Community-Based Care Transitions Program AGENCY: Centers for Medicare & Medicaid Services... to participate in the Medicare Community-based Care Transitions Program, which was authorized by... Tiongson, (410) 786-0342 or by e-mail at CareTransitions@cms.hhs.gov . ADDRESSES: Proposals should...

  5. Is there a demand for physical activity interventions provided by the health care sector? Findings from a population survey

    Directory of Open Access Journals (Sweden)

    Walter Lars

    2010-01-01

    Full Text Available Abstract Background Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity. Methods A regional public health survey was mailed to 13 440 adults (aged 18-84 years living in Östergötland County (Sweden in 2006. The survey was part of the regular effort by the regional Health Authorities. Results About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37% had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support. Conclusions These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for

  6. Mosquito population dynamics from cellular automata-based simulation

    Science.gov (United States)

    Syafarina, Inna; Sadikin, Rifki; Nuraini, Nuning

    2016-02-01

    In this paper we present an innovative model for simulating mosquito-vector population dynamics. The simulation consist of two stages: demography and dispersal dynamics. For demography simulation, we follow the existing model for modeling a mosquito life cycles. Moreover, we use cellular automata-based model for simulating dispersal of the vector. In simulation, each individual vector is able to move to other grid based on a random walk. Our model is also capable to represent immunity factor for each grid. We simulate the model to evaluate its correctness. Based on the simulations, we can conclude that our model is correct. However, our model need to be improved to find a realistic parameters to match real data.

  7. An ICT-Based Diabetes Management System Tested for Health Care Delivery in the African Context

    OpenAIRE

    Claude Takenga; Rolf-Dietrich Berndt; Olivier Musongya; Joël Kitero; Remi Katoke; Kakule Molo; Basile Kazingufu; Malikwisha Meni; Mambo Vikandy; Henri Takenga

    2014-01-01

    The demand for new healthcare services is growing rapidly. Improving accessibility of the African population to diabetes care seems to be a big challenge in most countries where the number of care centers and medical staff is reduced. Information and communication technologies (ICT) have great potential to address some of these challenges faced by several countries in providing accessible, cost-effective, and high-quality health care services. This paper presents the Mobil Diab system which i...

  8. A Population-Based Clinical Trial of Irinotecan and Carboplatin

    Directory of Open Access Journals (Sweden)

    Derick Lau

    2009-01-01

    Full Text Available Purpose. Phase I trials of anticancer drugs are commonly conducted using the method of modified Fibonacci. We have developed a population-based design for phase I trials of combining anticancer drugs such as irinotecan and carboplatin. Patients and Methods. Intrapatient dose escalation of irinotecan and carboplatin was performed according to a predetermined schema to reach individual dose-limiting toxicity (DLT in 50 patients with solid tumors refractory to previous chemotherapy. The individual toxicity-limiting dose levels were analyzed for normal distribution using the method of Ryan-Joiner and subsequently used to determine a population-based maximum tolerated dose (pMTD. For comparison, a simulation study was performed using the method of modified Fibonacci. Results. The most common dose-limiting toxicities (DLTs included neutropenia (58%, thrombocytopenia (16%, and diarrhea (8%. The frequency of individual toxicity-limiting dose levels of 50 patients approximated a normal distribution. The dose levels associated with individual limiting toxicities ranged from level 1 (irinotecan 100 mg/m2 and carboplatin AUC = 4 mg/mL x min to level 8 (irinotecan 350 mg/m2 and carboplatin AUC = 6. The pMTD was determined to be dose level 3 (150 mg/m2 for irinotecan and AUC = 5 for carboplatin. In contrast, the MTD was determined to be dose level 4 (200 mg/m2 for irinotecan and AUC 5 for carboplatin by modified-Fibonacci simulation. Conclusions. The population-based design of phase I trial allows optimization of dose intensity and derivation of a pMTD. The pMTD has been applied in phase II trial of irinotecan and carboplatin in patients with small-cell lung cancer.

  9. Wealth Inequality and Mental Disability Among the Chinese Population: A Population Based Study

    Directory of Open Access Journals (Sweden)

    Zhenjie Wang

    2015-10-01

    Full Text Available In the study described herein, we investigated and explored the association between wealth inequality and the risk of mental disability in the Chinese population. We used nationally represented, population-based data from the second China National Sample Survey on Disability, conducted in 2006. A total of 1,724,398 study subjects between the ages of 15 and 64, including 10,095 subjects with mental disability only, were used for the analysis. Wealth status was estimated by a wealth index that was derived from a principal component analysis of 10 household assets and four other variables related to wealth. Logistic regression analysis was used to estimate the odds ratio (OR and 95% confidence interval (CI for mental disability for each category, with the lowest quintile category as the referent. Confounding variables under consideration were age, gender, residence area, marital status, ethnicity, education, current employment status, household size, house type, homeownership and living arrangement. The distribution of various types and severities of mental disability differed significantly by wealth index category in the present population. Wealth index category had a positive association with mild mental disability (p for trend <0.01, but had a negative association with extremely severe mental disability (p for trend <0.01. Moreover, wealth index category had a significant, inverse association with mental disability when all severities of mental disability were taken into consideration. This study’s results suggest that wealth is a significant factor in the distribution of mental disability and it might have different influences on various types and severities of mental disability.

  10. Condition based payment: improving care of chronic illness

    OpenAIRE

    DiPiero, Albert; Sanders, David G

    2005-01-01

    Fee-for-service is more than a payment method; it defines the method of care. Fee-for-condition—a payment method that rewards superior results and encourages innovation—could greatly improve care for chronic conditions

  11. Potential Medicaid Cost Savings from Maternity Care Based..

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce...

  12. A Concept Analysis of Spiritual Care Based on Islamic Sources

    OpenAIRE

    Rahmatollah Marzband; Seyed Hamzeh Hosseini; Zeinab Hamzehgardeshi

    2016-01-01

    The cultural and religious resources of every community influence the definition of spiritual care. This paper discusses a concept analysis of spiritual care in an Islamic context. The Quran, narrations (Shie’h) and commentarial books were searched, for information data. The data was used to provide a comprehensive definition of the concept of spiritual care from Islamic literature. We identified the attributes, antecedents and consequences of spiritual care according to Roger’s concept analy...

  13. Atrial fibrillation in a primary care population: how close to NICE guidelines are we?

    LENUS (Irish Health Repository)

    Loo, Bryan

    2009-06-01

    The National Institute for Health and Clinical Excellence (NICE) guidelines for the management of atrial fibrillation were published in June 2006. It was anticipated that they would potentially lead to increased demand for echocardiography (ECHO), increased access to secondary care services (for example for cardioversion), and require additional resources for monitoring anticoagulation. A primary care survey was therefore initiated in South Devon, in advance of publication of the guidelines as a snapshot of existing practice, to determine any additional resources and education required to meet the new standards. The main aim was to determine what proportion of patients were managed exclusively in primary care, how frequently patients were investigated by ECHO and whether anticoagulation was being appropriately targeted at patients at high risk of thromboembolic events.

  14. Randomized Trial of a Family-based, Automated, Conversational Obesity Treatment Program for Underserved Populations

    Science.gov (United States)

    Wright, J. A.; Phillips, B.D.; Watson, B.L.; Newby, P.K.; Norman, G. J.; Adams, W.G.

    2013-01-01

    Objective To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care and delivered using interactive voice technology (IVR) to families from underserved populations. Design and Methods Fifty parent-child dyads (child 9–12 yrs, BMI >95th percentile) were recruited from a pediatric primary care clinic and randomized to either an IVR or a wait-list control (WLC) group. The majority were lower-income, African-American (72%) families. Dyads received IVR calls for 12 weeks. Call content was informed by two evidenced-based interventions. Anthropometric and behavioral variables were assessed at baseline and 3 mo follow-up. Results Forty-three dyads completed the study. IVR parents ate 1 cup more fruit than WLC (p 75% agreed that the calls were useful, made for people like them, credible, and helped them eat healthy foods. Conclusion An obesity treatment program delivered via IVR may be an acceptable and feasible resource for families from underserved populations. PMID:23512915

  15. Efficacy of a Morinda citrifolia Based Skin Care Regimen

    Directory of Open Access Journals (Sweden)

    Brett J. West

    2012-04-01

    Full Text Available A six week clinical trial of a Morinda citrifolia (noni based skin care regimen was conducted with 49 women, ages 38 to 55 years. Daily application of three product formulations to the face and neck resulted in significant reductions in lateral canthal fine lines and wrinkles (crow’s feet, as measured by technician scoring and digital image analysis. Use of the regimen also improved skin elasticity and firmness Cutometer® measurements. No evidence of skin irritation was present in any participant at any time during the trial. A study questionnaire revealed that the measured improvements were visibly perceptible to more than 90% of the participants. The trial results substantiate traditional uses of the noni plant to improve skin health.

  16. Association between Anthropometric Measures and Bone Mineral Density: Population-Based Study

    Directory of Open Access Journals (Sweden)

    HR Aghaei Meybodi

    2011-06-01

    Full Text Available "nBackground: Osteoporosis is a major public health concern around the world. It has been shown that bone mineral den­sity is correlated to anthropometric measures like height and weight, but this association may vary depending on ethnic and environmental factors. The aim of this study was to identify probable relations between anthropometric measures and bone mineral density."nMethods: In this population-based study, we compiled the data collected from Iranian Multicenter Osteoporosis Study to assess the possible associations between different anthropometric indices and bone mineral density at femur and lumbar spine. The gathered data was analyzed using t-test and one way ANOVA."nResults: Data was available for 4445 subjects, consisting 1900 males (42.7% and 2545 females (57.3%. We observed statistically significant correlations between bone mineral density and height, weight, waist circumference, hip circumfer­ence, waist to hip ratio and body mass index (BMI. Based on the result of linear regression modeling studies, BMI could be considered an independent predictor of bone mineral density."nConclusion: Iranian population shows similar measures compared to analogous studies in other populations. Lower weight should be carefully considered as a predisposing factor for bone loss and osteoporosis.

  17. Preventable trauma deaths: from panel review to population based-studies

    Directory of Open Access Journals (Sweden)

    Vesconi Sergio

    2006-04-01

    Full Text Available Abstract Preventable trauma deaths are defined as deaths which could be avoided if optimal care has been delivered. Studies on preventable trauma deaths have been accomplished initially with panel reviews of pre-hospital and hospital charts. However, several investigators questioned the reliability and validity of this method because of low reproducibility of implicit judgments when they are made by different experts. Nevertheless, number of studies were published all around the world and ultimately gained some credibility, particularly in regions where comparisons were made before and after trauma system implementation with a resultant fall in mortality. During the last decade of century the method of comparing observed survival with probability of survival calculated from large trauma registries has obtained popularity. Preventable trauma deaths were identified as deaths occurred notwithstanding a high calculated probability of survival. In recent years, preventable trauma deaths studies have been replaced by population-based studies, which use databases representative of overall population, therefore with high epidemiologic value. These databases contain readily available information which carry out the advantage of objectivity and large numbers. Nowadays, population-based researches provide the strongest evidence regarding the effectiveness of trauma systems and trauma centers on patient outcomes.

  18. Population-based study of acquired cerebellar ataxia in Al-Kharga district, New Valley, Egypt

    Directory of Open Access Journals (Sweden)

    Farghaly WMA

    2011-04-01

    Full Text Available Wafaa MA Farghaly1, Hamdy N El-Tallawy1, Ghaydaa A Shehata1, Tarek A Rageh1, Nabil Abdel Hakeem2, Noha M Abo-Elfetoh11Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt; 2Al Azhar University, Assiut Branch, EgyptBackground: The aim of this research was to determine the prevalence and etiology of acquired ataxia in Al-Kharga district, New Valley, Egypt.Methods: A population-based study of acquired ataxia was conducted in a defined geographical region with a total population of 62,583. A door-to-door survey was used to identify cases of acquired cerebellar ataxia. Patients with acquired cerebellar ataxia at any age and of both genders were included. Cases of known inherited cerebellar ataxia, acquired neurological disorders with ataxia as a minor feature, or pure acquired sensory ataxia, were excluded.Results: We identified 17 cases of acquired ataxia, of which eight were vascular, six were an ataxic cerebral palsy subtype, and three involved postencephalitic ataxia. The crude prevalence rate for acquired ataxia was 27.16/100,000 (95% confidence interval [CI]: 14.3–40.1. The mean age of the patients at interview was 31.8 (range 4–72 years, with a male to female ratio of 2.1:1. The most frequent presenting complaint was disturbance of gait (90.7%. The majority (92% were ambulatory, but only 9.3% were independently self-caring.Conclusion: This population-based study provides an insight into acquired cerebellar ataxia within a defined region, and may inform decisions about the rational use of health care resources for patients with acquired cerebellar ataxia. The most common causes of acquired cerebellar ataxia in this region were cerebrovascular injury and cerebral palsy.Keywords: acquired cerebellar ataxia, prevalence, subtypes, Egypt

  19. Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population

    OpenAIRE

    McLean, Kendra; Day, Lesley; Dalton, Andrew

    2015-01-01

    Background Falls among older people are of growing concern globally. Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades. The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective, of a group-based exercise program compared to routine care for falls preventio...

  20. Monitoring of osteoporosis among geriatric population in the primary care service

    Directory of Open Access Journals (Sweden)

    Šipovac Dragana

    2014-01-01

    Full Text Available Introduction. Osteoporosis is a chronic, progressive bone disease which leads to a reduction in bone mineral density and disruption of bone micro-architecture. Patients with osteoporosis have an increased risk of fractures caused by “small trauma” - stresses which would not normally cause fracture in a non-osteoporotic individual. This study was aimed at determining the incidence of osteoporosis in geriatric population, crucial demographic parameters (gender and age structure in patients, presence of comorbidities, and the most common drug choice in treatment of osteoporosis. Material and Methods. A retrospective study was conducted in the period from August 1st, 2012 to May 12th, 2014 and it included 526 patients over 65 years of age who were diagnosed to have osteoporosis based on clinical findings (presence/absence of pathological fractures, laboratory tests and osteodensitometry. Data were analyzed by using standard statistical methods and statistical significance was assessed by x2 and t - test. Results. The most affected patients were women (91%. The incidence of pathological fractures was 31.80%. The presence of two or more fractures caused by a “small trauma” was determined in 13.6%. Cardiovascular comorbidities dominated in 72.70% of cases. The most common therapeutic choice was the bisphosphonates, being administered in 77% along with the simultaneous use of vitamin D analogs - alfacalciferol (13.6%, cholecalciferol (40.9%, calcium carbonate + cholecalciferol (22.7%. Conclusion. Osteoporosis shows predominance in females aged 65-70 years. Comorbidities do not increase the risk of disease but significantly reduce the quality of life in patients. Bisphosphonates are the most common drug choice with the simultaneous use of calcium and vitamin D analogs.

  1. Young adults' trajectories of Ecstasy use: a population based study.

    Science.gov (United States)

    Smirnov, Andrew; Najman, Jake M; Hayatbakhsh, Reza; Plotnikova, Maria; Wells, Helene; Legosz, Margot; Kemp, Robert

    2013-11-01

    Young adults' Ecstasy use trajectories have important implications for individual and population-level consequences of Ecstasy use, but little relevant research has been conducted. This study prospectively examines Ecstasy trajectories in a population-based sample. Data are from the Natural History Study of Drug Use, a retrospective/prospective cohort study conducted in Australia. Population screening identified a probability sample of Ecstasy users aged 19-23 years. Complete data for 30 months of follow-up, comprising 4 time intervals, were available for 297 participants (88.4% of sample). Trajectories were derived using cluster analysis based on recent Ecstasy use at each interval. Trajectory predictors were examined using a generalized ordered logit model and included Ecstasy dependence (World Mental Health Composite International Diagnostic Instrument), psychological distress (Hospital Anxiety Depression Scale), aggression (Young Adult Self Report) and contextual factors (e.g. attendance at electronic/dance music events). Three Ecstasy trajectories were identified (low, intermediate and high use). At its peak, the high-use trajectory involved 1-2 days Ecstasy use per week. Decreasing frequency of use was observed for intermediate and high-use trajectories from 12 months, independently of market factors. Intermediate and high-use trajectory membership was predicted by past Ecstasy consumption (>70 pills) and attendance at electronic/dance music events. High-use trajectory members were unlikely to have used Ecstasy for more than 3 years and tended to report consistently positive subjective effects at baseline. Given the social context and temporal course of Ecstasy use, Ecstasy trajectories might be better understood in terms of instrumental rather than addictive drug use patterns. PMID:23899430

  2. DIVERGENCE BETWEEN POPULATIONS OF A MONOGAMOUS POLYCHAETE WITH MALE PARENTAL CARE: PREMATING ISOLATION AND CHROMOSOME VARIATION

    Science.gov (United States)

    Low dispersal and sexual selection are characteristic of the coastal polychaete Nereis acuminata Ehlers 1868 [also known as Nereis arenaceodentata Moore 1903 and Nereis (Neanthes) caudata elle Chiaje 1841]. e assessed levels of premating isolation between populations of this poly...

  3. Enhanced statistical tests for GWAS in admixed populations: assessment using African Americans from CARe and a Breast Cancer Consortium.

    Directory of Open Access Journals (Sweden)

    Bogdan Pasaniuc

    2011-04-01

    Full Text Available While genome-wide association studies (GWAS have primarily examined populations of European ancestry, more recent studies often involve additional populations, including admixed populations such as African Americans and Latinos. In admixed populations, linkage disequilibrium (LD exists both at a fine scale in ancestral populations and at a coarse scale (admixture-LD due to chromosomal segments of distinct ancestry. Disease association statistics in admixed populations have previously considered SNP association (LD mapping or admixture association (mapping by admixture-LD, but not both. Here, we introduce a new statistical framework for combining SNP and admixture association in case-control studies, as well as methods for local ancestry-aware imputation. We illustrate the gain in statistical power achieved by these methods by analyzing data of 6,209 unrelated African Americans from the CARe project genotyped on the Affymetrix 6.0 chip, in conjunction with both simulated and real phenotypes, as well as by analyzing the FGFR2 locus using breast cancer GWAS data from 5,761 African-American women. We show that, at typed SNPs, our method yields an 8% increase in statistical power for finding disease risk loci compared to the power achieved by standard methods in case-control studies. At imputed SNPs, we observe an 11% increase in statistical power for mapping disease loci when our local ancestry-aware imputation framework and the new scoring statistic are jointly employed. Finally, we show that our method increases statistical power in regions harboring the causal SNP in the case when the causal SNP is untyped and cannot be imputed. Our methods and our publicly available software are broadly applicable to GWAS in admixed populations.

  4. The protocols for the 10/66 dementia research group population-based research programme

    Directory of Open Access Journals (Sweden)

    Salas Aquiles

    2007-07-01

    Full Text Available Abstract Background Latin America, China and India are experiencing unprecedentedly rapid demographic ageing with an increasing number of people with dementia. The 10/66 Dementia Research Group's title refers to the 66% of people with dementia that live in developing countries and the less than one tenth of population-based research carried out in those settings. This paper describes the protocols for the 10/66 population-based and intervention studies that aim to redress this imbalance. Methods/design Cross-sectional comprehensive one phase surveys have been conducted of all residents aged 65 and over of geographically defined catchment areas in ten low and middle income countries (India, China, Nigeria, Cuba, Dominican Republic, Brazil, Venezuela, Mexico, Peru and Argentina, with a sample size of between 1000 and 3000 (generally 2000. Each of the studies uses the same core minimum data set with cross-culturally validated assessments (dementia diagnosis and subtypes, mental disorders, physical health, anthropometry, demographics, extensive non communicable disease risk factor questionnaires, disability/functioning, health service utilisation, care arrangements and caregiver strain. Nested within the population based studies is a randomised controlled trial of a caregiver intervention for people with dementia and their families (ISRCTN41039907; ISRCTN41062011; ISRCTN95135433; ISRCTN66355402; ISRCTN93378627; ISRCTN94921815. A follow up of 2.5 to 3.5 years will be conducted in 7 countries (China, Cuba, Dominican Republic, Venezuela, Mexico, Peru and Argentina to assess risk factors for incident dementia, stroke and all cause and cause-specific mortality; verbal autopsy will be used to identify causes of death. Discussion The 10/66 DRG baseline population-based studies are nearly complete. The incidence phase will be completed in 2009. All investigators are committed to establish an anonymised file sharing archive with monitored public access. Our

  5. Copula-Based Approach to Synthetic Population Generation.

    Science.gov (United States)

    Jeong, Byungduk; Lee, Wonjoon; Kim, Deok-Soo; Shin, Hayong

    2016-01-01

    Generating synthetic baseline populations is a fundamental step of agent-based modeling and simulation, which is growing fast in a wide range of socio-economic areas including transportation planning research. Traditionally, in many commercial and non-commercial microsimulation systems, the iterative proportional fitting (IPF) procedure has been used for creating the joint distribution of individuals when combining a reference joint distribution with target marginal distributions. Although IPF is simple, computationally efficient, and rigorously founded, it is unclear whether IPF well preserves the dependence structure of the reference joint table sufficiently when fitting it to target margins. In this paper, a novel method is proposed based on the copula concept in order to provide an alternative approach to the problem that IPF resolves. The dependency characteristic measures were computed and the results from the proposed method and IPF were compared. In most test cases, the proposed method outperformed IPF in preserving the dependence structure of the reference joint distribution. PMID:27490692

  6. Copula-Based Approach to Synthetic Population Generation

    Science.gov (United States)

    Kim, Deok-Soo

    2016-01-01

    Generating synthetic baseline populations is a fundamental step of agent-based modeling and simulation, which is growing fast in a wide range of socio-economic areas including transportation planning research. Traditionally, in many commercial and non-commercial microsimulation systems, the iterative proportional fitting (IPF) procedure has been used for creating the joint distribution of individuals when combining a reference joint distribution with target marginal distributions. Although IPF is simple, computationally efficient, and rigorously founded, it is unclear whether IPF well preserves the dependence structure of the reference joint table sufficiently when fitting it to target margins. In this paper, a novel method is proposed based on the copula concept in order to provide an alternative approach to the problem that IPF resolves. The dependency characteristic measures were computed and the results from the proposed method and IPF were compared. In most test cases, the proposed method outperformed IPF in preserving the dependence structure of the reference joint distribution. PMID:27490692

  7. Epidemiological study on Buccal Health in the 12 years old population of Health Care Area VIII in Cienfuegos.

    Directory of Open Access Journals (Sweden)

    Yumaidi Colina Sánchez

    2007-08-01

    Full Text Available Background: The 12 years-old children population is worldwide taken as a reference age to compare the buccal health condition of different countries, by means of various indicators that measure the presence of the main buccal diseases. The knowledge of these epidemiological profiles generates information to guide the services planning policies of the Primary Health Care. Objective: To characterize 12 years-old population's buccal health condition. Methods: Cross- sectional descriptive correlative study with a stratified probabilistic sample of 90 children starting from a universe conformed by the 269 adolescents that constitute the total of the 12 years old population of the Health Care Area VIII in Cienfuegos municipality. Pearson’s chi-square and Mantel-Haenszel lineal tendency tests were used with the determination of the relative risk and reliance intervals of 95%. Results: The decay prevalence reached 54, 4%. The COP-D index was 2, 45 being the decayed component the major percentage with 4.6%. The periodontal disease was more frequent in boys than in girls, with 54, 9% and 30, 8% respectively. 80,9% of the segments is healthy. In those affected, the calculation prevailed in 11,7%. It was determined that faulty obturations, inheritance and faulty buccal hygiene were the most affecting risk factors for children with decays, while in the periodontal disease it was faulty buccal hygiene. Malocclusions presented a prevalence rate of 40%. Out of which, 55,6% required secondary level attention. Those with habits present a risk 2 times superior of making sick. The sick epidemiological category was present in 77,8% of the total. Conclusions: We emphasize the prevention need as core issue of the primary medical care in the world today; being the General-Integral Dentist a transforming agent that according to his/her formation is capable to assume the existent health problem and to modify it positively, acting from the earliest ages.

  8. Psychiatric symptomatology and personality in a population of primary care patients

    Directory of Open Access Journals (Sweden)

    Maja Biała

    2014-06-01

    Full Text Available introduction and objective. Psychiatric disorders (and their high rates of prevalence in primary care have been widely analyzed, but the problem of underdiagnosis remains unresolved. This becomes increasingly more important in rural health centres in the face of lack of epidemiological data from these centres. The aim of this study is focused on the relationship between general health, psychiatric symptomatology and personality characteristics in the context of an adequate diagnosis. materials and methods. 518 primary care patients in 6 Polish urban clinical centres were studied using (in order of administration: a sociodemographic questionnaire, the General Health Questionnaire (GHQ-28 and Eysenck Personality Questionnaire (EPQ-R. results. The investigated sample was representative for urban primary care patients. The findings confirmed a significant association between neuroticism and general health. The strongest relation with current functioning and mental distress of the patients (GHQ general score was observed in case of symptoms of anxiety and insomnia. The symptoms of depression may be the most difficult to identify (psychiatric symptoms assessed using GHQ sub-scales. conclusions. According to the GHQ assumptions and confirmed by the presented study, sub-threshold psychiatric symptomatology affects the functioning of primary care patients and their general health. This correlates with personality factors. Improving adequacy of diagnosis becomes extremely important, as it may often be the only chance for appropriate therapy of mental problems for people living in rural areas due to lower availability of specialistic mental services. Further epidemiological studies concerning rural primary care and prevalence of the spectrum of mental disorders need to be conducted.

  9. The impact of a regional patient-centered medical home initiative on cost of care among commercially insured population in the US

    OpenAIRE

    Maeng DD; Sciandra JP; Tomcavage JF

    2016-01-01

    Daniel Dukjae Maeng, Joann P Sciandra, Janet F Tomcavage Geisinger Health System, Danville, PA, USAAbstract: The impact of a patient-centered medical home (PCMH) in reducing total cost of care remains a subject of debate, particularly among the non-elderly adult population. This study examines a 6-year experience of a large integrated regional health care delivery system in the US implementing PCMH among its commercially insured population. A regional health plan's claims data from 2008 t...

  10. The impact of a regional patient-centered medical home initiative on cost of care among commercially insured population in the US

    OpenAIRE

    Maeng, Daniel

    2016-01-01

    Daniel Dukjae Maeng, Joann P Sciandra, Janet F Tomcavage Geisinger Health System, Danville, PA, USAAbstract: The impact of a patient-centered medical home (PCMH) in reducing total cost of care remains a subject of debate, particularly among the non-elderly adult population. This study examines a 6-year experience of a large integrated regional health care delivery system in the US implementing PCMH among its commercially insured population. A regional health plan's claims data from 20...

  11. Risk of Cardiovascular Disease in a Traditional African Population with a High Infectious Load: A Population-Based Study

    OpenAIRE

    Koopman J.J.; van Bodegom D.; Jukema J.W.; Westendorp R.G.

    2012-01-01

    BACKGROUND: To test the inflammatory origin of cardiovascular disease, as opposed to its origin in western lifestyle. Population-based assessment of the prevalences of cardiovascular risk factors and cardiovascular disease in an inflammation-prone African population, including electrocardiography and ankle-arm index measurement. Comparison with known prevalences in American and European societies. METHODOLOGY/PRINCIPAL FINDINGS: Traditional population in rural Ghana, characterised by adverse ...

  12. Mental health care use in medically unexplained and explained physical symptoms: findings from a general population study

    OpenAIRE

    van Eck van der Sluijs, J; ten Have, Margreet; Rijnders, Cees; van Marwijk, Harm; de Graaf, Ron; Feltz-Cornelis, Christina

    2016-01-01

    Jonna F van Eck van der Sluijs,1,2 Margreet ten Have,3 Cees A Rijnders,4 Harm WJ van Marwijk,5,6 Ron de Graaf,3 Christina M van der Feltz-Cornelis1,2 1Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, 2Tranzo Department, Tilburg University, Tilburg, 3Netherlands Institute of Mental Health and Addiction, Utrecht, 4Department of Residency training, GGz Breburg, Tilburg, the Netherlands; 5Centre for Primary Care, Institute of Population Health, University of Manchester, Manc...

  13. Economic activities, illness pattern and utilisation of health care facilities in the rural population of KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Monjurul Hoque

    2009-04-01

    Full Text Available Background: The study was undertaken among the rural and black communities of the Uthungulu health district of the KwaZulu-Natal province, South Africa.Method: A cross-sectional community-based descriptive study was conducted. A multi-stage sampling strategy was adopted to obtain a representative sample of the communities.Results: The mean age of the population was 27 years and majority was female (54%. Among the adult population only 30% were educated, 19% were engaged in some form of economic activities while 9% were in the formal employment sector. The average monthly income per household was R1 301 (95% CI, R1 283; R1 308. The illnesses were reported by 27% of the total population over a period of one month. Notably higher rates of female individuals (29% were sick compared to males (24%, p < 0.001. The rates of illnesses among adult females (39% were also significantly higher than among males (31%, p < 0.009. Most of them (69% attended primary health care (PHC clinics for medical services, while 67% reported chronic conditions. Age (OR = 1.4, gender (OR = 0.711, education (OR = 0.64 and economic activities (OR = 1.9 were found to be associated with being ill or not.Conclusion: The rural black communities are underdeveloped and deprived, which results in higher prevalence of illnesses; however, the utilisation of PHC facilities is comparatively higher than in the rest of the province and other parts of the country. Interventions to improve community health care services among the deprived population should be focused through public health strategies such as all-encompassing PHC that includes health promotion, education and basic essential amenities.

  14. Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations

    Directory of Open Access Journals (Sweden)

    Jenkins Rachel

    2010-06-01

    Full Text Available Abstract Background Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. Methods A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care; development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. Results The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines

  15. Case Study: Evidence-Based Interventions Enhancing Diabetic Foot Care Behaviors among Hospitalized DM Patients

    Directory of Open Access Journals (Sweden)

    Titis Kurniawan

    2011-01-01

    Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients

  16. Integrating mental health into primary care for displaced populations: the experience of Mindanao, Philippines

    Directory of Open Access Journals (Sweden)

    Gil Tatiana

    2011-03-01

    Full Text Available Abstract Background For more than forty years, episodes of violence in the Mindanao conflict have recurrently led to civilian displacement. In 2008, Medecins Sans Frontieres set up a mental health program integrated into primary health care in Mindanao Region. In this article, we describe a model of mental health care and the characteristics and outcomes of patients attending mental health services. Methods Psychologists working in mobile clinics assessed patients referred by trained clinicians located at primary level. They provided psychological first aid, brief psychotherapy and referral for severe patients. Patient characteristics and outcomes in terms of Self-Reporting Questionnaire (SRQ20 and Global Assessment of Functioning score (GAF are described. Results Among the 463 adult patients diagnosed with a common mental disorder with at least two visits, median SRQ20 score diminished from 7 to 3 (p Conclusions Brief psychotherapy sessions provided at primary level during emergencies can potentially improve patients' symptoms of distress.

  17. Health care expenditure for hospital-based delivery care in Lao PDR

    Directory of Open Access Journals (Sweden)

    Douangvichit Daovieng

    2012-01-01

    Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family

  18. Dental health status of an aging VA population: implications for a preventive dental health care program.

    OpenAIRE

    Morhart, R E; Davis, M. E.; D. G. Weiss; Fitzgerald, R. J.; Rhyne, R R

    1986-01-01

    The purpose of this study was to describe the sociodemographic characteristics and dental health status of the largest eligible class of veterans (Class IV) within the Greater Miami catchment area. Only 43 percent of 4,882 Class IV patients within this area have sought VA dental care. Sociodemographic data were obtained from a randomized sample of both the VA-treated and non-VA-treated groups. The prevalence and incidence of dental diseases and actual dental treatment procedures completed for...

  19. Barriers to accessing eye care services among visually impaired populations in rural Andhra Pradesh, South India

    Directory of Open Access Journals (Sweden)

    Kovai Vilas

    2007-01-01

    Full Text Available Purpose: To understand the reasons why people in rural south India with visual impairment arising from various ocular diseases do not seek eye care. Materials and Methods: A total of 5,573 persons above the age of 15 were interviewed and examined in the South Indian state of Andhra Pradesh covering the districts of Adilabad, West Godavari and Mahaboobnagar. A pre-tested structured questionnaire on barriers to eye care was administered by trained field investigators. Results: Of the eligible subjects, 1234 (22.1%, N=5573 presented with distant visual acuity < 20/60 or equivalent visual field loss in the better eye. Of these, 898 (72.7%, N=1234 subjects had not sought treatment despite noticing a decrease in vision citing personal, economic and social reasons. The analysis also showed that the odds of seeking treatment was significantly higher for literates [odds ratio (OR 1.91, 95% confidence interval (CI 1.38 to 2.65], for those who would be defined as blind by visual acuity category (OR 1.35, 95% CI 0.96 to 1.90 and for those with cataract and other causes of visual impairment (OR 1.50, 95% CI 1.11 to 2.03. Barriers to seeking treatment among those who had not sought treatment despite noticing a decrease in vision over the past five years were personal in 52% of the respondents, economic in 37% and social in 21%. Conclusion: Routine planning for eye care services in rural areas of India must address the barriers to eye care perceived by communities to increase the utilization of services.

  20. Nurses in emotional competence: exploratory study on population of continued care national network

    OpenAIRE

    Lopes, Tânia; Veiga-Branco, Augusta; Baptista, Gorete

    2014-01-01

    The relevance of this study - the first empirical research (to our knowledge) in Continued Care National Network (RCNN) context - emerge to understand the role of emotions in workplace behaviour (Côté, 2005; Austin, Dore & Donovan, 2008; Liu et al. 2008; Barsade, Ramarajan, Burack, 2008), but here, with terminally ill people and great physical and psychological weakness. Recent scientific literature is exposing a significatly negative correlations between Emotional Intelligence...

  1. Vitamin status and cognitive function in a long-term care population

    OpenAIRE

    Meckling Kelly A; Kane Sheri-Lynn; Paulionis Lina

    2005-01-01

    Abstract Background Ageing can be associated with poor dietary intake, reduced nutrient absorption, and less efficient utilization of nutrients. Loss of memory and related cognitive function are also common among older persons. This study aimed to measure the prevalence of inadequate vitamin status among long-term care patients and determine if an association exists between vitamin status and each of three variables; cognitive function, vitamin supplementation, and medications which alter gas...

  2. Optimizing Drug Prescribing in Managed Care Populations: Improving Clinical and Economic Outcomes

    OpenAIRE

    Rachel Czubak; Jasmine Tucker; Zarowitz, Barbara J.

    2004-01-01

    Managed care presents interesting opportunities to optimize clinical and economic outcomes related to drug prescribing. There are very few randomized controlled trials that have evaluated methods to educate or incentivize physicians, implement formulary management or guideline tools, profile physicians, and implement pharmacist interventions to ensure optimal drug prescribing. Single methods of optimizing medication outcomes have not been shown to be as effective as multifaceted approaches. S...

  3. A Concept Analysis of Spiritual Care Based on Islamic Sources

    Directory of Open Access Journals (Sweden)

    Rahmatollah Marzband

    2016-05-01

    Full Text Available The cultural and religious resources of every community influence the definition of spiritual care. This paper discusses a concept analysis of spiritual care in an Islamic context. The Quran, narrations (Shie’h and commentarial books were searched, for information data. The data was used to provide a comprehensive definition of the concept of spiritual care from Islamic literature. We identified the attributes, antecedents and consequences of spiritual care according to Roger’s concept analysis approach. The review of the Islamic text showed that spiritual care is a series of spiritual skills or competencies that help patients to achieve excellent life. It is grouped into categories and has numerous positive effects on patients and caregivers. This study will be useful to Muslim clinicians and nurse educators as they strive to understand and incorporate spiritual care within their practice for Muslim patients.

  4. Population-Based Disease Management in the German Statutory Health Insurance: Implementation and Preliminary Results

    OpenAIRE

    Stephanie A.K. Stock; Marcus Redaelli; Karl W. Lauterbach

    2006-01-01

    Social healthcare systems in Europe must cope with aging populations and rising costs. For the German social healthcare system, which dates back to the 19th century, this problem is especially apparent, as soaring structural unemployment and the demographic transition of the population threaten the financial basis of the Statutory Health Insurance (SHI) [Gesetzliche Krankenversicherung]. In order to preserve free access to high-quality care and mandatory insurance for most of the population w...

  5. Knowledge of and attitude to foot care amongst Type 2 diabetes patients attending a university-based primary care clinic in Nigeria

    Directory of Open Access Journals (Sweden)

    Rabi I. Ekore

    2010-03-01

    Full Text Available Background: Individuals living with diabetes mellitus are at an increased risk of developing foot ulcers and cardiovascular complications or a neuropathy that may result in amputations. These complications have been shown to be already present in about 10% of diabetic patients at the time of diagnosis.Objectives: This study was carried out to determine the level of awareness and attitude to foot care among adult diabetic patients attending a university health centre (i.e. a primary care centre and to emphasise the ever-present need for health education and promotion and early complication detection (especially of foot problems among diabetic patients.Method: A descriptive cross-sectional, clinic-based study was carried out at the University of Ibadan Health Centre (Jaja Clinic. The study population consisted of consenting adult diabetic patients. Data were collected by the self-administration of structured questionnaires to eligible subjects and were analysed using the SPSS v.15software. Appropriate statistics were employed to analyse the collected data.Results: A total of 137 patients participated in the study and ranged in age from 37 to 75 years, with the mean ± SD age being 58.2 ± 9.2 years. Of the participants, 98 (71.5% were men and 39 (28.5%were women; all of the participants were married. The duration of illness ranged from 1 year to 20 years, with the median duration of illness being 3 ± 1.7 years. One hundred and twenty-six (92%patients had never received any education on foot care from their healthcare providers, while 11(8% had received some form of foot care education. Among those who had never received any foot care education, 92 (73% had been diabetic for 1–5 years, while the remaining 34 (27% had been diabetic for 6 – 20 years. Of the foot care measures that were known, 35 (25.5% patients knew to wash their feet daily and dry in between the toes thoroughly, 31 (22.6% knew not to go outdoors barefooted, 27 (19.7% checked

  6. A population-based study of the stratum corneum moisture

    Science.gov (United States)

    de Farias Pires, Thiago; Azambuja, Ana Paula; Horimoto, Andrea Roseli Vançan Russo; Nakamura, Mary Sanae; de Oliveira Alvim, Rafael; Krieger, José Eduardo; Pereira, Alexandre Costa

    2016-01-01

    Background The stratum corneum (SC) has important functions as a bound-water modulator and a primary barrier of the human skin from the external environment. However, no large epidemiological study has quantified the relative importance of different exposures with regard to these functional properties. In this study, we have studied a large sample of individuals from the Brazilian population in order to understand the different relationships between the properties of SC and a number of demographic and self-perceived variables. Methods One thousand three hundred and thirty-nine individuals from a rural Brazilian population, who were participants of a family-based study, were submitted to a cross-sectional examination of the SC moisture by capacitance using the Corneometer® CM820 and investigated regarding environmental exposures, cosmetic use, and other physiological and epidemiological measurements. Self-perception-scaled questions about skin conditions were also applied. Results We found significant associations between SC moisture and sex, age, high sun exposure, and sunscreen use frequency (Peffects. Dry skin self-perception was also found to be highly correlated with the objective measurement of the skin. Other environmental effects on SC moisture are also reported. PMID:27143945

  7. Portable atomic frequency standard based on coherent population trapping

    Science.gov (United States)

    Shi, Fan; Yang, Renfu; Nian, Feng; Zhang, Zhenwei; Cui, Yongshun; Zhao, Huan; Wang, Nuanrang; Feng, Keming

    2015-05-01

    In this work, a portable atomic frequency standard based on coherent population trapping is designed and demonstrated. To achieve a portable prototype, in the system, a single transverse mode 795nm VCSEL modulated by a 3.4GHz RF source is used as a pump laser which generates coherent light fields. The pump beams pass through a vapor cell containing atom gas and buffer gas. This vapor cell is surrounded by a magnetic shield and placed inside a solenoid which applies a longitudinal magnetic field to lift the Zeeman energy levels' degeneracy and to separate the resonance signal, which has no first-order magnetic field dependence, from the field-dependent resonances. The electrical control system comprises two control loops. The first one locks the laser wavelength to the minimum of the absorption spectrum; the second one locks the modulation frequency and output standard frequency. Furthermore, we designed the micro physical package and realized the locking of a coherent population trapping atomic frequency standard portable prototype successfully. The short-term frequency stability of the whole system is measured to be 6×10-11 for averaging times of 1s, and reaches 5×10-12 at an averaging time of 1000s.

  8. Measuring coverage in MNCH: a validation study linking population survey derived coverage to maternal, newborn, and child health care records in rural China.

    Directory of Open Access Journals (Sweden)

    Li Liu

    Full Text Available BACKGROUND: Accurate data on coverage of key maternal, newborn, and child health (MNCH interventions are crucial for monitoring progress toward the Millennium Development Goals 4 and 5. Coverage estimates are primarily obtained from routine population surveys through self-reporting, the validity of which is not well understood. We aimed to examine the validity of the coverage of selected MNCH interventions in Gongcheng County, China. METHOD AND FINDINGS: We conducted a validation study by comparing women's self-reported coverage of MNCH interventions relating to antenatal and postnatal care, mode of delivery, and child vaccinations in a community survey with their paper- and electronic-based health care records, treating the health care records as the reference standard. Of 936 women recruited, 914 (97.6% completed the survey. Results show that self-reported coverage of these interventions had moderate to high sensitivity (0.57 [95% confidence interval (CI: 0.50-0.63] to 0.99 [95% CI: 0.98-1.00] and low to high specificity (0 to 0.83 [95% CI: 0.80-0.86]. Despite varying overall validity, with the area under the receiver operating characteristic curve (AUC ranging between 0.49 [95% CI: 0.39-0.57] and 0.90 [95% CI: 0.88-0.92], bias in the coverage estimates at the population level was small to moderate, with the test to actual positive (TAP ratio ranging between 0.8 and 1.5 for 24 of the 28 indicators examined. Our ability to accurately estimate validity was affected by several caveats associated with the reference standard. Caution should be exercised when generalizing the results to other settings. CONCLUSIONS: The overall validity of self-reported coverage was moderate across selected MNCH indicators. However, at the population level, self-reported coverage appears to have small to moderate degree of bias. Accuracy of the coverage was particularly high for indicators with high recorded coverage or low recorded coverage but high specificity. The

  9. Effectiveness of structured, hospital-based, nurse-led atrial fibrillation clinics: a comparison between a real-world population and a clinical trial population

    Science.gov (United States)

    Qvist, Ina; Hendriks, Jeroen M L; Møller, Dorthe S; Albertsen, Andi E; Mogensen, Helle M; Oddershede, Gitte D; Odgaard, Annette; Mortensen, Leif Spange; Johnsen, Søren Paaske; Frost, Lars

    2016-01-01

    Objective A previous randomised trial showed that structured, nurse-led atrial fibrillation (AF) care is superior to conventional AF care, although further research is needed to determine the outcomes of such care in a real-world setting. We compared the outcomes of patients in real-world, nurse-led, structured hospital AF clinics with the outcomes of a randomised trial of the efficacy of a nurse-led AF clinic, with respect to a composite outcome of cardiovascular-related hospitalisation and death. Methods All patients were referred to the AF nurse specialist by cardiologists. The AF nurse specialist provided patient education, risk-factor control and stimulated empowerment and compliance. During follow-up, treatment was adjusted according to clinical guidelines. Patient education was repeated, and compliance with medical treatment was controlled. The study size was powered as a non-inferiority study. Outcome measures were adjudicated by the same principles in both cohorts. Results A total of 596 patients from the real world and 356 patients from a clinical trial were included in this study. No significant difference between groups with respect to age, type of AF or CHA2DS2VASc score was found. The composite primary end point occurred with an incidence rate of 8.0 (95% CI 6.1 to 10.4) per 100 person-years in the real-world population and 8.3 (95% CI 6.3 to 10.9) per 100 person-years in the clinical trial, with a crude HR of 0.83 (95% CI 0.56 to 1.23). Conclusions Structured, nurse-led, hospital-based AF care appears to be effective, and patient outcomes in an actual, hospital-based, structured AF care are as least as good as those in trial settings. PMID:26835143

  10. Temporal trend of carpal tunnel release surgery: a population-based time series analysis.

    Directory of Open Access Journals (Sweden)

    Naif Fnais

    Full Text Available BACKGROUND: Carpal tunnel release (CTR is among the most common hand surgeries, although little is known about its pattern. In this study, we aimed to investigate temporal trends, age and gender variation and current practice patterns in CTR surgeries. METHODS: We conducted a population-based time series analysis among over 13 million residents of Ontario, who underwent operative management for carpal tunnel syndrome (CTS from April 1, 1992 to March 31, 2010 using administrative claims data. RESULTS: The primary analysis revealed a fairly stable procedure rate of approximately 10 patients per 10,000 population per year receiving CTRs without any significant, consistent temporal trend (p = 0.94. Secondary analyses revealed different trends in procedure rates according to age. The annual procedure rate among those age >75 years increased from 22 per 10,000 population at the beginning of the study period to over 26 patients per 10,000 population (p<0.01 by the end of the study period. CTR surgical procedures were approximately two-fold more common among females relative to males (64.9% vs. 35.1 respectively; p<0.01. Lastly, CTR procedures are increasingly being conducted in the outpatient setting while procedures in the inpatient setting have been declining steadily - the proportion of procedures performed in the outpatient setting increased from 13% to over 30% by 2010 (p<0.01. CONCLUSION: Overall, CTR surgical-procedures are conducted at a rate of approximately 10 patients per 10,000 population annually with significant variation with respect to age and gender. CTR surgical procedures in ambulatory-care facilities may soon outpace procedure rates in the in-hospital setting.

  11. Hospital-based palliative care: A case for integrating care with cure

    Directory of Open Access Journals (Sweden)

    Priya Darshini Kulkarni

    2011-01-01

    Full Text Available The reason that probably prompted Dame Cicely Saunders to launch the palliative care movement was the need to move away from the impersonal, technocratic approach to death that had become the norm in hospitals after the Second World War. Palliative care focuses on relieving the suffering of patients and families. Not limited to just management of pain, it includes comprehensive management of any symptom, which affects the quality of life. Care is optimized through early initiation and comprehensive implementation throughout the disease trajectory. Effective palliative care at the outset can help accelerate a positive clinical outcome. At the end of life, it can enhance the opportunity for the patient and family to achieve a sense of growth, resolve differences, and find a comfortable closure. It helps to reduce the suffering and fear associated with dying and prepares the family for bereavement.

  12. Influence of population and general practice characteristics on prescribing of minor tranquilisers in primary care

    Directory of Open Access Journals (Sweden)

    Wagner AC

    2010-09-01

    Full Text Available Prevalence of generalised anxiety disorders is widespread in Great Britain. Previous small-scale research has shown variations in minor tranquiliser prescribing, identifying several potential predictors of prescribing volume. Objective: This study aimed to investigate the relationship between general practice minor tranquiliser prescribing rates and practice population and general practice characteristics for all general practices in England.Methods: Multiple regression analysis of minor tranquiliser prescribing volumes during 2004/2005 for 8,291 English general practices with general practice and population variables obtained from the General Medical Services (GMS statistics, Quality and Outcomes Framework (QOF, 2001 Census and 2004 Index of Multiple Deprivation (IMD. Results: The highest rates of minor tranquiliser prescribing were in areas with the greatest local deprivation while general practices situated in areas with larger proportions of residents of black ethnic origin had lower rates of prescribing. Other predictors of increased prescribing were general practices with older general practitioners and general practices with older registered practice populations.Conclusion: Our findings show that there is wide variation of minor tranquilisers prescribing across England which has implications regarding access to treatment and inequity of service provision. Future research should determine the barriers to equitable prescribing amongst general practices serving larger populations of black ethnic origin.

  13. Improving Diabetes Care in the Latino Population: The Emory Latino Diabetes Education Program

    Science.gov (United States)

    Rotberg, Britt; Greene, Rachel; Ferez-Pinzon, Anyul M.; Mejia, Robert; Umpierrez, Guillermo

    2016-01-01

    Background: The incidence of diabetes in Latinos is 12.8% compared to 9.3% of the general population. Latinos suffer from a higher prevalence of diabetic complications and mortality than whites yet receive less monitoring tests and education. Purpose: (1) Identify changes in clinical indicators among subjects with type 2 diabetes participating in…

  14. Predictors of Childhood Anxiety: A Population-Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Dawn Kingston

    Full Text Available Few studies have explored predictors of early childhood anxiety.To determine the prenatal, postnatal, and early life predictors of childhood anxiety by age 5.Population-based, provincial administrative data (N = 19,316 from Manitoba, Canada were used to determine the association between demographic, obstetrical, psychosocial, medical, behavioral, and infant factors on childhood anxiety.Risk factors for childhood anxiety by age 5 included maternal psychological distress from birth to 12 months and 13 months to 5 years post-delivery and an infant 5-minute Apgar score of ≤7. Factors associated with decreased risk included maternal age < 20 years, multiparity, and preterm birth.Identifying predictors of childhood anxiety is a key step to early detection and prevention. Maternal psychological distress is an early, modifiable risk factor. Future research should aim to disentangle early life influences on childhood anxiety occurring in the prenatal, postnatal, and early childhood periods.

  15. GIS-based poverty and population distribution analysis in China

    Science.gov (United States)

    Cui, Jing; Wang, Yingjie; Yan, Hong

    2009-07-01

    Geographically, poverty status is not only related with social-economic factors but also strongly affected by geographical environment. In the paper, GIS-based poverty and population distribution analysis method is introduced for revealing their regional differences. More than 100000 poor villages and 592 national key poor counties are chosen for the analysis. The results show that poverty distribution tends to concentrate in most of west China and mountainous rural areas of mid China. Furthermore, the fifth census data are overlaid to those poor areas in order to gain its internal diversity of social-economic characteristics. By overlaying poverty related social-economic parameters, such as sex ratio, illiteracy, education level, percentage of ethnic minorities, family composition, finding shows that poverty distribution is strongly correlated with high illiteracy rate, high percentage minorities, and larger family member.

  16. Task-role-based Access Control Model in Smart Health-care System

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

    As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for...

  17. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities.

    Science.gov (United States)

    Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen

    2015-01-01

    Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. PMID:25499658

  18. A home-based comprehensive care model in patients with Multiple Sclerosis: A study pre-protocol.

    Science.gov (United States)

    Young, Lufei; Healey, Kathleen; Charlton, Mary; Schmid, Kendra; Zabad, Rana; Wester, Rebecca

    2015-01-01

    Background Disability is prevalent in individuals with multiple sclerosis (MS), leading to difficulty in care access, significant caregiver burden, immense challenges in self-care and great societal burden.  Without highly coordinated, competent and accessible care, individuals living with progressive MS experience psychological distress, poor quality of life, suffer from life-threatening complications, and have frequent but avoidable healthcare utilizations. Unfortunately, current healthcare delivery models present severe limitations in providing easily accessible, patient-centered, coordinated comprehensive care to those with progressive MS. We propose a home-based comprehensive care model (MAHA) to address the unmet needs, challenges, and avoidable complications in individuals with progressive MS with disabling disease. Objective The article aims to describe the study design and methods used to implement and evaluate the proposed intervention.   Method The study will use a randomized controlled design to evaluate the feasibility of providing a 24-month, home-based, patient-centered comprehensive care program to improve quality of life, reduce complications and healthcare utilizations overtime (quarterly) for 24 months. A transdisciplinary team led by a MS-Comprehensivist will carry out this project. Fifty MS patients will be randomly assigned to the intervention and usual care program using block randomization procedures. We hypothesize that patients in the intervention group will have fewer complications, higher quality of life, greater satisfaction with care, and reduced healthcare utilization. The proposed project is also expected to be financially sustainable in fee-for-service models but best suited for and gain financial success in valued-based care systems.   Discussion This is the first study to examine the feasibility and effectiveness of a home-based comprehensive care management program in MS patients living with progressive disability. If

  19. Screening for thalassemia and other hemoglobinopathies in a tertiary care hospital of West Bengal: Implications for population screening

    Directory of Open Access Journals (Sweden)

    Bhawna Bhutoria Jain

    2012-01-01

    Full Text Available Hemoglobinopathies are common genetic disorders of hemoglobin, which can be prevented by population screening and offering genetic counseling. In absence of population-based screening for hemoglobinopathies, the hospital-based diagnosis register provide idea about the extent of problem in the community. The present study was undertaken to find out the burden of hemoglobinopathies and spectrum of this disorders among the population who were screened in the hospital-based screening program. A record-basedanalysis of subjects who underwent screening for hemoglobinopathies in Burdwan Medical College and Hospital over a period of 3 years and 4 months revealed that overall 29.3% of subjects were positive for hemoglobinopathies. Beta thalassemia heterozygous was the most commonhemoglobinopathy in this region closely followed by hemoglobin E heterozygous. In view of high prevalence of hemoglobinopathies in this region, a routine premarital screening program is needed for identification and prevention of high-risk marriages.

  20. Heart failure and levels of other comorbidities in patients with chronic obstructive pulmonary disease in a Swedish population: a register-based study

    OpenAIRE

    Kaszuba, Elzbieta; Odeberg, Håkan; Råstam, Lennart; Halling, Anders

    2016-01-01

    Background Despite the fact that heart failure and chronic obstructive pulmonary disease (COPD) often exist together and have serious clinical and economic implications, they have mostly been studied separately. Our aim was to study prevalence of coexisting heart failure and COPD in a Swedish population. A further goal was to describe levels of other comorbidity and investigate where the patients received care: primary, secondary care or both. Methods We conducted a register-based, cross-sect...

  1. Evangelical Protestants and the ACA: An Opening for Community-Based Primary Care?

    Science.gov (United States)

    Franz, Berkeley; Skinner, Daniel

    2016-07-01

    Evangelical Protestants make up the largest religious subgroup in the United States, and previous research has shown that Evangelical churches are disproportionately active in community engagement and efforts toward social change. Although Evangelical Protestant perspectives have been considered with regard to persistent socioeconomic stratification and racial discrimination, less focus has been given to how churches interpret poor health outcomes within the United States. In particular, this research addresses how enduring health disparities are understood within the larger discussion of healthcare reform. Due to the similarity of approaches favored by participants in this study and community-based philosophy, a suggestion is made for future health policy dialogue. Although Evangelical Protestants have been most likely to reject all aspects of the Affordable Care Act, in many ways the findings of this study suggest the potential for successful future health policy collaboration. In particular, community-based primary care might appeal to Evangelicals and health professionals in the ongoing effort to improve population health and the quality of healthcare in the United States. PMID:27050877

  2. Towards Evidence-based Precision Medicine: Extracting Population Information from Biomedical Text using Binary Classifiers and Syntactic Patterns.

    Science.gov (United States)

    Raja, Kalpana; Dasot, Naman; Goyal, Pawan; Jonnalagadda, Siddhartha R

    2016-01-01

    Precision Medicine is an emerging approach for prevention and treatment of disease that considers individual variability in genes, environment, and lifestyle for each person. The dissemination of individualized evidence by automatically identifying population information in literature is a key for evidence-based precision medicine at the point-of-care. We propose a hybrid approach using natural language processing techniques to automatically extract the population information from biomedical literature. Our approach first implements a binary classifier to classify sentences with or without population information. A rule-based system based on syntactic-tree regular expressions is then applied to sentences containing population information to extract the population named entities. The proposed two-stage approach achieved an F-score of 0.81 using a MaxEnt classifier and the rule- based system, and an F-score of 0.87 using a Nai've-Bayes classifier and the rule-based system, and performed relatively well compared to many existing systems. The system and evaluation dataset is being released as open source. PMID:27570671

  3. Android-based access to holistic emergency care record.

    Science.gov (United States)

    Koufi, Vassiliki; Malamateniou, Flora; Prentza, Andriana; Vassilacopoulos, George

    2013-01-01

    This paper is concerned with the development of an Emergency Medical Services (EMS) system which interfaces with a Holistic Emergency Care Record (HECR) that aims at managing emergency care holistically by supporting EMS processes and is accessible by Android-enabled mobile devices. PMID:23823406

  4. Latex sensitization in health care workers and in the US general population.

    Science.gov (United States)

    Garabrant, D H; Roth, H D; Parsad, R; Ying, G S; Weiss, J

    2001-03-15

    Sensitization to natural rubber latex is a prerequisite to type I immediate hypersensitivity reactions (urticaria, angioedema, anaphylaxis, and allergic rhinitis) that result from subsequent latex exposure. This study examines occupations in which latex glove use is common to determine whether it is associated with increased prevalence odds of latex sensitization (measured by latex-specific immunoglobulin E antibodies) by using data from 5,512 adults aged 17--60 years from the Third National Health and Nutrition Examination Survey (1988--1991). After other factors associated with latex sensitization were controlled for, there was a nonsignificant association between longest-held jobs in health care and latex sensitization (odds ratio (OR) = 1.49, 95 percent confidence interval (CI): 0.92, 2.40). For current occupations, latex sensitization was not associated with health care work in which gloves were used (OR = 1.17, 95 percent CI: 0.51, 2.65) or with other occupations in which latex glove use is common (OR = 1.01, 95 percent CI: 0.49, 2.07) compared with other occupations. Current health care workers who reported not using gloves were at increased risk of latex sensitization, both among those without a history of childhood atopy (OR = 2.30, 95 percent CI: 1.04, 5.13) and those with such a history (OR = 28.04, 95 percent CI: 3.64, 215.97). This odds ratio heterogeneity suggests that subjects with childhood atopy may be at high risk of latex sensitization. PMID:11257057

  5. Estrogen and Alzheimer′s disease in Aging Population: Population based case-control study

    Institute of Scientific and Technical Information of China (English)

    Xia Hong; Zhen-xin Zhang; Hui Li; Jie hao Zhao; Jue-bin Huang; ling Wei

    2000-01-01

    Objective: Wc conducted a population based case-control study to evaluate the effect of estrogen associated variables in Alzhcimer′s disease. Methods: A total of 2995 female residents aged 55 years or older was drawn-by means of stratified multistage cluster sampling in urban and rural areas of Beijing. Wc collected gynecological data of 2995 females. Cases were females Alzheimer′s disease ascertained by DSM-Ⅳ criteria and NINCDS-ADRDA critcria. Controls were female residents whose MMSE scores upper than 50 percentage. Odds Ratio were calculated from Logistic models. Results: By a Logistic stepwise multiple regression model, we found that the risk of dementia in women increased with increasing age (OR per year, 1.21, 95%CI, 1.16 -1.27). The risk decreased with increased duration with menstrual cycles (OR per year, 0.8L, 95%CI, 0.68 to 0.97). The risk decreased with increased age of menopause (OR per year, 0.97, 95%CI, 0.91 to 1.04). The risk decreased in women ever suffered from uterine, ovary, or breast tumor (OR, 0.30, 95%C1:0.04- 2.28). Conclusion: The risk of AD decreased with increased duration of menstrual cycles and increased age of menopause and in wome ever suffered fiom uterine. ovary or breast tumor. These findings offers additional support for a protective influence of estrogen i AD.

  6. Population aging in Albanian post-socialist society: Implications for care and family life

    Directory of Open Access Journals (Sweden)

    Meçe Merita

    2015-12-01

    Full Text Available Population aging is becoming an inevitable phenomenon in Albanian post-socialist society, posing multi-faceted challenges to its individuals, families and society as a whole. Since 1991, the Albanian population has been exposed to intensive demographic changes caused by unintended aspects of socio-economic transition from a planned socialist economy to a market-oriented capitalist one (Hoff, 2008. Ongoing processes of re-organization of social institutions increased its socio-economic insecurity leading to the application of various coping mechanisms. While adjusting themselves to other aspects of life, people changed their decisions of having children and leaving the country (Hoff, 2008. On the other hand, replacement of former traditional extended family forms with diverse living arrangements and family structures has been the outcome of the combination of three factors: falling fertility, increasing life expectancy and increasing migration (INSTAT, 2014.

  7. Changing clinical needs of people living with AIDS and receiving home based care in Malawi - the Bangwe Home Based Care Project 2003-2008 - a descriptive study

    Directory of Open Access Journals (Sweden)

    Gondwe Norton

    2010-06-01

    Full Text Available Abstract Background Home based care (HBC has been an important component of the response to the AIDS epidemic in Africa, and particularly so before antiretroviral therapy (ART became available. Has HBC become unnecessary now that ART is available in many African countries? One way to investigate this is to assess the changing need for comprehensive HBC as an ART programme becomes available. The Bangwe HBC programme in Malawi has been collecting data since 2003 before ART became available in 2005/6. Has the introduction of ART changed the clinical needs for HBC? Methods Information obtained at initial assessment and follow up visits of patients receiving HBC were combined to assess case severity, survival and the response to treatment. This information was used to assess trends in mortality and the incidence, duration and severity of common symptoms over a six year period in a defined urban population in Malawi. Results 1266 patients, of whom 1190 were followed up and of whom 652 (55% died, were studied. 282 (25% patients died within two months of being first seen with an improvement between 2003-2005 and 2006-2008 of reduced mortality from 28% to 20%. 341 (27% patients were unable to care for themselves on first assessment and 675 (53% had stage 4 AIDS disease. Most patients had a mix of symptoms at presentation. Self care increased somewhat over the six years although case severity as measured by WHO staging and nutritional status did not. 350 patients were on ART either started before or after initial assessment. There were significant barriers to accessing ART with 156 (51% of 304 stage 3 or 4 patients first assessed in 2007 or 2008 not receiving ART. Over the six year period new HBC cases reduced by 8% and follow up visits increased by 9% a year. Between 4 and 5 people sought HBC for the first time each week from an urban health centre catchment of 100,000, which required 37.3 follow up visits each week. Conclusions Since the availability of

  8. Geospatial Technology in Disease Mapping, E- Surveillance and Health Care for Rural Population in South India

    OpenAIRE

    Praveenkumar, B. A.; Suresh, K.; Nikhil, A.; M Rohan; Nikhila, B. S.; Rohit, C. K.; Srinivas, A.

    2014-01-01

    Providing Healthcare to rural population has been a challenge to the medical service providers especially in developing countries. For this to be effective, scalable and sustainable, certain strategic decisions have to be taken during the planning phase. Also, there is a big gap between the services available and the availability of doctors and medical resources in rural areas. Use of Information Technology can aid this deficiency to a good extent. In this paper, a mobile application...

  9. Monitoring of osteoporosis among geriatric population in the primary care service

    OpenAIRE

    Šipovac Dragana; Sević Siniša; Mikić Sandra Stefan; Kovačević Nadica; Ivanov Igor; Eić Nikola

    2014-01-01

    Introduction. Osteoporosis is a chronic, progressive bone disease which leads to a reduction in bone mineral density and disruption of bone micro-architecture. Patients with osteoporosis have an increased risk of fractures caused by “small trauma” - stresses which would not normally cause fracture in a non-osteoporotic individual. This study was aimed at determining the incidence of osteoporosis in geriatric population, crucial demographic parameters (gende...

  10. PATTERN OF OVARIAN NEOPLASM IN RURAL POPULATION: A FIVE YEAR STUDY FROM TERTIARY CARE HOSPITAL

    OpenAIRE

    Umesh

    2014-01-01

    OBJECTIVE : The aim of the study was to know the morphological pattern of benign and malignant ovarian neoplasms and their distribution in different age groups in rural population of India. MATERIAL AND METHODS : A retrospective study of all cases of ovarian neoplasms diagnosed at department of pathology, Maharaja Medical College, Agroha during period of five year (Aug, 07 — Oct.12) was done. The tumors were classified according to WHO classification after thorou...

  11. Effectiveness of family training and life skills on caring chronic mental disorders in an Iranian population

    Directory of Open Access Journals (Sweden)

    Mohsen Dareke

    2013-05-01

    Full Text Available This research is semi-empirical study which is done to examiningthe effectiveness of family trainings and life skills on Caring Chronic Mental Disorders in Mashhad (Iran. 300 participants has been chosen in randomly from the families of chronic mental disorders who has been admitted in round the clock centers in Mashhad and who had been in waiting list and these participants has been divided to two groups of experiment and control randomly and we introduce family trainings and life skills to experiment group. There was no training to control group. These two groups were tested period to the beginning of trainings and post training with instruments such as California Social Adjustment Questionnaire; Families’ Attitude and Awareness about Life Skills and Family Trainings; Rosenberg Self-Esteem; General Health Questionnaire;and Symptom Checklist-90-Revised. Results indicated that training had no effect on the attitude of families toward taking care of mental disorder, but family member،s attitudetoward mental disorder has been changed. This training has been influential on changing family member،s attitude toward life skills, social adjustment, self esteem, mental health increase and reducing mental disorders.

  12. The Association of Restless Legs Syndrome to History of Gestational Diabetes in an Appalachian Primary Care Population

    Science.gov (United States)

    Innes, Kim E.; Kandati, Sahiti; Flack, Kathryn L.; Agarwal, Parul; Selfe, Terry Kit

    2015-01-01

    Objective: Restless legs syndrome (RLS) is a burdensome sensorimotor disorder that has been linked to diabetes and obesity. However, the relationship of RLS to gestational diabetes mellitus (GDM), a common pregnancy complication strongly associated with obesity and a harbinger of diabetes, remains unknown. In this study, we examined the association of RLS to history of GDM in a sample of older female primary care patients. Methods: Participants were community-dwelling women aged ≥ 40 years drawn from an anonymous survey study of West Virginia adult primary care patients. Data gathered included detailed information on demographics, lifestyle factors, reproductive history, sleep patterns, and medical history; the survey also included an RLS diagnostic questionnaire. Women who were pregnant or had missing data on key variables were excluded from the analyses. Results: Of the 498 participants included in the final analytic sample, 24.5% met diagnostic criteria for RLS (17.9% with symptoms at least once/week). After adjustment for demographics, lifestyle characteristics, body mass index, diabetes and other comorbid conditions, parity, and other factors, those reporting history of GDM were almost three times as likely to meet criteria for RLS (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.3, 5.3). This association increased in magnitude with increasing symptom frequency (adjusted OR for RLS symptoms ≥ 3×/week = 4.8, CI 2.1, 11.2, p for trend = 0.004). Conclusions: History of GDM was strongly and positively related to RLS in this study of older female primary care patients, offering further support for a possible role of metabolic dysregulation in RLS development. Citation: Innes KE, Kandati S, Flack KL, Agarwal P, Selfe TK. The association of restless legs syndrome to history of gestational diabetes in an Appalachian primary care population. J Clin Sleep Med 2015;11(10):1121–1130. PMID:26156957

  13. Ocular biometry in the adult population in rural central China: a population-based, cross-sectional study

    Institute of Scientific and Technical Information of China (English)

    Ting; Fu; Yin-Wei; Song; Zhi-Qi; Chen; Jun-Wen; He; Kun; Qiao; Xu-Fang; Sun; Hong; Zhang; Jun-Ming; Wang

    2015-01-01

    ·AIM: To describe the distribution and determinants of ocular biometric parameters and to ascertain the relative importance of these determinants in a large population of adults in rural central China.·METHODS: A population-based, cross-sectional study performed in rural central China included 1721 participants aged 40 or more years. Ocular biometrical parameters including axial length(AL), anterior chamber depth(ACD), radius of corneal curvature(K) and horizontal corneal diameter [white-to-white(WTW)distance] were measured using non-contact partial coherence interferometry [intraocular lens(IOL)-Master].·RESULTS: Ocular biometric data on 1721 participants with a average age of 57.0 ±8.7y were analyzed at last.The general mean AL, ACD, mean corneal curvature radius(MCR), WTW were 22.80±1.12, 2.96±0.36, 7.56±0.26 and 11.75 ±0.40 mm, respectively. The mean values of each parameter in 40 to 49, 50 to 59, 60 to 69, and 70 to91 years age groups were as follows: AL, 22.77 ±0.87,22.76 ±1.06, 22.89 ±1.41, 22.92 ±0.80 mm; ACD, 3.10 ±0.32,2.98 ±0.34, 2.86 ±0.36, 2.77 ±0.35 mm; MCR, 7.58 ±0.25,7.54 ±0.26, 7.55 ±0.26, 7.49 ±0.28 mm; WTW, 11.79 ±0.38,11.75 ±0.40, 11.72 ±0.41, 11.67 ±0.41 mm. The AL, ACD,MCR and WTW were correlated with age and the AL was correlated with height and weight.·CONCLUSION: Our findings can serve as an important normative reference for multiple purposes and may help to improve the quality of rural eye care.

  14. Strain and its correlates among carers of people with dementia in low-income and middle-income countries. A 10/66 Dementia Research Group population-based survey

    OpenAIRE

    Prince, Martin; Brodaty, Henry; Uwakwe, Richard; Acosta, Daisy; Ferri, Cleusa P.; Guerra, Mariella; Huang, Yueqin; Jacob, KS; Llibre Rodriguez, Juan J.; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D; Jotheeswaran, AT; Liu, Zhaorui

    2012-01-01

    Objectives In a multi-site population-based study in several middle-income countries, we aimed to investigate relative contributions of care arrangements and characteristics of carers and care recipients to strain among carers of people with dementia. Based on previous research, hypotheses focused on carer sex, care inputs, behavioural and psychological symptoms (BPSD) and socioeconomic status, together with potential buffering effects of informal support and employing paid carers. Methods In...

  15. Penn State Worry Questionnaire - 10: A new tool for measurement-based care.

    Science.gov (United States)

    Yao, Beier; Sripada, Rebecca K; Klumpp, Heide; Abelson, James L; Muzik, Maria; Zhao, Zhuo; Rosenblum, Katherine; Briggs, Hedieh; Kaston, Michelle; Warren, Ricks

    2016-05-30

    The Penn State Worry Questionnaire - Past Week (PSWQ-PW) is an adaptation of the widely used Penn State Worry Questionnaire, measuring pathological worry weekly. However, it contains problematic negatively worded items and has not been validated in a large sample yet. To meet the needs of measurement-based care (MBC), we developed a shortened version (PSWQ-10) based on the PSWQ-PW, retaining only positively worded items, and examined its psychometric properties and clinical utility. Patients with Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), and other anxiety disorders completed the PSWQ-10 and other instruments during routine evaluation in an academic anxiety clinic. A second cohort from a perinatal clinic was evaluated similarly. The PSWQ-10 displayed excellent internal consistency, convergent and discriminant validity, and criterion group validity. Patients with GAD scored significantly higher than those with other anxiety disorders but did not differ from those with MDD. The PSWQ-10 showed sensitivity to change over time and demonstrated excellent psychometric properties in the perinatal population. The PSWQ-10 is a reliable, valid, efficient, and straightforward worry-focused instrument that can be readily used in MBC and help clinicians objectively measure worry as a treatment outcome in broad clinical populations. PMID:27137962

  16. Compact atomic clock prototype based on coherent population trapping

    Directory of Open Access Journals (Sweden)

    Danet Jean-Marie

    2014-01-01

    Full Text Available Toward the next generations of compact atomic clocks, clocks based on coherent population trapping (CPT offer a very interesting alternative. Thanks to CPT, a quantum interfering process, this technology has made a decisive step in the miniaturization direction. Fractional frequency stability of 1.5x10-10 at 1 s has been demonstrated in commercial devices of a few cm3. The laboratory prototype presented here intends to explore what could be the ultimate stability of a CPT based device. To do so, an original double-Λ optical scheme and a pulsed interrogation have been implemented in order to get a good compromise between contrast and linewidth. A study of two main sources of noise, the relative intensity and the local oscillator (LO noise, has been performed. By designing simple solutions, it led to a new fractional frequency limitation lower than 4x10-13 at 1 s integration. Such a performance proves that such a technology could rival with classical ones as double resonance clocks.

  17. A population-based study of the stratum corneum moisture

    Directory of Open Access Journals (Sweden)

    Pires TF

    2016-04-01

    Full Text Available Thiago de Farias Pires,1 Ana Paula Azambuja,2 Andrea Roseli Vançan Russo Horimoto,1 Mary Sanae Nakamura,2 Rafael de Oliveira Alvim,1 José Eduardo Krieger,1 Alexandre Costa Pereira1 1Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, 2Natura Innovation and Product Technology Ltd., Cajamar, SP, Brazil Background: The stratum corneum (SC has important functions as a bound-water modulator and a primary barrier of the human skin from the external environment. However, no large epidemiological study has quantified the relative importance of different exposures with regard to these functional properties. In this study, we have studied a large sample of individuals from the Brazilian population in order to understand the different relationships between the properties of SC and a number of demographic and self-perceived variables. Methods: One thousand three hundred and thirty-nine individuals from a rural Brazilian population, who were participants of a family-based study, were submitted to a cross-sectional examination of the SC moisture by capacitance using the Corneometer® CM820 and investigated regarding environmental exposures, cosmetic use, and other physiological and epidemiological measurements. Self-perception-scaled questions about skin conditions were also applied. Results: We found significant associations between SC moisture and sex, age, high sun exposure, and sunscreen use frequency (P<0.025. In specific studied sites, self-reported race and obesity were also found to show significant effects. Dry skin self-perception was also found to be highly correlated with the objective measurement of the skin. Other environmental effects on SC moisture are also reported. Keywords: investigative dermatology, stratum corneum moisture, Corneometer, sun exposure, familial data modeling

  18. Leveraging The Affordable Care Act To Enroll Justice-Involved Populations In Medicaid: State And Local Efforts.

    Science.gov (United States)

    Bandara, Sachini N; Huskamp, Haiden A; Riedel, Lauren E; McGinty, Emma E; Webster, Daniel; Toone, Robert E; Barry, Colleen L

    2015-12-01

    The Affordable Care Act provides an unprecedented opportunity to enroll criminal justice-involved populations in health insurance, particularly Medicaid. As a result, many state and county corrections departments have launched programs that incorporate Medicaid enrollment in discharge planning. Our study characterizes the national landscape of programs enrolling criminal justice-involved populations in Medicaid as of January 2015. We provide an overview of sixty-four programs operating in jails, prisons, or community probation and parole systems that enroll individuals during detention, incarceration, and the release process. We describe the variation among the programs in terms of settings, personnel, timing of eligibility screening, and target populations. Seventy-seven percent of the programs are located in jails, and 56 percent use personnel from public health or social service agencies. We describe four practices that have facilitated the Medicaid enrollment process: suspending instead of terminating Medicaid benefits upon incarceration, presuming that an individual is eligible for Medicaid before the process is completed, allowing enrollment during incarceration, and accepting alternative forms of identification for enrollment. The criminal justice system is a complex one that requires a variety of approaches to enroll individuals in Medicaid. Future research should examine how these approaches influence health and criminal justice outcomes. PMID:26643624

  19. Patient and nurse experiences of theory-based care.

    Science.gov (United States)

    Flanagan, Jane

    2009-04-01

    The pre-surgery nursing practice model derived from Newman's theory was developed to change the delivery of nursing care in a pre-surgical clinic. Guided by the theoretical knowledge of health as expanding consciousness, transpersonal caring, and reflective practice, key practice changes included a) incorporating Newman's praxis process, b) changing the physical space, and c) providing opportunities to reflect on practice. The purpose of this study was to utilize a phenomenological approach to evaluate a new model of care among 31 patients and 4 nurses. PMID:19342715

  20. Exploring the Utility of Ultra-Brief Delirium Assessments in a Nonintensive Care Geriatric Population: The GEM Study

    OpenAIRE

    Powers, James S.; Doering, Tracey; Gordon, Sharon; Svetlana K Eden; Shintani, Ayumi; Schnelle, John

    2012-01-01

    Objective: To determine how an ultra-brief structured tool that would require usually less than a minute for delirium assessment compares with a clinical assessment based on Diagnostic and Statistical Manual-IV (DSM-IV) in a geriatric postacute care (PAC) rehabilitation unit. Design: Prospective observational cohort study. Setting: Postacute geriatric hospital ward of a Veteran’s Affairs hospital. Participants: Consecutively admitted patients between 50 and 100 years old for inpatient postacu...

  1. On the Estimation of Heritability with Family-Based and Population-Based Samples

    Directory of Open Access Journals (Sweden)

    Youngdoe Kim

    2015-01-01

    Full Text Available For a family-based sample, the phenotypic variance-covariance matrix can be parameterized to include the variance of a polygenic effect that has then been estimated using a variance component analysis. However, with the advent of large-scale genomic data, the genetic relationship matrix (GRM can be estimated and can be utilized to parameterize the variance of a polygenic effect for population-based samples. Therefore narrow sense heritability, which is both population and trait specific, can be estimated with both population- and family-based samples. In this study we estimate heritability from both family-based and population-based samples, collected in Korea, and the heritability estimates from the pooled samples were, for height, 0.60; body mass index (BMI, 0.32; log-transformed triglycerides (log TG, 0.24; total cholesterol (TCHL, 0.30; high-density lipoprotein (HDL, 0.38; low-density lipoprotein (LDL, 0.29; systolic blood pressure (SBP, 0.23; and diastolic blood pressure (DBP, 0.24. Furthermore, we found differences in how heritability is estimated—in particular the amount of variance attributable to common environment in twins can be substantial—which indicates heritability estimates should be interpreted with caution.

  2. Identifying Population Groups with Low Palliative Care Program Enrolment Using Classification and Regression Tree Analysis

    Science.gov (United States)

    Gao, Jun; Lavergne, M. Ruth; McIntyre, Paul

    2013-01-01

    Classification and regression tree (CART) analysis was used to identify subpopulations with lower palliative care program (PCP) enrolment rates. CART analysis uses recursive partitioning to group predictors. The PCP enrolment rate was 72 percent for the 6,892 adults who died of cancer from 2000 and 2005 in two counties in Nova Scotia, Canada. The lowest PCP enrolment rates were for nursing home residents over 82 years (27 percent), a group residing more than 43 kilometres from the PCP (31 percent), and another group living less than two weeks after their cancer diagnosis (37 percent). The highest rate (86 percent) was for the 2,118 persons who received palliative radiation. Findings from multiple logistic regression (MLR) were provided for comparison. CART findings identified low PCP enrolment subpopulations that were defined by interactions among demographic, social, medical, and health system predictors. PMID:21805944

  3. Intimate Partner Violence in a Lebanese Population Attending Gynecologic Care: A Cultural Perspective.

    Science.gov (United States)

    Awwad, Johnny; Ghazeeri, Ghina; Nassar, Anwar H; Bazi, Tony; Fakih, Ahmad; Fares, Farah; Seoud, Muhieddine

    2014-02-12

    Occurrence of intimate partner violence (IPV) against women in the Lebanese society has been largely ignored by local legal and religious authorities. Our aim is to estimate the prevalence of IPV among married Lebanese women, and investigate perception of abuse, referral patterns, and measures taken to deal with abusive situations. In this cross-sectional study, married women aged 20 to 65 presenting to the American University of Beirut Medical Center for gynecological care were interviewed on various forms of IPV. Out of 100 women invited to participate, 91 consented to take part in the survey of whom 37 (40.67%) gave a history of physical abuse, 30 (33.0%) of sexual abuse, 59 (64.8%) of verbal abuse, and 17 (18.7%) of emotional abuse. Spouse-imposed social isolation was reported in 20 (22.0%) women, and economic abuse in 30 (33.0%). Reasons for deciding to stay in an abusive relationship were "lack of any family or social support" (40.5%), "lack of financial resources" (40.5%), and "fear that the partner may take away the children" (37.8%). Women expressed satisfaction with their spouse's treatment irrespective of the existence of various forms of violence. A significant increase in the risk of weapon use against wife was correlated with decreased monthly income of the household, whereas a protective effect was conferred by an increased number of children. This study highlights the need for routine screening in health care settings for better identification of victims of violence. The selective conventional perception of abuse and the reactive normalization of violence observed indicate the necessity for culturally informed interventional strategies to complement screening. PMID:24522858

  4. Market-Based Health Care in Specialty Surgery: Finding Patient-Centered Shared Value.

    Science.gov (United States)

    Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R

    2015-10-01

    : The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients. PMID:26308640

  5. A Novel Quantum Dots–Based Point of Care Test for Syphilis

    Directory of Open Access Journals (Sweden)

    Li Ding

    2010-01-01

    Full Text Available Abstract One-step lateral flow test is recommended as the first line screening of syphilis for primary healthcare settings in developing countries. However, it generally shows low sensitivity. We describe here the development of a novel fluorescent POC (Point Of Care test method to be used for screening for syphilis. The method was designed to combine the rapidness of lateral flow test and sensitiveness of fluorescent method. 50 syphilis-positive specimens and 50 healthy specimens conformed by Treponema pallidum particle agglutination (TPPA were tested with Quantum Dot-labeled and colloidal gold-labeled lateral flow test strips, respectively. The results showed that both sensitivity and specificity of the quantum dots–based method reached up to 100% (95% confidence interval [CI], 91–100%, while those of the colloidal gold-based method were 82% (95% CI, 68–91% and 100% (95% CI, 91–100%, respectively. In addition, the naked-eye detection limit of quantum dot–based method could achieve 2 ng/ml of anti-TP47 polyclonal antibodies purified by affinity chromatography with TP47 antigen, which was tenfold higher than that of colloidal gold–based method. In conclusion, the quantum dots were found to be suitable for labels of lateral flow test strip. Its ease of use, sensitiveness and low cost make it well-suited for population-based on-the-site syphilis screening.

  6. A Novel Quantum Dots-Based Point of Care Test for Syphilis

    Science.gov (United States)

    Yang, Hao; Li, Ding; He, Rong; Guo, Qin; Wang, Kan; Zhang, Xueqing; Huang, Peng; Cui, Daxiang

    2010-05-01

    One-step lateral flow test is recommended as the first line screening of syphilis for primary healthcare settings in developing countries. However, it generally shows low sensitivity. We describe here the development of a novel fluorescent POC (Point Of Care) test method to be used for screening for syphilis. The method was designed to combine the rapidness of lateral flow test and sensitiveness of fluorescent method. 50 syphilis-positive specimens and 50 healthy specimens conformed by Treponema pallidum particle agglutination (TPPA) were tested with Quantum Dot-labeled and colloidal gold-labeled lateral flow test strips, respectively. The results showed that both sensitivity and specificity of the quantum dots-based method reached up to 100% (95% confidence interval [CI], 91-100%), while those of the colloidal gold-based method were 82% (95% CI, 68-91%) and 100% (95% CI, 91-100%), respectively. In addition, the naked-eye detection limit of quantum dot-based method could achieve 2 ng/ml of anti-TP47 polyclonal antibodies purified by affinity chromatography with TP47 antigen, which was tenfold higher than that of colloidal gold-based method. In conclusion, the quantum dots were found to be suitable for labels of lateral flow test strip. Its ease of use, sensitiveness and low cost make it well-suited for population-based on-the-site syphilis screening.

  7. Potentially inappropriate prescribing in an Irish elderly population in primary care.

    LENUS (Irish Health Repository)

    Ryan, Cristín

    2009-12-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

  8. Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care.

    Science.gov (United States)

    Herman, Patricia M; Ingram, Maia; Rimas, Heather; Carvajal, Scott; Cunningham, Charles E

    2016-09-01

    We used a discrete-choice conjoint experiment to model the mental health services preferences of patients of a federally-qualified health center serving a primarily low-income, Hispanic farmworker population in southwestern Arizona. The two attributes that had the largest influence on patient choices (i.e., received the highest importance scores) were where patients receive these services and the language and cultural awareness of the provider who prescribed their treatment. Simulations indicated that the clinic could substantially improve its patients' welfare with even a single change. The single most effective change in terms of patient preferences would be to offer behavioral health services onsite. PMID:26410547

  9. Evidence-Based Care of Acute Wounds: A Perspective

    OpenAIRE

    Ubbink, Dirk T.; Brölmann, Fleur E; Go, Peter M N Y H; Vermeulen, Hester

    2015-01-01

    Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects.

  10. Community-based rehabilitation: working in partnership with eye care

    Directory of Open Access Journals (Sweden)

    Joerg Weber

    2013-05-01

    Full Text Available Any response to the needs of people with visual impairment and their families will be more effective if eye care workers and CBR programme staff can work together at the community level.

  11. The Appreciative Pedagogy of Palliative Care: Arts-Based or Evidence-Based?

    OpenAIRE

    Lander, Dorothy A.; Graham-Pole, John R

    2006-01-01

    The authors integrate poetry and narrative into their self-study application of the research methodology known as Appreciative Inquiry (AI) focused on: (a) their personal and professional practice and development; (b) their teaching practice in universities and informal/popular education settings; and, (c) their educational research in the area of hospice and palliative care giving. AI is both an arts-based participatory philosophy of practice and a qualitative research methodology.

  12. Incentive-Based Primary Care: Cost and Utilization Analysis

    OpenAIRE

    Hollander, Marcus J.; Kadlec, Helena

    2015-01-01

    This study used Canadian Ministry of Health administrative data for Fiscal Year 2010–2011. After controlling for patients’ age, sex, service-needs level, and continuity of care (ie, attachment to a general practice), the incentives reduced the net annual health care costs for patients with hypertension, chronic obstructive pulmonary disease, and congestive heart failure, but not for diabetes. The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and ...

  13. Arteriovenous fistula: An evidence based practice in nursing care

    OpenAIRE

    Evangelia Prevyzi

    2013-01-01

    The arteriovenous fistula (AVF) is the most frequent form of vascular access for patients undergoing haemodialysis because it ensures good quality of dialysis and reduce haemodialysis mortality. For this reason, the nephrology nurse plays an important role in the appropriate care of fistula with a view to promoting the longevity and prevention of complications. Purpose: The purpose of this review was to investigate the role of Nephrology nurse in the appropriate care of fistula, promoting lon...

  14. A comparison of effectiveness of hepatitis B screening and linkage to care among foreign-born populations in clinical and nonclinical settings

    Directory of Open Access Journals (Sweden)

    Chandrasekar E

    2015-01-01

    Full Text Available Edwin Chandrasekar,1 Ravneet Kaur,1 Sharon Song,1 Karen E Kim2 1Asian Health Coalition, Chicago, IL, USA; 2Division of the Biological Sciences and Office of Community Engagement and Cancer Disparities, University of Chicago, Chicago, IL, USA Abstract: Hepatitis B (HBV is an urgent, unmet public health issue that affects Asian Americans disproportionately. Of the estimated 1.2 million living with chronic hepatitis B in USA, more than 50% are of Asian ethnicity, despite the fact that Asian Americans constitute less than 6% of the total US population. The Centers for Disease Control and Prevention recommends HBV screening of persons who are at high risk for the disease. Yet, large numbers of Asian Americans have not been diagnosed or tested, in large part because of perceived cultural and linguistic barriers. Primary care physicians are at the front line of the US health care system, and are in a position to identify individuals and families at risk. Clinical settings integrated into Asian American communities, where physicians are on staff and wellness care is emphasized, can provide testing for HBV. In this study, the Asian Health Coalition and its community partners conducted HBV screenings and follow-up linkage to care in both clinical and nonclinical settings. The nonclinic settings included health fair events organized by churches and social services agencies, and were able to reach large numbers of individuals. Twice as many Asian Americans were screened in nonclinical settings than in health clinics. Chi-square and independent samples t-test showed that participants from the two settings did not differ in test positivity, sex, insurance status, years of residence in USA, or education. Additionally, the same proportion of individuals found to be infected in the two groups underwent successful linkage to care. Nonclinical settings were as effective as clinical settings in screening for HBV, as well as in making treatment options available to

  15. [Palliative care: an approach based on the professional health categories].

    Science.gov (United States)

    Hermes, Hélida Ribeiro; Lamarca, Isabel Cristina Arruda

    2013-09-01

    Palliative care has emerged as a humanitarian philosophy of caring for terminally ill patients, alleviating their pain and suffering. This care involves the action of an interdisciplinary team, in which all the professional recognize the limits of their performance will help the terminally ill patient to die with dignity. This article deals with the issue of death and dying, both from the traditional and the contemporary standpoint, and how palliative care have been treated in the job categories of medicine, social work, psychology and nursing. The methodology of this study consists of a literature review of articles in the SciELO database, electronic journals and technical books related to the topic. Analysis of the articles revealed a shortage of subjects that deal with the theme of death in professional curricula, as well as few palliative care services in Brazilian society and barriers faced by this new approach to the terminal patient. This research aims to broaden the discussion of palliative care in public health, and provide information for future studies that will address the theme. PMID:23989564

  16. Developing evidence-based maternity care in Iran: a quality improvement study

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  17. Development and Implementation of Team-Based Panel Management Tools: Filling the Gap between Patient and Population Information Systems.

    Science.gov (United States)

    Watts, Brook; Lawrence, Renée H; Drawz, Paul; Carter, Cameron; Shumaker, Amy Hirsch; Kern, Elizabeth F

    2016-08-01

    Effective team-based models of care, such as the Patient-Centered Medical Home, require electronic tools to support proactive population management strategies that emphasize care coordination and quality improvement. Despite the spread of electronic health records (EHRs) and vendors marketing population health tools, clinical practices still may lack the ability to have: (1) local control over types of data collected/reports generated, (2) timely data (eg, up-to-date data, not several months old), and accordingly (3) the ability to efficiently monitor and improve patient outcomes. This article describes a quality improvement project at the hospital system level to develop and implement a flexible panel management (PM) tool to improve care of subpopulations of patients (eg, panels of patients with diabetes) by clinical teams. An in-depth case analysis approach is used to explore barriers and facilitators in building a PM registry tool for team-based management needs using standard data elements (eg, laboratory values, pharmacy records) found in EHRs. Also described are factors that may contribute to sustainability; to date the tool has been adapted to 6 disease-focused subpopulations encompassing more than 200,000 patients. Two key lessons emerged from this initiative: (1) though challenging, team-based clinical end users and information technology needed to work together consistently to refine the product, and (2) locally developed population management tools can provide efficient data tracking for frontline clinical teams and leadership. The preliminary work identified critical gaps that were successfully addressed by building local PM registry tools from EHR-derived data and offers lessons learned for others engaged in similar work. (Population Health Management 2016;19:232-239). PMID:26440062

  18. Perspectives on advance directives in Japanese society: A population-based questionnaire survey

    OpenAIRE

    Slingsby Brian; Akabayashi Akira; Kai Ichiro

    2003-01-01

    Abstract Background In Japan, discussion concerning advance directives (ADs) has been on the rise during the past decade. ADs are one method proposed to facilitate the process of communication among patients, families and health care providers regarding the plan of care of a patient who is no longer capable of communicating. In this paper, we report the results of the first in-depth survey on the general population concerning the preferences and use of ADs in Japan. Method A self-administered...

  19. Care participation and burden among informal caregivers of older adults with care needs and associations with dementia

    OpenAIRE

    Vaingankar, Janhavi Ajit; Chong, Siow Ann; Abdin, Edimansyah; Picco, Louisa; Jeyagurunathan, Anitha; Zhang, Yunjue; Sambasivam, Rajeswari; Chua, Boon Yiang; Ng, Li Ling; Prince, Martin; Subramaniam, Mythily

    2015-01-01

    Background: Few studies have estimated care burden in large, representative, multi-ethnic Asian population-based informal caregivers of older adults with care needs. This study describes informal caregivers’ care participation for a population-based sample of older adults with care needs in Singapore, investigates differences by dementia status, and examines correlates of caregivers’ burden. Methods: Data collected from 693 pairs of older adults, aged 60 to 100 years, having any care needs, a...

  20. Stigma, burden, social support, and willingness to care among caregivers of PLWHA in home based care South Africa

    OpenAIRE

    Singh, Dinesh; Chaudoir, Stephenie R.; Escobar, Maria Cabrera; Kalichman, Seth

    2011-01-01

    Despite its benefits for people living with HIV/AIDS (PLWHA), home based care (HBC) may have negative effects on caregivers. Caregivers experience high levels of burden and may be targets of HIV related prejudice and discrimination. In this cross-sectional survey of 358 caregivers from five hospices across KwaZulu-Natal, South Africa, 49 (13.7 %) caregivers personally experienced discrimination as a result of caring for PLWHA. One hundred and seventy (47.5%) marked one or more items on the HI...

  1. An example of population-level risk assessments for small mammals using individual-based population models

    DEFF Research Database (Denmark)

    Schmitt, Walter; Auteri, Domenica; Bastiansen, Finn;

    2016-01-01

    This article presents a case study demonstrating the application of 3 individual-based, spatially explicit population models (IBMs, also known as agent-based models) in ecological risk assessments to predict long-term effects of a pesticide to populations of small mammals. The 3 IBMs each used...... differing internal model design and scenarios, results indicated in all 3 cases low population sensitivity unless FungicideX was applied at very high (×10) rates. Recovery from local population impacts was generally fast. Only when patch extinctions occured in simulations of intentionally high acute toxic...... a hypothetical fungicide (FungicideX) in different scenarios: spraying in cereals (common vole, Microtus arvalis), spraying in orchards (field vole, Microtus agrestis), and cereal seed treatment (wood mouse, Apodemus sylvaticus). Each scenario used existing model landscapes, which differed greatly in size...

  2. A spatial analysis of patterns of growth and concentration of population based on homogeneous population censuses: Spain (1877-2001

    Directory of Open Access Journals (Sweden)

    Xavier Franch Auladell

    2013-01-01

    Full Text Available This work constitutes a contribution to the analysis of long term patterns of population concentration applied to the case of Spain. The proposed methodology is based on the homogenisation of both data and administrative units which takes the municipal structure of the 2001 census as its base reference. This work seeks to show how applying spatial analysis techniques to this type of homogeneous data series allows us to make more detailed studies of population patterns within a given territory. The most important conclusions that we reached was that, in Spain, sustained population growth has followed a spatial pattern that has become increasingly consolidated over time. The tendencies observed have produced an uneven distribution of population within the national territory marked by the existence of a series of well-defined, and often very localised, areas that spread beyond the limits of the official administrative boundaries.

  3. The strategic role of competency based medical education in health care reform: a case report from a small scale, resource limited, Caribbean setting

    OpenAIRE

    Busari, Jamiu O; Duits, Ashley J.

    2015-01-01

    Background Curaçao is a Dutch Caribbean island with a relatively high aging population, a high prevalence of chronic diseases and a health care system that is driven by cost-containment. In 2009 the development of a new value-based health care (VBHC) system was initiated on the island, and a key role was identified for the St. Elisabeth Hospital as a (model) platform for implementing this initiative. We therefore decided to investigate for the requirements needed to build a health care enviro...

  4. An applied simulation model for estimating the supply of and requirements for registered nurses based on population health needs.

    Science.gov (United States)

    Tomblin Murphy, Gail; MacKenzie, Adrian; Alder, Robert; Birch, Stephen; Kephart, George; O'Brien-Pallas, Linda

    2009-11-01

    Aging populations, limited budgets, changing public expectations, new technologies, and the emergence of new diseases create challenges for health care systems as ways to meet needs and protect, promote, and restore health are considered. Traditional planning methods for the professionals required to provide these services have given little consideration to changes in the needs of the populations they serve or to changes in the amount/types of services offered and the way they are delivered. In the absence of dynamic planning models that simulate alternative policies and test policy mixes for their relative effectiveness, planners have tended to rely on projecting prevailing or arbitrarily determined target provider-population ratios. A simulation model has been developed that addresses each of these shortcomings by simultaneously estimating the supply of and requirements for registered nurses based on the identification and interaction of the determinants. The model's use is illustrated using data for Nova Scotia, Canada. PMID:20164064

  5. Creating an Ethnodrama to Catalyze Dialogue in Home-Based Dementia Care.

    Science.gov (United States)

    Speechley, Mark; DeForge, Ryan T; Ward-Griffin, Catherine; Marlatt, Nicole M; Gutmanis, Iris

    2015-11-01

    This article describes the development of a theater script derived from a critical ethnographic study that followed people living with dementia--and their family and professional caregivers--over an 18-month period. Analysis of the ethnographic data yielded four themes that characterized home-based dementia care relationships: managing care resources, making care decisions, evaluating care practices, and reifying care norms. The research team expanded to include a colleague with playwright experience, who used these themes to write a script. A theater director was included to cast and direct the play, and finally, a videography company filmed the actors on a realistic set. To contribute to the qualitative health research and the research-based theater knowledge translation literatures, this article describes and explains the creative decisions taken as part of our effort to disseminate research focused on home-based dementia care in a way that catalyzes and fosters critical (actionable) dialogue. PMID:26468252

  6. Higher migraine risk in healthcare professionals than in general population: a nationwide population-based cohort study in Taiwan

    OpenAIRE

    Kuo, Wan-Yin; Huang, Chien-Cheng; Weng, Shih-Feng; Lin, Hung-Jung; Su, Shih-Bin; Wang, Jhi-Joung; Guo, How-Ran; Hsu, Chien-Chin

    2015-01-01

    Background High stress levels and shift work probably trigger migraine in healthcare professionals (HCPs). However, the migraine risk differences between HCPs and the general population is unknown. Methods This nationwide population-based cohort study used Taiwan’s National Health Insurance Research Database. Physicians (50,226), nurses (122,357), and other HCPs (pharmacists, technicians, dietitians, rehabilitation therapists, social workers, etc.) (45,736) were enrolled for the study cohort,...

  7. Pancreatic cancer: Wait times from presentation to treatment and survival in a population-based study.

    Science.gov (United States)

    Jooste, Valérie; Dejardin, Olivier; Bouvier, Véronique; Arveux, Patrick; Maynadie, Marc; Launoy, Guy; Bouvier, Anne-Marie

    2016-09-01

    Pancreatic survival is one of the worst in oncology. To what extent wait times affect outcomes in unknown No population-based study has previously explored patient and treatment delays among individuals with pancreatic cancer. The aim of this study was to estimate patient and treatment delays in patients with pancreatic cancer and to measure their association with survival in a nonselected population. All patients diagnosed with pancreatic cancer for the first time between 2009 and 2011 and registered in two French digestive cancer registries were included. Patient delay (time from onset of symptoms until the first consultation categorized into <1 or ≥1 month), and treatment delay (time between the first consultation and treatment categorized into less or more than 29 days, the median time) were collected. Overall delay was used to test associations between survival and the timeliness of care by combining patient delay and treatment delay. Patient delay was longer than 1 month in 46% of patients. A patient delay longer than one month was associated with the absence of jaundice (p < 0.001) and the presence of metastasis (p = 0.003). After adjusting for other covariates, such as symptoms and treatment, the presence of metastasis was negatively associated with treatment delay longer than 29 days (p = 0.025). After adjustment for other covariates, especially metastatic dissemination and the result of the resection, overall delay was not significantly associated with prognosis. We found little evidence to suggest that timely care was associated with the survival of patients. PMID:27130333

  8. Area-level poverty and preterm birth risk: A population-based multilevel analysis

    Directory of Open Access Journals (Sweden)

    Muglia Louis A

    2008-09-01

    Full Text Available Abstract Background Preterm birth is a complex disease with etiologic influences from a variety of social, environmental, hormonal, genetic, and other factors. The purpose of this study was to utilize a large population-based birth registry to estimate the independent effect of county-level poverty on preterm birth risk. To accomplish this, we used a multilevel logistic regression approach to account for multiple co-existent individual-level variables and county-level poverty rate. Methods Population-based study utilizing Missouri's birth certificate database (1989–1997. We conducted a multilevel logistic regression analysis to estimate the effect of county-level poverty on PTB risk. Of 634,994 births nested within 115 counties in Missouri, two levels were considered. Individual-level variables included demographics factors, prenatal care, health-related behavioral risk factors, and medical risk factors. The area-level variable included the percentage of the population within each county living below the poverty line (US census data, 1990. Counties were divided into quartiles of poverty; the first quartile (lowest rate of poverty was the reference group. Results PTB th quartile (4.9%, p adjOR 1.18 (95% CI 1.03, 1.35, with a similar effect at earlier gestational ages (adjOR 1.27 (95% CI 1.06, 1.52. Conclusion Women residing in socioeconomically deprived areas are at increased risk of preterm birth, above other underlying risk factors. Although the risk increase is modest, it affects a large number of pregnancies.

  9. Detectable HIV Viral Load in Kenya: Data from a Population-Based Survey

    Science.gov (United States)

    Cherutich, Peter; Kim, Andrea A.; Kellogg, Timothy A.; Sherr, Kenneth; Waruru, Anthony; De Cock, Kevin M.; Rutherford, George W.

    2016-01-01

    Introduction At the individual level, there is clear evidence that Human Immunodeficiency Virus (HIV) transmission can be substantially reduced by lowering viral load. However there are few data describing population-level HIV viremia especially in high-burden settings with substantial under-diagnosis of HIV infection. The 2nd Kenya AIDS Indicator Survey (KAIS 2012) provided a unique opportunity to evaluate the impact of antiretroviral therapy (ART) coverage on viremia and to examine the risks for failure to suppress viral replication. We report population-level HIV viral load suppression using data from KAIS 2012. Methods Between October 2012 to February 2013, KAIS 2012 surveyed household members, administered questionnaires and drew serum samples to test for HIV and, for those found to be infected with HIV, plasma viral load (PVL) was measured. Our principal outcome was unsuppressed HIV viremia, defined as a PVL ≥ 550 copies/mL. The exposure variables included current treatment with ART, prior history of an HIV diagnosis, and engagement in HIV care. All point estimates were adjusted to account for the KAIS 2012 cluster sampling design and survey non-response. Results Overall, 61·2% (95% CI: 56·4–66·1) of HIV-infected Kenyans aged 15–64 years had not achieved virological suppression. The base10 median (interquartile range [IQR]) and mean (95% CI) VL was 4,633 copies/mL (0–51,596) and 81,750 copies/mL (59,366–104,134), respectively. Among 266 persons taking ART, 26.1% (95% CI: 20.0–32.1) had detectable viremia. Non-ART use, younger age, and lack of awareness of HIV status were independently associated with significantly higher odds of detectable viral load. In multivariate analysis for the sub-sample of patients on ART, detectable viremia was independently associated with younger age and sub-optimal adherence to ART. Discussion This report adds to the limited data of nationally-representative surveys to report population- level virological

  10. Detectable HIV Viral Load in Kenya: Data from a Population-Based Survey.

    Directory of Open Access Journals (Sweden)

    Peter Cherutich

    Full Text Available At the individual level, there is clear evidence that Human Immunodeficiency Virus (HIV transmission can be substantially reduced by lowering viral load. However there are few data describing population-level HIV viremia especially in high-burden settings with substantial under-diagnosis of HIV infection. The 2nd Kenya AIDS Indicator Survey (KAIS 2012 provided a unique opportunity to evaluate the impact of antiretroviral therapy (ART coverage on viremia and to examine the risks for failure to suppress viral replication. We report population-level HIV viral load suppression using data from KAIS 2012.Between October 2012 to February 2013, KAIS 2012 surveyed household members, administered questionnaires and drew serum samples to test for HIV and, for those found to be infected with HIV, plasma viral load (PVL was measured. Our principal outcome was unsuppressed HIV viremia, defined as a PVL ≥ 550 copies/mL. The exposure variables included current treatment with ART, prior history of an HIV diagnosis, and engagement in HIV care. All point estimates were adjusted to account for the KAIS 2012 cluster sampling design and survey non-response.Overall, 61·2% (95% CI: 56·4-66·1 of HIV-infected Kenyans aged 15-64 years had not achieved virological suppression. The base10 median (interquartile range [IQR] and mean (95% CI VL was 4,633 copies/mL (0-51,596 and 81,750 copies/mL (59,366-104,134, respectively. Among 266 persons taking ART, 26.1% (95% CI: 20.0-32.1 had detectable viremia. Non-ART use, younger age, and lack of awareness of HIV status were independently associated with significantly higher odds of detectable viral load. In multivariate analysis for the sub-sample of patients on ART, detectable viremia was independently associated with younger age and sub-optimal adherence to ART.This report adds to the limited data of nationally-representative surveys to report population- level virological suppression. We established heterogeneity across the

  11. The change in attitude and knowledge of health care personnel and general population following trainings provided during integration of mental health in Primary Health Care in Iran: a systematic review

    OpenAIRE

    Rahimi-Movaghar Afarin; Yousefi Nooraie Reza; Bolhari Jafar; Shariat Seyed Vahid; Gharaee Banafsheh; Mansouri Naghmeh; Alirezaie Narges

    2009-01-01

    Abstract Background Mental health has been integrated in the primary health care program in small cities and villages of Iran in a national level since the late 1980s. We performed a systematic review of literature to investigate the effect of education on change in attitude and knowledge of mental health care providers and the population covered in the program during the recent two decades in Iran. Methods Electronic bibliographic databases including Pubmed, PsycINFO and EMBase as well as th...

  12. Scalable Entity-Based Modeling of Population-Based Systems, Final LDRD Report

    Energy Technology Data Exchange (ETDEWEB)

    Cleary, A J; Smith, S G; Vassilevska, T K; Jefferson, D R

    2005-01-27

    The goal of this project has been to develop tools, capabilities and expertise in the modeling of complex population-based systems via scalable entity-based modeling (EBM). Our initial focal application domain has been the dynamics of large populations exposed to disease-causing agents, a topic of interest to the Department of Homeland Security in the context of bioterrorism. In the academic community, discrete simulation technology based on individual entities has shown initial success, but the technology has not been scaled to the problem sizes or computational resources of LLNL. Our developmental emphasis has been on the extension of this technology to parallel computers and maturation of the technology from an academic to a lab setting.

  13. PATTERN OF OVARIAN NEOPLASM IN RURAL POPULATION: A FIVE YEAR STUDY FROM TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Umesh

    2014-02-01

    Full Text Available OBJECTIVE : The aim of the study was to know the morphological pattern of benign and malignant ovarian neoplasms and their distribution in different age groups in rural population of India. MATERIAL AND METHODS : A retrospective study of all cases of ovarian neoplasms diagnosed at department of pathology, Maharaja Medical College, Agroha during period of five year (Aug, 07 — Oct.12 was done. The tumors were classified according to WHO classification after thorough examination of slides and their distribution in different age groups was also noted. RESULTS : There were total fifty three cases of ovarian tumors noted during this period. Benign tumors comprised 81.13% and malignant tumors were 18.86%. Surface epithelial tumor emerged as the commonest variety accounting for 60.37%, followed by germ cell tumor (32.07% and sex cord stromal tumors were least common comprising 7.54 % of all ovarian neoplasm. No metastatic tumor or tumors with borderline malignancy were seen. Serous cystadenoma was the commonest tumor (43.39% followed by mature cystic teratoma (30.23%.Among the malignant tumor, malignant germ cell tumor were the commonest type (40%, followed by 30 %of each surface epithelial tumor and sex cord stromal tumor. CONCLUSION : Benign ovarian tumors are seen more common than malignant tumor. Malignant epithelial tumors are seen after the age of 30 years and malignant germ cell tumor are seen below the age of 30 years. Bilaterality is more commonly seen in malignant o varian neoplasm

  14. Searching for evidence-based information in eye care

    OpenAIRE

    Karen Blackhall

    2005-01-01

    A growth in health awareness has led to an increase in the volume and availability of health information. Health care professionals may feel under pressure to read this increasing volume of material. A search on the internet is often a quick and efficient way to find information and this can be done by using one of the many search engines such as Google or Google Scholar2 or one of the health care information portals such as Omni. A previous article by Sally Parsley in the Community Eye Healt...

  15. Closing the health equity gap: evidence-based strategies for primary health care organizations

    Directory of Open Access Journals (Sweden)

    Browne Annette J

    2012-10-01

    Full Text Available Abstract Introduction International evidence shows that enhancement of primary health care (PHC services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a the key dimensions of equity-oriented services to guide PHC organizations, and (b strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a in-depth interviews with a total of 114 participants (73 patients; 41 staff, (b over 900 hours of participant observation, and (c an analysis of key organizational documents, which shed light on the policy and funding environments. Results Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions These evidence- and theoretically

  16. If diabetes is a public health problem, why not treat it as one? A population-based approach to chronic illness.

    Science.gov (United States)

    Glasgow, R E; Wagner, E H; Kaplan, R M; Vinicor, F; Smith, L; Norman, J

    1999-01-01

    It is increasingly acknowledged that diabetes and other chronic illnesses are major public health problems. Medicare and many managed health care organizations have recognized the enormous personal and societal costs of uncontrolled diabetes in terms of complications, patient quality of life, and health care system resources. However, the current system of reactive acute-episode focused disease care practiced in many settings does not adequately address this public health problem. An alternative proactive, population-based approach to chronic illnesses such as diabetes is proposed and illustrated. This multilevel systems approach addresses supportive and inhibitory social-environmental factors at multiple levels (personal, family, health care team, work, neighborhood, community). Key disciplines contributing to a population-based approach to diabetes include epidemiology, behavioral science, health care services, public health, health economics, and quality of life professions. Current and potential contributions of each of these disciplines are illustrated and an integrative, population-based systems approach to diabetes management and prevention of complications is proposed. This approach is also seen as applicable to other chronic illnesses. PMID:10499137

  17. A Comparison of Internet-Based Participant Recruitment Methods: Engaging the Hidden Population of Cannabis Users in Research

    Directory of Open Access Journals (Sweden)

    Elizabeth Clare Temple

    2011-01-01

    Full Text Available While a growing number of researchers are embracing Internet-based data collection methods, the adoption of Internet-based recruitment methods has been relatively slow. This may be because little is known regarding the relative strengths and weaknesses of different methods of Internet-based participant recruitment, nor how these different recruitment strategies impact on the data collected. These issues are addressed in this article with reference to a study comparing the effectiveness of three Internet-based strategies in recruiting cannabis users for an online study. Consideration of the recruitment data leads us to recommend that researchers use multipronged Internet-based recruitment campaigns with appropriately detailed recruitment messages tailored to the population of interest and located carefully to ensure they reach the intended audience. Further, we suggest that building rapport directly with potential participants, or utilising derived rapport and implicit endorsements, is an important aspect of successful Internet-based participant recruitment strategies.

  18. Prevention and primary care research for children. The need for evidence to precede "evidence-based".

    Science.gov (United States)

    Kleinman, L C

    1998-05-01

    Medical care in the United States continues to face tremendous financial pressures. Public and private health policy claim to encourage primary care and preventive services, but also discourage services that have not been demonstrated to be effective and/or cost-effective. This article suggests a model to illustrate the conceptual relationship between traditional American medical care and "evidenced-based" medicine. It further examines how the lack of an adequate research base makes a move to purely evidence-based care premature for primary care and prevention services. The paper defines a new conceptual statistic, the uncertainty index, as the proportion of non-refuted current practice that is also not corroborated by research evidence. The greater the uncertainty index, the less appropriate is a clinical model restricted to evidence-based care. Specific theoretical barriers to outcomes research in prevention are discussed and simple criteria to determine the desirable components of care are suggested. The need for theoretical and empirical research into primary care and prevention, especially for children, is emphasized. Care that is of low risk, not of extremely high cost, and that is generally believed useful by the community of practitioners is particularly desirable in the absence of data refuting its value. PMID:9635081

  19. Socio-demographic caracteristics and prevalence of risk factors in a hypertensive and diabetics population: a cross-sectional study in primary health care in Brazil

    OpenAIRE

    Baldisserotto, Julio; Luciane KOPITTKE; Nedel, Fulvio Borges; Takeda, Silvia Pasa; Mendonça, Claunara Schilling; Sirena, Sérgio Antonio; Diercks, Margarita Silva; de Lima, Lena Azeredo; Nicolau, Belinda

    2016-01-01

    Background Systemic arterial hypertension and diabetes mellitus, and their related morbidity and mortality, are currently the most common public health problems and also a higher burden of disease in Brazil. They represent a real challenge for primary health care. This study describes the methodology and baseline data of an adult population with hypertension and diabetes attending in primary health care. Methods It is a cross sectional study which presents data from a longitudinal research. 3...

  20. Using the Electronic Medical Record to Examine Racial and Ethnic Differences in Depression Diagnosis and Treatment in a Primary Care Population

    OpenAIRE

    Trinh, Nhi-Ha T.; LaRocca, Rachel; Regan, Susan; Chang, Trina E.; Gilman, Stephen E.; Fava, Maurizio; Yeung, Albert

    2012-01-01

    Objective: We assessed racial and ethnic differences in depression diagnosis and treatment in a primary care population. Methods: A sample of primary care outpatients in 2007 was generated using the electronic medical record (EMR). Patients were considered depressed if their providers billed for depression-related codes; they were considered prescribed antidepressants if any antidepressants were on their medication list. Rates of diagnosis and medication prescription were estimated using a ge...

  1. Estimation of statistical binding properties of ligand population during in vitro selection based on population dynamics theory.

    Science.gov (United States)

    Aita, Takuyo; Nishigaki, Koichi; Husimi, Yuzuru

    2014-01-01

    During in vitro selection process, it is very valuable to monitor the binding properties of the ligand population in real time, particularly the population average of the association constant in the population. If this monitoring can be realized, the selection process can be controlled in a rational way. In this paper, we present a simple method to estimate the binding properties of the ligand population during in vitro selection. The framework of the method is as follows. First, the number of all the collected ligand molecules, which are eluted after incubation and washing, is measured. Ideally, this number corresponds to the number of all the ligand molecules bound with the target-receptor or other materials in a test tube. This measurement is performed through several successive rounds of selection. Second, the measured numbers of molecules are subjected to a theoretical analysis, based on the mathematical theory of population dynamics in the selection process. Then, we can estimate the probability density of the binding free energy in the ligand population. The validity of our method was confirmed by several computer simulations based on a physicochemical model. PMID:24239675

  2. Out of care and into care again: A Danish register‐based study of children placed in out-of‐home care before their third birthday

    DEFF Research Database (Denmark)

    Ubbesen, Mads Bonde; Petersen, Liselotte; Mortensen, Preben Bo;

    2012-01-01

    Objective: When children are reunited with their families of origin and the reasons for placing them in out-of-home care no longer exist, it is usually considered a good outcome. Unfortunately, some children are later returned to care. The objective of this register-based study is to describe in ...... histories. A psychiatric history is associated with re-entry only when the family structure consists of two parents. An immigration background is associatedwith a higher like- lihood of reunification and with a lower likelihood of re-entry. ©......Objective: When children are reunited with their families of origin and the reasons for placing them in out-of-home care no longer exist, it is usually considered a good outcome. Unfortunately, some children are later returned to care. The objective of this register-based study is to describe in...... terms of rates the processes of reunification and re-entry, involving children placed in out-of-homecare before their third birthday. Further- more, the objective is to study whether individual and parental characteristics predict reunifications and re-entries. Method: Data were obtained by using...

  3. Nanotechnology Based Materials and Devices for Health Care

    Science.gov (United States)

    Srivastava, Deepaka; Cho, K.; Brenner, Don; Menon, Madhu; Andriotis, Antonis; Sagman, Uri; Biegel, Bryan A. (Technical Monitor)

    2002-01-01

    This viewgraph presentation provides information on trends in NASA nanotechnology research and development, and future biotechnological applications for that nanotechnology. The presentation covers nanoelectronics, nanosensors, and nanomaterials, biomimetics, devices and materials for health care, carbon nanotubes, biosensors for astrobiology, solid-state nanopores for DNA sequencing, and protein nanotubes.

  4. PCA-based population structure inference with generic clustering algorithms

    OpenAIRE

    Huang Chun-Hsi; Abdool Ali; Lee Chih

    2009-01-01

    Abstract Background Handling genotype data typed at hundreds of thousands of loci is very time-consuming and it is no exception for population structure inference. Therefore, we propose to apply PCA to the genotype data of a population, select the significant principal components using the Tracy-Widom distribution, and assign the individuals to one or more subpopulations using generic clustering algorithms. Results We investigated K-means, soft K-means and spectral clustering and made compari...

  5. Surviving managed care: the effect on job satisfaction in hospital-based nursing.

    Science.gov (United States)

    Buiser, M

    2000-06-01

    Major changes brought about by managed care have redefined the nursing profession. Current trends such as case management, downsizing, restructuring of the workforce, and changes in the patient profile have had numerous effects, particularly on job satisfaction among hospital-based nurses. Strategies to improve job satisfaction during this era of increased managed care penetration include enhanced communication mechanisms, support from hospital administration, implementation of care models that promote professional nursing practice, adequate staffing, and competitive salaries and benefits. PMID:11033702

  6. Translating an Evidence-based Lifestyle Intervention Program into Primary Care: Lessons Learned

    OpenAIRE

    Blonstein, Andrea C.; Yank, Veronica; Stafford, Randall S.; Wilson, Sandra R.; Rosas, Lisa Goldman; Ma, Jun

    2013-01-01

    Obesity is one of the top health priorities in the United States. Primary care physicians are the designated “gatekeepers” for obesity prevention, detection, and treatment. However, they and the current U.S. health care structure and reimbursement systems are often ill-equipped to implement evidence-based obesity care. The Group Lifestyle Balance™ (GLB) program is a group-delivery adaptation of the predominantly one-on-one lifestyle intervention proven efficacious in the Diabetes Prevention P...

  7. Abortion services in a high-needs district: a community-based model of care

    Directory of Open Access Journals (Sweden)

    Snook S

    2013-06-01

    Full Text Available INTRODUCTION: In 2009, a high-deprivation district health board in New Zealand set up a community-based abortion clinic in order to provide a local service and to avoid out-of-region referrals. The service offers medical abortions for women with pregnancies of up to 63 days' gestation, and surgical abortion with local anaesthetic for women with pregnancies of up to 14 weeks' gestation. AIM: To describe the services developed and assess safety and timeliness for the first year of community-based services. METHODS: An audit of clinical records for patients seen in 2010 was performed in order to obtain data on location of services, timeliness, safety and complications. RESULTS: Eighty-two percent of locally provided abortions in 2010 were medical abortions, completed on average less than two days after referral to the service. One percent of patients experienced haemorrhaging post abortion, and 4% had retained products. These rates are within accepted standards for an abortion service. DISCUSSION: This report illustrates that a community-based model of care can be both clinically and culturally safe, while providing a much-needed service to a high-needs population.

  8. Use of nursing homes by a high-risk long-term care population.

    OpenAIRE

    Manheim, L M; Hughes, S L

    1986-01-01

    Limited information exists concerning lifetime use of nursing home services by the aged. This article examines the longitudinal experience, over four years, of elderly individuals at high risk of institutionalization, and develops a simple model of nursing home use based on these observations. This model allows us to predict future lifetime use under alternative assumptions. The main observations drawn from this sample are that high-risk elderly tend to move from the community to nursing home...

  9. A parent motivational interviewing program for dental care in children of a rural population

    OpenAIRE

    González Del Castillo McGrath, Mauricio; Guizar Mendoza, Juan Manuel; Madrigal Orozco, Catalina; Anguiano Flores, Laura; Amador Licona, Norma

    2014-01-01

    Objectives: To determine the effectiveness of a motivational interviewing-based educational program in reducing the number and intensity of new caries and bacterial dental plaque levels at 6 months post randomization. Study Design: A randomized and single blind clinical trial in 100 schoolchildren between 6-10 years of age presenting the highest risk score of caries according to the Caries Management by Risk Assessment (CAMBRA) criteria was performed. These patients were randomized to two gro...

  10. Using a self-service kiosk to identify behavioural health needs in a primary care clinic serving an urban, underserved population

    Directory of Open Access Journals (Sweden)

    Glenda Wrenn

    2015-09-01

    Full Text Available Background Integration of behavioural health into primary care clinics is an established model of care and important approach to eliminating mental health disparities, but demands on provider time is a barrier to mental health screening. The purpose of this study was to determine the feasibility of using a kiosk placed in a primary care clinic to screen for multiple mental health disorders.Methods Quality improvement initiative with Plan-Do-Study-Act implementation and time series monitoring of utilisation outcomes.Results A total of 281 screens were completed identifying positive screens for depression (30% and bipolar disorder (17%. Post-traumatic stress disorder and concerning substance use were less common.Conclusions Development of health information technology to facilitate behavioural health assessment in primary care is a promising approach to integrated care and provides additional benefits of population health monitoring. 

  11. Severity of malocclusion in adolescents: populational-based study in the north of Minas Gerais, Brazil.

    Science.gov (United States)

    Silveira, Marise Fagundes; Freire, Rafael Silveira; Nepomuceno, Marcela Oliveira; Martins, Andrea Maria Eleutério de Barros Lima; Marcopito, Luiz Francisco

    2016-01-01

    OBJECTIVE To identify the factors associated with severity of malocclusion in a population of adolescents. METHODS In this cross-sectional population-based study, the sample size (n = 761) was calculated considering a prevalence of malocclusion of 50.0%, with a 95% confidence level and a 5.0% precision level. The study adopted correction for the effect of delineation (deff = 2), and a 20.0% increase to offset losses and refusals. Multistage probability cluster sampling was adopted. Trained and calibrated professionals performed the intraoral examinations and interviews in households. The dependent variable (severity of malocclusion) was assessed using the Dental Aesthetic Index (DAI). The independent variables were grouped into five blocks: demographic characteristics, socioeconomic condition, use of dental services, health-related behavior and oral health subjective conditions. The ordinal logistic regression model was used to identify the factors associated with severity of malocclusion. RESULTS We interviewed and examined 736 adolescents (91.5% response rate), 69.9% of whom showed no abnormalities or slight malocclusion. Defined malocclusion was observed in 17.8% of the adolescents, being severe or very severe in 12.6%, with pressing or essential need of orthodontic treatment. The probabilities of greater severity of malocclusion were higher among adolescents who self-reported as black, indigenous, pardo or yellow, with lower per capita income, having harmful oral habits, negative perception of their appearance and perception of social relationship affected by oral health. CONCLUSIONS Severe or very severe malocclusion was more prevalent among socially disadvantaged adolescents, with reported harmful habits and perception of compromised esthetics and social relationships. Given that malocclusion can interfere with the self-esteem of adolescents, it is essential to improve public policy for the inclusion of orthodontic treatment among health care provided to this

  12. Severity of malocclusion in adolescents: populational-based study in the north of Minas Gerais, Brazil

    Directory of Open Access Journals (Sweden)

    Marise Fagundes Silveira

    2016-01-01

    Full Text Available ABSTRACT OBJECTIVE To identify the factors associated with severity of malocclusion in a population of adolescents. METHODS In this cross-sectional population-based study, the sample size (n = 761 was calculated considering a prevalence of malocclusion of 50.0%, with a 95% confidence level and a 5.0% precision level. The study adopted correction for the effect of delineation (deff = 2, and a 20.0% increase to offset losses and refusals. Multistage probability cluster sampling was adopted. Trained and calibrated professionals performed the intraoral examinations and interviews in households. The dependent variable (severity of malocclusion was assessed using the Dental Aesthetic Index (DAI. The independent variables were grouped into five blocks: demographic characteristics, socioeconomic condition, use of dental services, health-related behavior and oral health subjective conditions. The ordinal logistic regression model was used to identify the factors associated with severity of malocclusion. RESULTS We interviewed and examined 736 adolescents (91.5% response rate, 69.9% of whom showed no abnormalities or slight malocclusion. Defined malocclusion was observed in 17.8% of the adolescents, being severe or very severe in 12.6%, with pressing or essential need of orthodontic treatment. The probabilities of greater severity of malocclusion were higher among adolescents who self-reported as black, indigenous, pardo or yellow, with lower per capita income, having harmful oral habits, negative perception of their appearance and perception of social relationship affected by oral health. CONCLUSIONS Severe or very severe malocclusion was more prevalent among socially disadvantaged adolescents, with reported harmful habits and perception of compromised esthetics and social relationships. Given that malocclusion can interfere with the self-esteem of adolescents, it is essential to improve public policy for the inclusion of orthodontic treatment among

  13. Severity of malocclusion in adolescents: populational-based study in the north of Minas Gerais, Brazil

    Science.gov (United States)

    Silveira, Marise Fagundes; Freire, Rafael Silveira; Nepomuceno, Marcela Oliveira; Martins, Andrea Maria Eleutério de Barros Lima; Marcopito, Luiz Francisco

    2016-01-01

    ABSTRACT OBJECTIVE To identify the factors associated with severity of malocclusion in a population of adolescents. METHODS In this cross-sectional population-based study, the sample size (n = 761) was calculated considering a prevalence of malocclusion of 50.0%, with a 95% confidence level and a 5.0% precision level. The study adopted correction for the effect of delineation (deff = 2), and a 20.0% increase to offset losses and refusals. Multistage probability cluster sampling was adopted. Trained and calibrated professionals performed the intraoral examinations and interviews in households. The dependent variable (severity of malocclusion) was assessed using the Dental Aesthetic Index (DAI). The independent variables were grouped into five blocks: demographic characteristics, socioeconomic condition, use of dental services, health-related behavior and oral health subjective conditions. The ordinal logistic regression model was used to identify the factors associated with severity of malocclusion. RESULTS We interviewed and examined 736 adolescents (91.5% response rate), 69.9% of whom showed no abnormalities or slight malocclusion. Defined malocclusion was observed in 17.8% of the adolescents, being severe or very severe in 12.6%, with pressing or essential need of orthodontic treatment. The probabilities of greater severity of malocclusion were higher among adolescents who self-reported as black, indigenous, pardo or yellow, with lower per capita income, having harmful oral habits, negative perception of their appearance and perception of social relationship affected by oral health. CONCLUSIONS Severe or very severe malocclusion was more prevalent among socially disadvantaged adolescents, with reported harmful habits and perception of compromised esthetics and social relationships. Given that malocclusion can interfere with the self-esteem of adolescents, it is essential to improve public policy for the inclusion of orthodontic treatment among health care

  14. Population-based study of central post-stroke pain in Rimini district, Italy

    Directory of Open Access Journals (Sweden)

    Raffaeli W

    2013-09-01

    Full Text Available William Raffaeli,1 Cristina E Minella,2 Francesco Magnani,3 Donatella Sarti3 1ISAL Foundation, Institute for Research on Pain, Torre Pedrera, Rimini, Italy 2Pain Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 3Department of Pain Therapy and Palliative Care, Infermi Hospital, Rimini, Italy Abstract: Central post-stroke pain (CPSP is still an underestimated complication of stroke, resulting in impaired quality of life and, in addition to the functional and cognitive consequences of stroke, the presence of CPSP may be associated with mood disorders, such as depression, anxiety, and sleep disturbances. This type of pain may also impair activities of daily living and further worsen quality of life, negatively influencing the rehabilitation process. The prevalence of CSPS in the literature is highly variable (1%–12% according to different studies, and this variability could be influenced by selection criteria and the different ethnic populations being investigated. With this scenario in mind, we performed a population-based study to assess the prevalence of CPSP and its main features in a homogeneous health district (Rimini, Italy, including five hospitals for a total population of 329,970 inhabitants. From 2008 to 2010, we selected 1,494 post-stroke patients and were able to interview 660 patients, 66 (11% of whom reported pain with related tactile and thermal hyperesthesia, accompanied by needle puncture, tingling, swelling, and pressure sensations. Patients reported motor impairment and disability, which influenced their working ability, rehabilitation, and social life. Despite this severe pain state, there was a high percentage of patients who did not receive adequate treatment for pain. Keywords: stroke, central post-stroke pain, disability

  15. Share your story, shape your care: engaging the diverse and disperse population of Northwestern Ontario in healthcare priority setting.

    Science.gov (United States)

    Shields, Kristin; DuBois-Wing, Gwen; Westwood, Ellis

    2010-01-01

    In 2009, the North West Local Health Integration Network hosted Share Your Story, Shape Your Care, an innovative community engagement initiative. Over 800 residents and health service providers in Northwestern Ontario participated and identified healthcare priorities, reacted to proposed strategies and shared ideas and stories. Primarily web-based (with a Choicebook, message board, blog and YouTube video), paper copies and conversation guides supported informed and reflective participation. This project enabled community-level participation in healthcare, supporting local planning and decision-making, and was awarded the inaugural Innovation Using Technology Award by the International Association for Public Participation. PMID:20523159

  16. Economic Impact of Adverse Drug Events – A Retrospective Population-Based Cohort Study of 4970 Adults

    Science.gov (United States)

    Gyllensten, Hanna; Hakkarainen, Katja M.; Hägg, Staffan; Carlsten, Anders; Petzold, Max; Rehnberg, Clas; Jönsson, Anna K.

    2014-01-01

    Background The aim was to estimate the direct costs caused by ADEs, including costs for dispensed drugs, primary care, other outpatient care, and inpatient care, and to relate the direct costs caused by ADEs to the societal COI (direct and indirect costs), for patients with ADEs and for the entire study population. Methods We conducted a population-based observational retrospective cohort study of ADEs identified from medical records. From a random sample of 5025 adults in a Swedish county council, 4970 were included in the analyses. During a three-month study period in 2008, direct and indirect costs were estimated from resource use identified in the medical records and from register data on costs for resource use. Results Among 596 patients with ADEs, the average direct costs per patient caused by ADEs were USD 444.9 [95% CI: 264.4 to 625.3], corresponding to USD 21 million per 100 000 adult inhabitants per year. Inpatient care accounted for 53.9% of all direct costs caused by ADEs. For patients with ADEs, the average societal cost of illness was USD 6235.0 [5442.8 to 7027.2], of which direct costs were USD 2830.1 [2260.7 to 3399.4] (45%), and indirect costs USD 3404.9 [2899.3 to 3910.4] (55%). The societal cost of illness was higher for patients with ADEs compared to other patients. ADEs caused 9.5% of all direct healthcare costs in the study population. Conclusions Healthcare costs for patients with ADEs are substantial across different settings; in primary care, other outpatient care and inpatient care. Hence the economic impact of ADEs will be underestimated in studies focusing on inpatient ADEs alone. Moreover, the high proportion of indirect costs in the societal COI for patients with ADEs suggests that the observed costs caused by ADEs would be even higher if including indirect costs. Additional studies are needed to identify interventions to prevent and manage ADEs. PMID:24637879

  17. Population-based Surveillance for Hepatitis C Virus, United States, 2006–2007

    OpenAIRE

    Klevens, R. Monina; Miller, Jeremy; Vonderwahl, Candace; Speers, Suzanne; Alelis, Karen; Sweet, Kristin; Rocchio, Elena; Poissant, Tasha; Vogt, Tara M.; Gallagher, Kathleen

    2009-01-01

    Surveillance for hepatitis C virus infection in 6 US sites identified 20,285 newly reported cases in 12 months (report rate 69 cases/100,000 population, range 25–108/100,000). Staff reviewed 4 laboratory reports per new case. Local surveillance data can document the effects of disease, support linkage to care, and help prevent secondary transmission.

  18. Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial

    OpenAIRE

    Prinz, Ronald J.; Sanders, Matthew R.; Shapiro, Cheri J.; Whitaker, Daniel J.; Lutzker, John R.

    2009-01-01

    The prevention of child maltreatment necessitates a public health approach. In the U.S. Triple P System Population Trial, 18 counties were randomly assigned to either dissemination of the Triple P—Positive Parenting Program system or to the services-as-usual control condition. Dissemination involved Triple P professional training for the existing workforce (over 600 service providers), as well as universal media and communication strategies. Large effect sizes were found for three independent...

  19. Are marginalized women being left behind? A population-based study of institutional deliveries in Karnataka, India

    Directory of Open Access Journals (Sweden)

    Adamson Paul C

    2012-01-01

    Full Text Available Abstract Background While India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations. Methods A population-based survey was carried out among 16 randomly selected rural villages in rural Mysore District in Karnataka, India between August and September 2008. All households in selected villages were enumerated and women with children 6 years of age or younger underwent an interviewer-administered questionnaire on antenatal care and institutional delivery. Results Institutional deliveries in rural areas of Mysore District increased from 51% to 70% between 2002 and 2008. While increasing numbers of women were accessing antenatal care and delivering in hospitals, large disparities were found in uptake of these services among different castes. Mothers belonging to general castes were almost twice as likely to have an institutional birth as compared to scheduled castes and tribes. Mothers belonging to other backward caste or general castes had 1.8 times higher odds (95% CI: 1.21, 2.89 of having an institutional delivery as compared to scheduled castes and tribes. In multivariable analysis, which adjusted for inter- and intra-village variance, Below Poverty Line status, caste, and receiving antenatal care were all associated with institutional delivery. Conclusion The results of the study suggest that while the Indian Government has made significant progress in increasing antenatal care and institutional deliveries among rural populations, further success in lowering maternal mortality will likely hinge on the success of NRHM programs focused on serving marginalized groups. Health interventions which target SC/ST may also have to address both perceived and actual stigma and discrimination, in addition to providing needed services. Strategies for overcoming these barriers may include

  20. The contribution of interventional cardiology procedures to the population radiation dose in a 'health-care level I' representative region

    International Nuclear Information System (INIS)

    This study evaluates per-procedure, collective and per capita effective dose to the population by interventional cardiology (IC) procedures performed during 2002-11 at the main hospital of Aosta Valley Region that can be considered as representative of the health-care level I countries, as defined by the UNSCEAR, based on its socio-demographic characteristics. IC procedures investigated were often multiple procedures in patients older than 60 y. The median extreme dose-area product values of 300 and 22 908 cGy cm2 were found for standard pacemaker implantation and coronary angioplasty, respectively, while the relative mean per-procedure effective dose ranged from 0.7 to 47 mSv. A 3-fold increase in frequency has been observed together with a correlated increase in the delivered per capita dose (0.05-0.27 mSv y-1) and the collective dose (5.8-35 man Sv y-1). Doses increased particularly from 2008 onwards mainly because of the introduction of coronary angioplasty procedures in the authors' institution. IC practice contributed remarkably in terms of effective dose to the population, delivering ∼10 % of the total dose by medical ionising radiation examination categories. (authors)

  1. Using data from patient interactions in primary care for population level chronic disease surveillance: The Sentinel Practices Data Sourcing (SPDS) project

    OpenAIRE

    Ghosh, Abhijeet; Charlton, Karen E.; Girdo, Lisa; Batterham, Marijka

    2014-01-01

    Background Population health planning within a health district requires current information on health profiles of the target population. Information obtained during primary care interactions may provide a valuable surveillance system for chronic disease burden. The Sentinel Practices Data Sourcing project aimed to establish a sentinel site surveillance system to obtain a region-specific estimate of the prevalence of chronic diseases and mental health disorders within the Illawarra-Shoalhaven ...

  2. Evidence based nursing practice : one exploratory study between different care settings

    OpenAIRE

    Pereira, Rui Pedro Gomes; Martins, Alice; Peixoto, Maria José; Martins, Teresa; Barbieri, Maria do Céu; Carneiro, António Vaz

    2014-01-01

    Introduction: Currently, the importance of a clinical practice based on the best available evidence justifies the development of investigation to construct a situational diagnosis that allows to identify in different contexts of care, barriers, attitudes and practices towards an evidence-based nursing. Objective: In this investigation we aim to identify barriers regarding the adoption of an Evidence Based Practice (EBP) in different care settings and describe the main nurse’s attitudes and pr...

  3. Europe's strong primary care systems are linked to better population health but also to higher health spending.

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.; Zee, J. van der; Groenewegen, P.

    2013-01-01

    Strong primary care systems are often viewed as the bedrock of health care systems that provide high-quality care, but the evidence supporting this view is somewhat limited. We analyzed comparative primary care data collected in 2009-10 as part of a European Union-funded project, the Primary Health

  4. An Empirical Typology of Residential Care/Assisted Living Based on a Four-State Study

    Science.gov (United States)

    Park, Nan Sook; Zimmerman, Sheryl; Sloane, Philip D.; Gruber-Baldini, Ann L.; Eckert, J. Kevin

    2006-01-01

    Purpose: Residential care/assisted living describes diverse facilities providing non-nursing home care to a heterogeneous group of primarily elderly residents. This article derives typologies of assisted living based on theoretically and practically grounded evidence. Design and Methods: We obtained data from the Collaborative Studies of Long-Term…

  5. Mediators of Telephone-Based Continuing Care for Alcohol and Cocaine Dependence

    Science.gov (United States)

    Mensinger, Janell Lynn; Lynch, Kevin G.; Tenhave, Thomas R.; McKay, James R.

    2007-01-01

    A previous randomized trial with 224 alcohol and/or cocaine addicts who had completed an initial phase of treatment indicated that 12 weeks of telephone-based continuing care yielded higher abstinence rates over 24 months than did group counseling continuing care. The current study examined mediators of this treatment effect. Results suggested…

  6. Findings From a Nursing Care Audit Based on the Nursing Process: A Descriptive Study

    OpenAIRE

    Poortaghi; Salsali; Ebadi; Rahnavard; Maleki

    2015-01-01

    Background Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally. Objectives This study aimed to audit nursing care based on a nursing process model. Patients and Methods This was a cross-sectional descriptive study in which a nursing audit checkl...

  7. Iterations of the SafeCare Model: An Evidence-Based Child Maltreatment Prevention Program

    Science.gov (United States)

    Edwards, Anna; Lutzker, John R.

    2008-01-01

    SafeCare is an evidenced-based parenting program for at-risk and maltreating parents that addresses the social and family ecology in which child maltreatment occurs. SafeCare home visitors focus on behavioral skills that are trained to predetermined performance criteria. Recent research has stressed the importance of successful dissemination and…

  8. Predictors of quality of life of people receiving intensive community-based care

    NARCIS (Netherlands)

    Emmerink, P.M.J.; Roeg, Diana

    2015-01-01

    Purpose Intensive community-based care (ICBC) is a home-treatment approach aiming to support people ‘living in the community’ with severe psychiatric and addiction problems. Although subjective quality of life (SQOL) is an increasingly important outcome measure in health care, little is known on ICB

  9. 75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

    Science.gov (United States)

    2010-11-03

    ... Transitions Program (CCTP) Meeting AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice... about the upcoming Community-based Care Transitions Program. The meeting is open to the public, but... will be posted on the CMS Care Transitions Web site at...

  10. A FCA-based analysis of sequential care trajectories

    OpenAIRE

    Egho, Elias; Jay, Nicolas; Raïssi, Chedy; Napoli, Amedeo

    2011-01-01

    This paper presents a research work in the domains of sequential pattern mining and formal concept analysis. Using a combined method, we show how concept lattices and interestingness measures such as stability can improve the task of discovering knowledge in symbolic sequential data. We give example of a real medical application to illustrate how this approach can be useful to discover patterns of trajectories of care in a french medico-economical database.

  11. Population-based service mammography screening: the Icelandic experience

    Directory of Open Access Journals (Sweden)

    Sigurdsson K

    2013-05-01

    Full Text Available Kristjan Sigurdsson,1,3 Elínborg Jóna Ólafsdóttir,21The Icelandic Cancer Detection Clinic, 2The Icelandic Cancer Registry, Icelandic Cancer Society, 3Faculty of Medicine, University of Iceland, Reykjavik, IcelandObjective: This study analyzes the efficacy of the Icelandic population-based service mammography screening.Material and methods: Women aged 40–69 were invited for screening at 2-year intervals starting in November 1987. The study evaluates: (A attendance and other screened performance parameters during 1998–2010; (B trends in age-standardized and age-specific incidence rates during 1969–2010 and mortality rates during 1969–2010; and (C distribution of risk factors and disease specific death rates according to mode of detection.Results: (A In the age group of 40–69, the average 2-year attendance was 62%, recall rate was 4.1%, needle biopsy rate was 1.3%, surgery rate was 0.6%, invasive cancer rate was 0.4%, and ductal carcinoma in situ (DCIS rate was 0.06%. (B The linear incidence trend after the start of screening decreased significantly in the age group 40–49, increased significantly in the age group 50–69, but decreased non-significantly in the age group 70–79. The decreased age-specific incidence in the 70–79 age group was, however, greater than the increased age-specific incidence at the ages 50–69. The mortality rate decreased 41% for all age groups and the linear mortality trend decreased significantly at ages 40–49, 50–69, and 70–79. In the age group 40–74 years, the age-specific mortality decreased by 6.9 cases per 2000 during a 10-year period. (C Screen-detected women had significantly smaller tumors, more favorable tumor grade, fewer axillary metastases and, after correction for other risk factors, the likelihood of dying from cancer decreased 54% (hazard ratio: 0.46; 95% confidence interval: 0.31–0.69 for these patients compared to cases of nonparticipators.Conclusion: The study results

  12. Cyberbullying among Finnish adolescents – a population-based study

    Directory of Open Access Journals (Sweden)

    Lindfors Pirjo L

    2012-11-01

    Full Text Available Abstract Background Cyberbullying, threatening or harassing another via the internet or mobile phones, does not cause physically harm and thus the consequences are less visible. Little research has been performed on the occurrence of cyberbullying among adolescents or the perception of its seriousness. Only a few population-based studies have been published, none of which included research on the witnessing of cyberbullying. Here, we examined exposure to cyberbullying during the last year, and its frequency and perceived seriousness among 12 to 18-year-old adolescents in Finland. We studied four dimensions of cyberbullying: being a victim, bully, or both victim and bully of cyberbullying, and witnessing the cyberbullying of friends. Methods Self-administered questionnaires, including four questions on cyberbullying, were mailed to a representative sample of 12-, 14-, 16-, and 18-year-old Finns in 2009 (the Adolescent Health and Lifestyle Survey. The respondents could answer via the internet or paper questionnaire. Results The number of respondents was 5516 and the response rate was 56%. Girls more often than boys reported experiencing at least one dimension of cyberbullying during the last year. The proportion was highest among 14-year-olds and lowest among 18-year-olds of both sexes. Among girls, the most commonly encountered dimension was witnessing the cyberbullying of friends (16%; and being a victim was slightly more common than being a bully (11% vs. 9%. Among boys, an equal proportion, approximately 10%, had been a victim, a bully, or had witnessed cyberbullying. The proportion of bully-victims was 4%. Serious and disruptive cyberbullying was experienced by 2% of respondents and weekly cyberbullying by 1%; only 0.5% of respondents had been bullied weekly and considered bullying serious and disruptive. Conclusions Adolescents are commonly exposed to cyberbullying, but it is rarely frequent or considered serious or disruptive. Cyberbullying

  13. A population-based study of glioblastoma multiforme

    International Nuclear Information System (INIS)

    Purpose: To describe (1) the use of surgery and radiotherapy (RT) in the treatment of patients with glioblastoma (GBM) in Ontario, (2) survival, and (3) proportion of survival time spent in the hospital after diagnosis. Methods and Materials: We performed a population-based cohort study of all Ontario Cancer Registry (OCR) cases of GBM diagnosed between 1982 and 1994. We linked OCR records, hospital files containing surgical procedure codes from the Canadian Institute for Health Information, and province-wide RT records. We studied the odds of treatment using multivariate logistic regression. We expressed the time spent in the hospital as the mean number of days per case, and as a proportion of the interval between diagnosis and death, or 24 months following diagnosis, whichever came first. We used the life-table method and Cox proportional hazards regression to describe survival. Results: The proportion of patients with GBM undergoing any surgery directed at the tumor varied with age (p<0.0001) and region of residence (p<0.0001). The proportion undergoing RT varied with age (p<0.0001), region of residence (p<0.0001), and year of diagnosis (p=0.01). RT dose ≥53.5 Gy varied with age (p<0.0001), region of residence (p<0.0001), and year of diagnosis (p=0.0002). Median survival was 11 months among patients receiving RT and 3 months among those not receiving RT. The percentage of survival time spent in the hospital was similar among those who received from 49.5 to <53.5 Gy, compared to ≥53.5 Gy. Overall survival and the adjusted relative risk of death varied with age and region of residence. Conclusion: We observed practice variation in the treatment of patients with GBM according to age, region of residence, and year of diagnosis. Survival did not increase during the study period. The variation in RT dose between those receiving from 49.5 to <53.5 Gy compared to ≥53.5 Gy was not paralleled by variation in survival between regions where one or the other of the

  14. Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy.

    Science.gov (United States)

    Jarlenski, Marian; Borrero, Sonya; La Charité, Trey; Zite, Nikki B

    2016-06-01

    Medicaid is an important source of health insurance coverage for low-income pregnant women and covers nearly half of all deliveries in the United States. In the face of budgetary pressures, several state Medicaid programs have implemented or are considering implementing episode-based payments for perinatal care. Under the episode-based payment model, Medicaid programs make a single payment for all pregnancy-related medical services provided to women with low- and medium-risk pregnancies from 40 weeks before delivery through 60 days postpartum. The health care provider who delivers a live birth is assigned responsibility for all care and must meet certain quality metrics and stay within delineated cost-per-episode parameters. Implementation of cost- and quality-dependent episode-based payments for perinatal care is notable because there is no published evidence about the effects of such initiatives on pregnancy or birth outcomes. In this article, we highlight challenges and potential adverse consequences related to defining the perinatal episode and assigning a responsible health care provider. We also describe concerns that perinatal care quality metrics may not address the most pressing health care issues that are likely to improve health outcomes and reduce costs. In their current incarnations, Medicaid programs' episode-based payments for perinatal care may not improve perinatal care delivery and subsequent health outcomes. Rigorous evaluation of the new episode-based payment initiatives is critically needed to inform policymakers about the intended and unintended consequences of implementing episode-based payments for perinatal care. PMID:27159762

  15. Care Seeking Patterns Among Women Who Have Experienced Gender-Based Violence in Afghanistan.

    Science.gov (United States)

    Stokes, Sonya; Seritan, Andreea L; Miller, Elizabeth

    2016-06-01

    This study explored patterns of abuse and care seeking among women victims of gender-based violence (GBV) in Afghanistan. Individual, semi-structured interviews were conducted with 22 Afghan women (M age = 19 years) living in a shelter for victims of GBV. Interviews were analyzed thematically. Participants reported experiencing multiple forms of abuse. The majority received medical treatment for abuse-related health concerns. However, less than half reported abuse to health care providers or were asked by health care providers about the context of their injuries. Strategies to improve health care responses to GBV are needed to ensure safety and support for Afghan women. PMID:26681300

  16. FEAMAC/CARES Stochastic-Strength-Based Damage Simulation Tool for Ceramic Matrix Composites

    Science.gov (United States)

    Nemeth, Noel; Bednarcyk, Brett; Pineda, Evan; Arnold, Steven; Mital, Subodh; Murthy, Pappu; Bhatt, Ramakrishna

    2016-01-01

    Reported here is a coupling of two NASA developed codes: CARES (Ceramics Analysis and Reliability Evaluation of Structures) with the MAC/GMC (Micromechanics Analysis Code/ Generalized Method of Cells) composite material analysis code. The resulting code is called FEAMAC/CARES and is constructed as an Abaqus finite element analysis UMAT (user defined material). Here we describe the FEAMAC/CARES code and an example problem (taken from the open literature) of a laminated CMC in off-axis loading is shown. FEAMAC/CARES performs stochastic-strength-based damage simulation response of a CMC under multiaxial loading using elastic stiffness reduction of the failed elements.

  17. A Randomized Controlled Trial of Hospital-based Case Management in Cancer Care

    DEFF Research Database (Denmark)

    Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens

    2012-01-01

    BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital......-based CM on (i) GPs' evaluation of information from the hospital and collaboration with the hospital staff and (ii) patients' contacts with GPs during daytime and out of hours. DESIGN: A randomized controlled trial allocated 280 colorectal cancer patients 1:1 to either a control group or CM intervention...

  18. Bayesian Population Physiologically-Based Pharmacokinetic (PBPK Approach for a Physiologically Realistic Characterization of Interindividual Variability in Clinically Relevant Populations.

    Directory of Open Access Journals (Sweden)

    Markus Krauss

    Full Text Available Interindividual variability in anatomical and physiological properties results in significant differences in drug pharmacokinetics. The consideration of such pharmacokinetic variability supports optimal drug efficacy and safety for each single individual, e.g. by identification of individual-specific dosings. One clear objective in clinical drug development is therefore a thorough characterization of the physiological sources of interindividual variability. In this work, we present a Bayesian population physiologically-based pharmacokinetic (PBPK approach for the mechanistically and physiologically realistic identification of interindividual variability. The consideration of a generic and highly detailed mechanistic PBPK model structure enables the integration of large amounts of prior physiological knowledge, which is then updated with new experimental data in a Bayesian framework. A covariate model integrates known relationships of physiological parameters to age, gender and body height. We further provide a framework for estimation of the a posteriori parameter dependency structure at the population level. The approach is demonstrated considering a cohort of healthy individuals and theophylline as an application example. The variability and co-variability of physiological parameters are specified within the population; respectively. Significant correlations are identified between population parameters and are applied for individual- and population-specific visual predictive checks of the pharmacokinetic behavior, which leads to improved results compared to present population approaches. In the future, the integration of a generic PBPK model into an hierarchical approach allows for extrapolations to other populations or drugs, while the Bayesian paradigm allows for an iterative application of the approach and thereby a continuous updating of physiological knowledge with new data. This will facilitate decision making e.g. from preclinical to

  19. Assessing the acceptability of community pharmacy based pharmaceutical care services in Karachi

    Directory of Open Access Journals (Sweden)

    Muhammad Amir, B.Pharmacy, MSc. MBA, Assistant Professor/Clinical Pharmacist

    2011-01-01

    Full Text Available Provision of pharmaceutical care services in community pharmacies is a new trend in pharmacy practice worldwide. Published literature from developed countries is available showing benefits of pharmaceutical care services provided in community pharmacies. However, relatively little published literature is available from developing countries in which unique market environments are encountered. This study was conducted to assess the acceptability of community pharmacy based pharmaceutical care services in Karachi. Pharmaceutical care services were developed and offered to pharmacy customers for a period of two months. Acceptability was evaluated with respect to enrollment of participants in the program, discontinuation, and complaints registered. The findings provide a better understanding of pharmaceutical care marketing strategies and are discussed within the context of the health care environment in Karachi.

  20. Student Perceptions of and Confidence in Self-Care Course Concepts Using Team-based Learning.

    Science.gov (United States)

    Frame, Tracy R; Gryka, Rebecca; Kiersma, Mary E; Todt, Abby L; Cailor, Stephanie M; Chen, Aleda M H

    2016-04-25

    Objective. To evaluate changes in student perceptions of and confidence in self-care concepts after completing a team-based learning (TBL) self-care course. Methods. Team-based learning was used at two universities in first professional year, semester-long self-care courses. Two instruments were created and administered before and after the semester. The instruments were designed to assess changes in student perceptions of self-care using the theory of planned behavior (TPB) domains and confidence in learning self-care concepts using Bandura's Social Cognitive Theory. Wilcoxon signed rank tests were used to evaluate pre/post changes, and Mann Whitney U tests were used to evaluate university differences. Results. Fifty-three Cedarville University and 58 Manchester University students completed both instruments (100% and 92% response rates, respectively). Student self-care perceptions with TPB decreased significantly on nine of 13 items for Cedarville and decreased for one of 13 items for Manchester. Student confidence in self-care concepts improved significantly on all questions for both universities. Conclusion. Data indicate TBL self-care courses were effective in improving student confidence about self-care concepts. Establishing students' skill sets prior to entering the profession is beneficial because pharmacists will use self-directed learning to expand their knowledge and adapt to problem-solving situations. PMID:27170817